What are the guideline sources, guidelines and references for African trypanosomiasis ?
Guideline sources The following summarized guidelines for the evaluation and management of african trypanosomiasis are prepared by our editorial team based on guidelines from the World Health Organization (WHO 2019) and the Infectious Diseases Society of America (IDSA 2008). 1 2 Calculator WHO criteria for staging of Afric Guidelines 1. Diagnostic procedures Lumbar puncture: Perform a lumbar puncture for stratification in patients not meeting the following criteria: low index of suspicion of severe disease based on clinical judgment, and high confidence that the patient will have an appropriate follow-up to detect relapse early. B Consider performing a lumbar puncture in patients rejecting or not tolerating fexinidazole, to decide between pentamidine and nifurtimox-eflornithine combination therapy. C https://web.pathway.md/diseases/recobLels5aCZdsoq 1/3 6/23/23, 2:17 AM African trypanosomiasis Pathway 2. Medical management Setting of care: Consider deciding on outpatient administration of fexinidazole (under daily supervision) in consultation with the patient, family members, and clinicians, taking into account the following factors: convenience to the patient and the family (such as distance and costs) development of side effects interfering with treatment compliance existing comorbidities capacity of the healthcare system for supervised administration as an outpatient. C Hospitalize patients in the following cases: concomitant psychiatric disorders pediatric patients with body weight < 35 kg 100 WBCs in CSF after treatment (exceptionally) with fexinidazole risk of poor compliance with treatment. B Fexinidazole: Consider initiating treatment, preferentially with fexinidazole, omitting lumbar puncture in patients aged 6 years and weighing 20 kg meeting both of the following conditions: low index of suspicion of severe disease based on clinical judgment high confidence that the patient will have an appropriate follow-up to detect relapse early. C Show 2 more Nifurtimox-eflornithine combination therapy: Administer nifurtimox-eflornithine combination therapy in patients requiring lumbar puncture stratification but not undergoing lumbar puncture, and in patients with unreliable lumbar puncture results. B Administer nifurtimox-eflornithine combination therapy in patients with severe second-stage disease. B 3. Specific circumstances Pediatric patients: Administer pentamidine in pediatric patients aged < 6 years or weighing < 20 kg with first-stage disease. Administer nifurtimox-eflornithine combination therapy in patients with second-stage disease. B Administer fexinidazole in pediatric patients aged 6 years or weighing 20 kg with first- B or second-stage disease with WBCs in CSF < 100/ L. B Pregnant patients: consider administering fexinidazole after the first trimester. C Patients with encephalitis: Administer eflornithine, or melarsoprol as an alternative, in patients with Trypanosoma brucei gambiense encephalitis. B https://web.pathway.md/diseases/recobLels5aCZdsoq 2/3 6/23/23, 2:17 AM African trypanosomiasis Pathway Administer melarsoprol in patients with Trypanosoma brucei rhodesiense encephalitis. B References 1. No authors listed. WHO interim guidelines for the treatment of gambiense human African trypanosomiasis. Geneva: World Health Organization; 2019. Open 2. Tunkel AR, Glaser CA, Bloch KC et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008 Aug 1;47 3 303 27. Open 3. World Health Organization. Control and surveillance of human African trypanosomiasis. World Health Organ Tech Rep Ser. 2013; 984 1 237. Open https://web.pathway.md/diseases/recobLels5aCZdsoq 3/3