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African sleeping sickness

BMJ 2008; 336 doi: (Published 27 March 2008) Cite this as: BMJ 2008;336:679
  1. Francesco Checchi, lecturer1,
  2. Michael P Barrett, reader2
  1. 1Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2Division of Infection and Immunity, Institute of Biomedical and Life Sciences, Glasgow Biomedical Research Centre, University of Glasgow, Glasgow G12 8TA
  1. francesco.checchi{at}

    Eflornithine should be the drug of choice for stage 2 disease, but resistance must be monitored

    When human African trypanosomiasis (sleeping sickness) killed millions of people during Africa’s colonial period 60-100 years ago, interest was similar to that for today’s HIV epidemic, but the disease is now largely forgotten. The continuing importance of this disease is highlighted in the accompanying paper by Priotto and colleagues, who report the effectiveness and safety of eflornithine used for its first line treatment.1

    The most common form of human African trypanosomiasis is caused by the parasite Trypanosoma brucei gambiense andis transmitted by the tsetse fly.2 Because diagnostic tests are too complex to integrate into primary health care, by the time most cases present they have already progressed from the benign easily treatable stage of the disease (haemolymphatic, stage 1) to the late stage (meningoencephalitic, stage 2), where parasites invade the central nervous system. If the disease is untreated, the patient has almost a 100% risk of dying within one to four years, after progressive neurological degeneration.

    Only two drugs are available for treatment of late stage disease. The first is a derivative of arsenic, melarsoprol. In areas where resistant parasites may be prevalent—such as Sudan, Uganda, the Democratic Republic of Congo, or Angola—melarsoprol has …

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