Management approach for patients with human African trypanosomiasis (HAT) caused by Trypanosoma brucei gambiense

WBC: white blood cell count; CSF: cerebrospinal fluid; IM: intramuscular; IV: intravenous; NECT: Nifurtimox-Eflornithine Combination Therapy.
* Sleep disorder is common in severe and nonsevere HAT; therefore, presence of this feature cannot be used to determine need for lumbar puncture.
¶ The CSF WBC threshold of 100 cells/microL applies only in the decision regarding whether to use fexinidazole. If fexinidazole is not used, treatment consists of pentamidine if WBC ≤5 cells/microL and no trypanosomes are present; otherwise, treatment consists of NECT.
Δ Patients should eat or drink a source of sugar prior to administration to avoid hypoglycemia and remain supine for ≥1 hour after administration to reduce likelihood of hypotension. Monitor vital signs before and 1 hour after administration (and continue if hemodynamic instability). Electrocardiogram and serum glucose monitoring should be considered when feasible.
◊ Fexinidazole should be administered only if there is high confidence in appropriate follow up for early detection of relapse. Concomitant food intake is required for adequate absorption. Outpatient treatment is possible under certain conditions; refer to UpToDate clinical topic review of HAT treatment for further discussion of administration.