Treatment of Gambiense Human African Trypanosomiasis with CSF WBC ≥100/µL or Unavailable CSF Data (Age ≥6 Years, Body Weight ≥20 kg)

Clinical Scenario

This protocol applies to patients with confirmed gambiense human African trypanosomiasis (HAT) who are aged ≥6 years and weigh ≥20 kg, and who present under any of the following CSF conditions:

CSF WBC ≥ 100/µL Failed lumbar puncture CSF data unavailable

When CSF white blood cell count is markedly elevated or CSF staging data cannot be obtained, clinical features may be consistent with severe meningo-encephalitic HAT. Treatment selection in this setting reflects that elevated disease severity.

Treatment Approach Partial summary — full regimen via protocol

Management involves intravenous treatment with melarsoprol, administered once daily over a defined multi-day course. A concomitant oral corticosteroid is given alongside the primary treatment to help reduce the risk of adverse reactions, with a tapering schedule at the end of the course. The complete dosing schedule, duration, tapering details, and administration specifics are available in the full structured protocol.

Instant Access to Structured Evidence-Based Regimens

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 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 (see section 3.4.2), administered at 1 mg/kg per day (maximum dose 50 mg) for 9 days, tapering the dosage on days 10–12 (Table 11).

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