[Cerebral trypanosomiasis: epidemiology, clinical aspects, therapy and illness course]

More than 20,000 people are infected with one of the two forms of African trypanosomiasis each year. Without treatment the outcome is almost always fatal. There are, however, problems involved in drug treatment. Reactive encephalitis is recorded in up to 18% of all cases treated for cerebral trypanosomiasis. Recently a lack of response to treatment has been reported with increasing frequency from endemic areas. Relapses occur in up to 10% of cases. Reasons for relapses include insufficient treatment due to poor compliance or lack of drugs, reinfection in endemic areas, pharmacokinetic problems, the parasite's evasive mechanisms, and primary and/or secondary drug resistance.