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Trypanosoma brucei-rhodesiense
Etiologic agent of east African trypanosomiasis.
Epidemiology:
1) East Africa
2) transmitted by the bite of the tsetse fly (genus Glossina)
Clinical manifestations:
1) rapidly progressive acute febrile illness with lymphadenopathy
2) fevers, headache myalgias, night sweats
3) hypotension, sepsis-like presentation
4) patients die before central nervous system involvement is prominent
Management:
1) suramin (stage I, normal CSF)
a) 100-200 mg IV test dose to detect hypersensitivity
b) adults: 1 g IV on days 1,3,7,14 & 21
c) children: 20 mg/kg/day (max 1 g) IV on days 1,3,7,14 & 21
d) slow IV infusion of freshly prepared 10% aqueous solution
2) melarsoprol (stage II, abnormal CSF)
a) stage II or stage I who fail suramin &/or pentamidine
b) because of toxicity, never the 1st agent for treatment of stage I
c) three courses of treatment each 3 days in duration
1] 2-3.6 mg/kg/day IV divided TID
2] 3.6 mg/kg/day IV divided TID (1 week later)
3] 3.6 mg/kg/day IV divided TID (10-21 days later)
d) caution, highly toxic
3) tryparsamide plus suramin
a) tryparsamide
- 30 mg/kg/day (max 2 g) IV every 5th day for 12 doses
b) suramin
- 10 mg/kg/day IV every 5th day for 12 doses
4) pentamidine
a) alternative agent for stage I
b) 4 mg/kg/day IV or IM for 10 days
5) no vaccine available
6) lethal if not treated
Related
fly/gnat-borne infection
General
Trypanosoma brucei (African trypanosomiasis)
Properties
KINGDOM: animal
PHYLUM: protozoa
References
- Clinical Diagnosis & Management by Laboratory Methods,
19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia,
PA. 1996, pg 1266
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, 1193-96