Treatment of Gambiense HAT When CSF WBC Is ≥ 100/µL or CSF Data Is Unavailable
This protocol addresses gambiense human African trypanosomiasis in patients aged 6 years or older and weighing at least 20 kg, specifically in the setting of an elevated cerebrospinal fluid white blood cell count (≥ 100/µL) — or when a lumbar puncture could not be performed and CSF data are unavailable.
Clinical Scenario
Gambiense HAT presenting with clinical features consistent with severe meningo-encephalitic disease. The critical staging parameter is a CSF WBC count of ≥ 100/µL; this protocol also applies when CSF analysis was not possible due to a failed or contraindicated lumbar puncture.
Treatment Approach
In this presentation, management involves a combination antiparasitic regimen using eflornithine together with nifurtimox — the complete protocol specifies the full administration details, sequencing, and clinical monitoring criteria.
References
- NECT is the first-choice treatment in gambiense HAT patients presenting clinical features consistent with severe meningo-encephalitic HAT and with ≥ 100 WBC/µL in CSF or where CSF data are unavailable.
- If after NECT the patient relapses, the first rescue treatment should be NECT-long, which comprises eflornithine infusions (400 mg/kg per day in two infusions) for a total of 14 days.
- Nifurtimox is given for 10 days, exactly as in the NECT schedule.