Treatment of Rhodesiense HAT in Children Under 6 Years or Under 20 kg with CNS-Stage Disease (CSF WBC >5/µL)
This protocol covers Trypanosoma brucei rhodesiense human African trypanosomiasis (HAT) in a specific, high-risk sub-population: patients aged under 6 years or with a body weight under 20 kg who have evidence of central nervous system involvement — a CSF white blood cell count above 5 cells/µL or trypanosomes detected in the cerebrospinal fluid.
Clinical scenario
Rhodesiense HAT in a patient aged <6 years or body weight <20 kg, presenting with CNS-stage disease confirmed by >5 WBC/µL or trypanosomes in CSF. Standard first-choice treatment options carry defined limitations in this age and weight group, and exceptional clinical situations may arise in which an alternative approach must be considered.
Treatment approach
In exceptional circumstances — when established options are not feasible or have not succeeded — a compassionate rescue treatment strategy may be considered for this population. This approach is not routine and must not be undertaken without direct consultation with a medical specialist, who will determine appropriateness, dosage, and administration on a case-by-case basis.
References
Melarsoprol is the first-choice treatment in patients aged < 6 years or body weight < 20 kg presenting with > 5 WBC/µL or trypanosomes in CSF.
Even though fexinidazole has not been studied in patients aged < 6 years or < 20 kg body weight, it may be considered as compassionate rescue treatment when other treatment options have failed.
In such exceptional cases, a medical specialist should be consulted for dosage and administration.
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