Trypanosomiasis: Treatment, Procedure, Cost and Side Effects

This is also known as Sleeping sickness.

There are only four drugs that are registered for the treatment of trypanosomiasis, they are: pentamidine, melarsoprol, suramin and eflornithine. There is also another drug, nifurtimox, which is used in combination only under special authorizations. None of these drugs are anodyne which means all of them have a certain level of toxicity. Pentamidine and suramin are generally used only in the first or early stage of T.b.gambiense and T.b. rhodesiense infections respectively. Eflornithine is used in monotherapy but only during the second stage of T.b.gambiense infection since reports indicate that it is not effective against the disease due to T.b rhodesiense. Since 2009, the combination of eflornithine and nifurtimox (NECT) has been adopted as first line treatment for second stage of trypanosomiasis in all disease endemic countries. The combination of both drugs reduces the duration of eflornithine monotherapy treatment and is easier to administer, while improving the level of efficacy and safety.

The first stage or ‘Stage I’ of this condition is generally treated with pentamidine or suramin via the means of intramuscular injection or intravenous infusion only if sufficient observation of the patient is possible. Stage II is typically treated with melarsoprol or eflornithine which if possible introduced to the body intravenously. Both pentamidine and suramin have very limited side effects. On the other hand melarsoprol is extremely effective but is known to have many serious side effects which can lead to neurological damage in the a patient, though the drug is often a patient's last hope in many late stage cases. Eflornithine is extremely expensive but has side effects that may be treated with ease. In regions of the world where the disease is common eflornithine is provided for free by the World Health Organization. The best treatment recommended by doctors for stage II is a combination therapy of oral nifurtimox and intravenous eflornithine, which is called NEER. In 2009, the World Health Organization inducted NEER into the list of essential medicines. Before there was this new treatment option, most patients were treated with eflornithine monotherapy (to be administered four times a day intravenously for 14 days) or melarsoprol (a derivative of arsenic, very toxic and less effective) . The NEER is as effective as treatment with eflornithine monotherapy, with the advantage of requiring far fewer injections and shorter hospital stay (just seven days).

All patients diagnosed with sleeping sickness must undergo examinations to determine whether the cerebrospinal fluid is involved in the central nervous system, since the choice of treatment medication will depend on the disease stage. The World Health Organization criteria for central nervous system involvement include increased protein in cerebrospinal fluid and a white cell count of more than 5. Trypanosomes can often be observed in cerebrospinal fluid in persons with second stage infection.

Patients need to talk to their doctors and give them their full medical history as well as a list of all the medications they are on. The treatment can only be started after the patients have undergone a few tests and come out with positive results.

There are no particular side effects to the treatment.

The post treatment guidelines generally include a strict medical routine decided by the doctor based on which stage the disease was. The patient needs to follow this routine along with a list of medication to recover faster.

Time taken for the recovery from the treatment differs from patient to patient. The severity of the condition and also the type of treatment the patient underwent plays a huge role in how long the patient would take to recover. Some patients begin to recover faster than others.

The price depends on how sever the disease is or at what stage has it reached. The usual doctor’s consultation fee is around Rs. 500 to Rs. 1,000. After the diagnose is done the treatment price can range from Rs. 1000 to 2000.

In order for the treatment to be permanent, the patient post treatment needs to maintain a healthy lifestyle and follow the directions given by the doctor.