Treatment of Gambiense Human African Trypanosomiasis in Patients Aged ≥ 6 Years with CSF WBC Below 100/µL
This protocol covers the treatment approach for gambiense HAT in a specific clinical subgroup defined by patient age, body weight, and the degree of central nervous system involvement as reflected in cerebrospinal fluid findings.
Clinical criteria for this protocol
- Gambiense human African trypanosomiasis (HAT)
- Age ≥ 6 years
- Body weight ≥ 20 kg
- No clinical signs of severe meningo-encephalitic disease, or CSF white blood cell count < 100/µL
Treatment approach
The regimen involves melarsoprol, administered by slow intravenous injection over a defined course, given alongside a concomitant oral corticosteroid intended to reduce the risk of adverse reactions. The complete schedule, including the corticosteroid tapering plan, is in the full structured protocol.
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.
- If the patient relapses after the above rescue treatments, then melarsoprol should be considered as a final treatment option due to its toxicity.
- Concomitant oral prednisolone may reduce the risk of adverse reactions, administered at 1 mg/kg per day (maximum dose 50 mg) for 9 days, tapering the dosage on days 10–12.
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