Monitoring

Considering the toxicity of the drugs used in the treatment of human African trypanosomiasis (HAT), close monitoring for adverse effects during treatment is needed.

Assessment of treatment outcome requires following up the patient for up to 24 months; there is no test of cure, and relapses may occur more than a year after treatment. Relapses may occur earlier (e.g., weeks or months) with rhodesiense HAT compared with gambiense HAT as disease progression is usually more rapid. A relapse is defined as the presence of trypanosomes in any body fluid or tissue, or a high white blood cell (WBC) count in the cerebrospinal fluid (CSF) if trypanosomes are not seen.[32]

Gambiense HAT

  • In patients treated with pentamidine and nifurtimox plus eflornithine, systematic and active follow-up is not recommended, owing to the high efficacy of these therapies, where good compliance with the full schedule is guaranteed because of them being injectable.[32] Instead, treatment outcome assessment should focus on symptomatic patients only.

  • Given that fexinidazole is a relatively new drug, and the risk of insufficient compliance with the full treatment schedule and/or with the concomitant food intake that is essential for drug absorption, it is recommended that these patients be asked to attend for general examination every 6 months up to 24 months after treatment, or at any time if symptoms reappear.[32]

Rhodesiense HAT

  • Patients should attend for general examination at least at the end of treatment (day 10), and at 1 and 3 months post-treatment. A check-up is required at 6 and 12 months post-treatment.[32]

If signs or symptoms suggest the possibility of a relapse, laboratory examinations of body fluids, including CSF, should be performed in order to detect trypanosomes and/or CSF leukocytosis.[32]

Although there are limited guidelines to conclude therapeutic failure in the absence of trypanosomes, reappearance of clinical signs and a significant increase in CSF WBC count that are not attributable to other diseases are often used as additional criteria.[160][161]

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