There has been a large rise in the number of cases of human African trypanosomiasis in the last 10 years. Drugs for human African try-panosomiasis, such as pentamidine, suramin, and melarsoprol, were developed decades ago. There has been a recent welcome initiative to manufacture and distribute antitrypanoso-mal drugs free of charge. However, increasing drug resistance and frequent serious drug-related toxicity underline the urgent need for new medicines.
Melarsoprol (SED-14, 981; SEDA-23, 310; SEDA-24, 335)
Nervous system Encephalopathic syndromes complicating treatment of stage II human African trypanosomiasis with melarsoprol in 588 patients have recently been reviewed (53C). The overall rate of encephalopathy was 5.8% and presented in three ways: coma, convulsions, and psychotic reactions. The overall death rate was 38%. Comatose patients had a death rate of 52% and were commonly co-infected with malaria (14/16). Symptoms during treatment of fever (RR = 11.5), headache (RR = 2.5), bullous eruptions (RR = 4.5), and systolic hypotension (RR = 2.6) were associated with an increased risk of encephalopathic syndromes, especially coma.
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