Guidelines for the treatment of human African trypanosomiasis / World Health Organization.

Format:

Book

Author/Creator:

World Health Organization, author, issuing body.

Language:

English

Subjects (All):

Neglected Diseases--prevention & control.

Neglected Diseases.

Trypanosomiasis--Chemotherapy.

Trypanosomiasis.

Physical Description:

1 online resource (1 PDF file (xi, 34 pages)) : illustrations

Place of Publication:

Geneva, Switzerland : World Health Organization, 2024.

Summary:

Human African trypanosomiasis (HAT), or sleeping sickness, is a parasitic infection that is endemic in sub-Saharan Africa and is almost invariably fatal unless treated. The infection is transmitted to humans through the bite of an infected tsetse fly. The parasite multiplies in the lymph and blood, causing unspecific symptoms and signs (first-stage or haemo-lymphatic stage) and, over time, crosses the blood-brain barrier to infect the central nervous system (second-stage or meningo-encephalitic stage). Brain involvement causes various neurological disturbances, including sleep disorders (hence the name "sleeping sickness"), progression to coma and, ultimately, death. The disease has two forms: the slowly progressing form (gambiense HAT), caused by infection with Trypanosoma brucei gambiense, found in western and central Africa (92% of cases in 2018-2022); and the more rapidly progressive form (rhodesiense HAT), caused by infection with T. b. rhodesiense, in eastern and southern Africa (responsible for the remainder of cases). All age groups and both sexes are at risk of both forms of HAT, although prevalence is higher in adults than in children. The incidence of the disease has strongly declined in response to intensive surveillance and control interventions in endemic areas. As a result, HAT is among the neglected tropical diseases targeted for elimination by the World Health Organization (WHO). The remarkable progress in the control of gambiense HAT has relied on case-finding and curative treatment, which interrupts transmission by depleting the reservoir of parasites in humans. This has been combined in some areas with vector control activities. In contrast to gambiense HAT, treatment of rhodesiense HAT patients has little impact on disease transmission, but it is certainly life-saving. The WHO interim guidelines for the treatment of gambiense HAT, issued in 2019 added as a therapeutic option the new medicine fexinidazole. Thanks to its recent extension of indication, fexinidazole is now also recommended for treatment of rhodesiense HAT. The present guidelines incorporate all these changes, leading to a substantial reconfiguration of therapeutic choices for both disease forms. HAT is a serious, life-threatening disease and the efficacy of fexinidazole depends on swallowing the medicine after an appropriate intake of food as well as on completing the full 10-day treatment schedule. Therefore, the recommendations regarding fexinidazole administration are considered key elements that must be carefully followed. When the conditions listed in these guidelines are not met for any individual patient, the alternative available treatments should be prescribed.

Contents:

Acknowledgements

Abbreviations and acronyms

Executive summary

1. Introduction and general aspects

1.1. Goal

1.2. Target audience

1.3. Guiding principles

1.4. Methodology and process of developing the guidelines

1.5. Background

2. Treatment of gambiense HAT

2.1. Case definitions, assessment of gambiense HAT patients and treatment choice

2.2. Fexinidazole

2.3. Pentamidine

2.4. NECT

2.5. Eflornithine monotherapy

2.6. Melarsoprol

2.7. Gambiense HAT treatment in pregnancy

2.8. Follow-up after gambiense HAT treatment

2.9. Treatment of gambiense HAT relapses

3. Treatment of rhodesiense HAT

3.1. Case definitions, assessment of rhodesiense HAT patients and treatment choice

3.2. Fexinidazole

3.3. Suramin

3.4. Melarsoprol

3.5. Pentamidine in rhodesiense HAT

3.6. Rhodesiense HAT treatment in pregnancy

3.7. Follow-up after treatment of rhodesiense HAT

3.8. Treatment of rhodesiense HAT relapses

References

Annex. Guideline development methods

Web Annex A. Evidence summary: systematic review of oral fexinidazole as first line treatment for rhodesiense Human African Trypanosomiasis: Commissioned by WHO Cochrane Response

Katrin Probyn, Brian Buckley, Elise Cogo, Hanna Bergman, Jennifer Petkovic, Meghan Sebastianski, Yanina Sguassero, Nicholas Henschke, and Gemma Villanueva.

Published online: February 2024.

Web Annex B. PICO questions, EtD tables, GDG recommendations

Web Annex C. Summary of declared interests.

Notes:

Description based on publisher supplied metadata and other sources.