Therapy for African trypanosomiasis

The main problem in the treatment of human African trypanosomiasis remains the toxicity of the universal and effective drug melarsoprol (4% to 8% lethality during treatment). Other drugs do not penetrate the central nervous system, where the trypanosome migrate very early in the infection before any inflammatory signs appear in the cerebrospinal fluid. DL-α-Difluoromethylornithine provides an efficient and safe alternative for Trypanosoma brucei gambiense infection, while Trypanosoma brucei rhodesiense is more resistant. Moreover, the administration scheme is spread over 5 weeks including 14 days of intravenous injections. Nifurtimox taken orally for 1 or 2 months has a marked effect on the T. brucei gambiense infection. Too frequent relapses are observed in some trials. Imidazoles, new arsenicals, and antimitotics, were successfully tested in experimental models. Combinations of drugs with additive or potentiating effects mainly based on decarboxylase enzymes or methylating molecules seem promising.