Treatment of Gambiense Human African Trypanosomiasis in Patients Aged ≥ 6 Years Without Severe Meningo-encephalitic Disease
This protocol covers the first-line management of gambiense human African trypanosomiasis (HAT) in patients aged 6 years or older with a body weight of at least 20 kg, presenting without clinical signs of severe meningo-encephalitic disease or with a CSF white blood cell count below 100/µL.
Clinical Scenario
- Confirmed gambiense human African trypanosomiasis
- Age ≥ 6 years
- Body weight ≥ 20 kg
- No clinical signs of severe meningo-encephalitic HAT, or CSF WBC < 100/µL
Treatment Approach
An oral agent taken once daily for 10 days with food is the first-choice treatment in this setting, given in a weight-based loading-then-maintenance schedule; second-choice alternatives are determined by CSF findings.
References
- Fexinidazole is therefore the first-choice treatment in gambiense HAT patients aged ≥ 6 years and body weight ≥ 20 kg presenting without clinical features consistent with severe meningo-encephalitic HAT or presenting with < 100 WBC/µL in CSF.
- Fexinidazole must be taken once daily for 10 days, with a loading dose over the first four days and a maintenance (lower) dose over the last six days (Table 2).
- The second choice to fexinidazole is pentamidine (if ≤ 5 WBC/µL and no trypanosomes in CSF) or NECT (if > 5 WBC/µL or trypanosomes in CSF).