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Human trypanosomiasis in the Ivory Coast: therapy and problems
1Projet de Recherches Cliniques sur la Trypanosomiase (PRCT), Daloa, Côte d'Ivoire.
Acta Tropica
|September 1, 1993
Summary
Human African trypanosomiasis (sleeping sickness) is resurging in Ivory Coast due to neglected control. Melarsoprol, pentamidine, and DFMO treatments show varying side effects and relapse rates, with DFMO better tolerated when given intravenously for 14 days.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Public Health
Background:
- Human African trypanosomiasis (HAT), or sleeping sickness, caused by Trypanosoma gambiense, is experiencing a resurgence in Ivory Coast.
- Neglect of control activities over the past five years has contributed to this alarming rise in cases.
- High prevalence, reaching 7% in some villages, necessitates urgent re-evaluation of control and treatment strategies.
Purpose of the Study:
- To describe the challenges and side-effects associated with current sleeping sickness treatments in Ivory Coast.
- To evaluate the efficacy and tolerability of melarsoprol, pentamidine, and DFMO in HAT patients.
- To identify optimal treatment regimens for HAT based on observed outcomes.
Main Methods:
- Retrospective analysis of treatment outcomes for 626 sleeping sickness patients.
- Detailed documentation of side-effects, mortality, and relapse rates for three different drugs: melarsoprol, pentamidine, and DFMO.
- Comparison of treatment efficacy and tolerability based on administration route and duration for DFMO.
Main Results:
- Melarsoprol (ARSOBAL) treatment in 350 patients resulted in 4% encephalopathy, 5.7% mortality during treatment, and 3.7% relapses.
- Pentamidine treatment in 150 patients showed a 2% relapse/reinfection rate and one fatal case of diabetes mellitus.
- DFMO treatment, especially when limited to 14 days and administered intravenously, was equally effective and better tolerated, with common side-effects including diarrhea (64.4%) and anemia (35.5%).
Conclusions:
- Current HAT treatments in Ivory Coast present significant challenges due to severe side-effects and varying efficacy.
- Melarsoprol is associated with high rates of encephalopathy and mortality, while pentamidine has a lower relapse rate but carries risks of other complications.
- DFMO, particularly with a 14-day intravenous-only regimen, offers a more tolerable and effective treatment option for sleeping sickness, warranting wider implementation.