The Efficacy of Pentamidine in the Treatment of Early-Late Stage Trypanosoma brucei gambiense Trypanosomiasis

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  • Projet de Recherches Cliniques sur la Trypanosomiase, Faculte de Medecine, Service de Neurologie, Central Hospitalo-Universitaire Cocody, Laboratoire d'Immunologie et de Parasitologie Moleculaire, Universite de Bordeaux II, Daloa, Cote d'Ivoire, France

Fifty-eight patients in the early-late stage (early central nervous system involvement) of Trypanosoma brucei gambiense trypanosomiasis were treated with pentamidine and divided into four groups (G1, G2, G3, and G4) according to cerebrospinal fluid (CSF) indicators: white blood cell (WBC) count, protein level (CSF protein), and the presence or absence of trypanosomes. Group G1 consisted of eight patients with normal CSF WBC counts and CSF protein levels and trypanosomes in the CSF. Group G2 consisted of nine patients with elevated CSF WBC counts, normal levels of CSF protein, and trypanosomes in the CSF. Group G3 consisted of 31 patients with high CSF WBC counts, normal CSF protein levels, but no trypanosomes in the CSF. Group G4 consisted of 10 patients with normal CSF WBC counts and CSF protein levels and trypanosomes demonstrated by CSF culture. Post-treatment follow-up of all patients for at least one year revealed three relapses. There were two deaths from diseases unrelated to trypanosomiasis or to the treatment protocol. Of these patients, 52 were followed for more than two years, the time necessary to confirm a complete cure, indicating a cure rate of 94%. Pentamidine is therefore effective in treating the early-late stage of T. b. gambiense trypanosomiasis, and is comparable with melarsoprol or eflornithine in terms of its tolerance and availability.