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Volume 18, Number 2—February 2012


Multiorgan Dysfunction Caused by Travel-associated African Trypanosomiasis

Lucy E. CottleComments to Author , Joanna R. Peters1, Alison Hall, J. Wendi Bailey, Harry A. Noyes, Jane E. Rimington, Nicholas J. Beeching, S. Bertel Squire, and Mike B.J. Beadsworth
Author affiliations: Royal Liverpool University Hospital, Liverpool, UK (L.E. Cottle, J.R. Peters, A. Hall, N.J. Beeching, S.B. Squire, M.B.J. Beadsworth); Liverpool School of Tropical Medicine, Liverpool (J.W. Bailey, N.J. Beeching, S.B. Squire, M.B.J. Beadsworth); University of Liverpool, Liverpool (H.A. Noyes); Hawkshead Medical Practice, Ambleside, UK (J.E. Rimington)

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Table 1

Treatment regimen for Trypanosoma brucei rhodesiense infection in adults*

Disease stage Drug, route of administration Regimen Adverse effects
First Suramin, intravenous Test dose of 100 mg in 100 mL 0.9% saline over 30 min on day 0; and 5 doses of 20 mg/kg (maximum 1 g/dose) in 250 mL 0.9% saline over 3 h on days 1, 3, 7, 14, 21 Hypersensitivity reactions (early and late); nephrotoxicity, hepatotoxicity, hemolytic anemia, peripheral neuropathy, agranulocytosis, thrombocytopenia, and cutaneous reactions
Second Melarsoprol, intravenous 2.0–3.6 mg/kg/d (maximum 180 mg/d) for 3 d; after 7 d, 3.6 mg/kg/d for 3 d; after 7 more d, 3.6 mg/kg/d for 3 d† Encephalopathy, cutaneous reactions, peripheral neuropathy, cardiac arrhythmias, thrombophlebitis, fever, and gastric upset

*Source of drug regimen: Brun et al. (2) and Abramowicz (3).
†In frail patients, begin with 18 mg melarsoprol and progressively increase dose (3). Pretreatment with suramin for 2–4 d is recommended for debilitated patients.

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1Current affiliation: Worthing Hospital, Worthing, UK.

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