Examination of fluid from the chancre, thin or thick blood smears, buffy coats, lymph node aspirates, bone marrow biopsy specimens, or CSF can reveal the parasite.
- Parasitemia is more likely in stage 1 than in stage 2 disease and in pts infected with T. b. rhodesiense rather than T. b. gambiense.
- CSF should be examined whenever the diagnosis is being considered. Increased opening pressure, increased protein level, and increased mononuclear cell counts are common.
Treatment: Sleeping Sickness Stage 1 disease - T. b. rhodesiense: suramin (a test dose of 100-200 mg followed by 20 mg/kg IV on days 1, 5, 12, 18, and 26)
- - Hypersensitivity reactions and renal damage are the most important adverse effects.
- - A urinalysis should be done before each dose. Treatment should be discontinued if hematuria or increasing proteinuria is found or if casts are present in the sediment.
- T. b. gambiense:pentamidine (4 mg/kg daily IM or IV for 10 days)
- - Serious adverse reactions include nephrotoxicity, abnormal liver function, neutropenia, hypoglycemia, and sterile abscesses.
- - Suramin is an alternative agent.
Stage 2 disease - T. b. rhodesiense: melarsoprol (2.2 mg/kg IV daily for 10 days). To reduce reactive encephalopathy, administer prednisolone (1 mg/kg) with each dose of melarsoprol.
- T. b. gambiense:Eflornithine (100 mg/kg IV qid for 2 weeks) is the first-line agent. Either melarsoprol (2.2 mg/kg qd IV for 10 days) or nifurtimox (5 mg/kg PO tid for 7 days) plus eflornithine (100 mg/kg IV bid for 7 days) is an alternative.
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