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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Gambiense trypanosomiasis: Frequency of, and risk factors for, failure of melarsoprol therapy
Transactions of the Royal Society of Tropical Medicine and Hygiene, Volume 88, No. 4, Year 1994
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Description
1083 patients with late-stage Trypanosoma brucei gambiense sleeping sickness were treated with melarsoprol in Nioki hospital, Zaire, between 1983 and 1990. Sixty-two (5·7%) died during treatment. Of the 1021 patients who survived the treatment, 63 (6·2%) subsequently relapsed, 58 (92%) of whom were diagnosed within 2 years of melarsoprol treatment. There was no evidence of an increase in the frequency of treatment failures during the study period, and the rate of relapses that we documented is comparable to that reported from Zaire more than 30 years ago. Relapses were more frequent among patients who had trypanosomes seen in the cerebrospinal fluid (CSF) at the time of the initial diagnosis (odds ratio [OR] = 2·76, 95% confidence interval [CI] = 1·65–4·63, P = 0·0001). Male patients had twice as many relapses as females (OR = 2·00, 95% CI = 1·19–3·36, P = 0·009), which was partly explained by males having trypanosomes in the CSF more often than females. There were important geographical variations in the frequency of relapses within the territory of the Nioki rural health zone, suggesting that the circulation of trypanosomes was geographically limited. Prednisolone treatment did not increase the risk of treatment failure, nor did decreasing the total dose of melarsoprol from 12 to 9 injections for patients with ≥100 white blood cells/mm3 of CSF. Since patients with trypanosomes in the CSF are also those who are at the highest risk of melarsoprolinduced encephalopathy, more aggressive treatment regimens cannot be recommended. Indeed our data suggest that there may be a threshold above which further increasing the total dosage of melarsoprol will not reduce the risk of relapse. © 1994 Oxford University Press.
Authors & Co-Authors
Pépin, Jacques
Canada, Sherbrooke
Université de Sherbrooke
Milord, François
Canada, Sherbrooke
Université de Sherbrooke
Khonde, A. N.
Canada, Sherbrooke
Université de Sherbrooke
South Africa
Zone de Santé Rurale de Nioki
Niyonsenga, Theo
Canada, Sherbrooke
Université de Sherbrooke
Loko, Lutete
South Africa
Zone de Santé Rurale de Nioki
Mpia, Bokelo
South Africa
Zone de Santé Rurale de Nioki
Statistics
Citations: 73
Authors: 6
Affiliations: 2
Identifiers
Doi:
10.1016/0035-9203(94)90430-8
ISSN:
00359203
e-ISSN:
18783503
Research Areas
Health System And Policy
Study Design
Case-Control Study
Participants Gender
Male
Female