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African trypanosomiasis

Last reviewed: 9 Nov 2024
Last updated: 19 Nov 2024
19 Nov 2024

WHO recommends fexinidazole for rhodesiense HAT

The World Health Organization (WHO) has updated its guidelines for the management of human African trypanosomiasis (HAT). HAT is a serious, life-threatening disease, with approximately 55 million people at risk of infection in 36 sub-Saharan countries.

The updated guidelines now include recommendations for the management of rhodesiense HAT, previously missing from the 2019 guidelines, which only covered the management of gambiense HAT.

The updated guidelines recommend fexinidazole, an orally administered antitrypanosomal drug, as a first-line treatment for rhodesiense HAT. Fexinidazole is therefore now recommended for either gambiense HAT or rhodesiense HAT in patients older than 6 years of age who weigh more than 20 kg.

The new recommendations improve the management options for rhodesiense HAT. Many patients will no longer:

  • require injectable treatments

  • require a lumbar puncture for disease staging (in eligible patients)

  • be exposed to melarsoprol, a highly toxic drug.

Fexinidazole has a high efficacy rate; in one study the cure rate was 100% in first-stage disease, and 94.3% in second-stage disease. The mortality rate was substantially lower compared with melarsoprol.

See Management: approach

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • previous stay in rural west and central Africa (Trypanosoma brucei gambiense)
  • previous stay in game parks in east and southern Africa (T b rhodesiense)
  • enlarged cervical lymph nodes/Winterbottom sign (T b gambiense)
  • chancre (T b rhodesiense)
  • disturbances of consciousness and sleep
Full details

Other diagnostic factors

  • history of several treatments against malaria with no improvement
  • headache
  • fever
  • fatigue and general malaise
  • history of infertility, menstrual disorders, high miscarriage rate (women)
  • reduced libido, impotence (men)
  • pruritus
  • edema
  • impaired motor functions
  • mental changes
  • signs of cardiac failure (T b rhodesiense)
  • rash
  • hepatosplenomegaly
  • sensory disorders
Full details

Risk factors

  • exposure to tsetse fly
  • living or working in an area with people infected with gambiense trypanosomiasis
  • living or working in an area with animals infected with rhodesiense trypanosomiasis
Full details

Diagnostic tests

1st tests to order

  • complete blood count
  • erythrocyte sedimentation rate
  • serum immunoglobulins (Ig)
  • rapid diagnostic tests
  • card agglutination test for trypanosomiasis (CATT)
  • immunofluorescence
  • enzyme-linked immunosorbent assay (ELISA)
  • chancre aspirate microscopy
  • lymph node aspirate microscopy
  • blood microscopy
  • microhematocrit centrifugation technique
  • quantitative buffy coat technique
  • mini-anion exchange centrifugation technique (mAECT)
Full details

Tests to consider

  • electrocardiogram
  • cerebrospinal fluid (CSF) white blood cell (WBC) count
  • CSF microscopy
  • double centrifugation of CSF
  • modified single centrifugation of CSF
  • CSF protein
Full details

Emerging tests

  • polymerase chain reaction (PCR)
  • reverse transcriptase real-time PCR (RT-PCR)
  • intrathecal immunoglobulin production
  • stage biomarkers
  • immune trypanolysis
  • T b gambiense inhibition ELISA (g-iELISA)
  • MRI brain

Treatment algorithm

ACUTE

gambiense human African trypanosomiasis (HAT)

rhodesiense human African trypanosomiasis (HAT)

ONGOING

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Contributors

Authors

Veerle Lejon, PhD

Director of Research

Institut de Recherche pour le Développement

Montpellier

France

Disclosures

VL is an author of several references cited in this topic. VL declares that she has no competing interests.

José Ramón Franco, MD, MPH

Medical Officer

Control of Neglected Tropical Diseases

Human African Trypanosomiasis Control Program

World Health Organization

Geneva

Switzerland

Disclosures

JRF is an author of several references cited in this topic. JRF declares that he has no competing interests.

Pere P. Simarro, MD, PhD

Former head of WHO HAT control and surveillance programme

WHO temporary advisor

World Health Organization

Geneva

Switzerland

Disclosures

PPS is an author of several references cited in this topic.

Peer reviewers

Sanjeev Krishna, MA (Cantab), BMChB (Oxon), DPhil, FRCP, ScD (Cantab), FMedSci

Professor of Molecular Parasitology and Medicine

Centre for Infection

Division of Cellular and Molecular Medicine

St. George's

University of London

London

UK

Disclosures

SK is a consultant for the Foundation for Innovative Diagnostics, a non-profit organization developing diagnostics for neglected diseases such as HAT. SK is an author of a reference cited in this topic.

Mike Barrett, BSc, PhD

Professor

Division of Infection and Immunity

Institute of Biomedical and Life Sciences

The Glasgow Biomedical Research Centre

University of Glasgow

Glasgow

UK

Disclosures

MB declares that he has no competing interests.

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