Document Detail


Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis.
MedLine Citation:
PMID:  11348533     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Encephalopathies are the most feared complications of sleeping sickness treatment with melarsoprol. To investigate the existence of risk factors, the incidence of encephalopathic syndromes and the relationship between the development of different types of encephalopathies and the clinical outcome was studied in a clinical trial with 588 patients under treatment with melarsoprol. The 38 encephalopathy cases were classified into three types according to the leading clinical picture: coma type, convulsion type and psychotic reactions. Nine patients were attributed to the convulsion type, defined as a transient event of short duration with convulsions followed by a post-ictal phase, without signs of a generalized disease. None of these patients died from the reaction. Febrile reactions in the 48 h preceding the reaction were generally not observed in this group. Twenty-five patients were attributed to the coma type, which is a progredient coma lasting several days. Those patients often had signs of a generalized disease such as fever (84%), headache (72%) or bullous skin (8%) reactions. The risk of mortality was high in this group (52%). About 14/16 patients with encephalopathic syndrome of the coma type were infected with malaria. Patients with psychotic reactions or abnormal psychiatric behaviour (3/38) and one patient who died after alcohol intake were excluded from the analysis. The overall rate of encephalopathic syndromes in the cases analysed (n=34) was 5.8%, of which 38.2% died. We did not find any parameters of predictive value for the risk of developing an encephalopathic syndrome based on the symptoms and signs before treatment initiation. The appearance during treatment of febrile reactions (RR 11.5), headache (RR 2.5), bullous eruptions (RR 4.5) and systolic hypotension (RR 2.6) were associated with an increased risk for the occurrence of encephalopathic syndromes especially of the coma type.
Authors:
J Blum; S Nkunku; C Burri
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Tropical medicine & international health : TM & IH     Volume:  6     ISSN:  1360-2276     ISO Abbreviation:  Trop. Med. Int. Health     Publication Date:  2001 May 
Date Detail:
Created Date:  2001-05-11     Completed Date:  2001-06-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9610576     Medline TA:  Trop Med Int Health     Country:  England    
Other Details:
Languages:  eng     Pagination:  390-400     Citation Subset:  IM    
Affiliation:
Swiss Tropical Institute, Basel, Switzerland. blum@keep.touch.ch
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MeSH Terms
Descriptor/Qualifier:
Adult
Angola
Central Nervous System Protozoal Infections / chemically induced*,  classification,  mortality,  parasitology*
Drug Administration Schedule
Female
Humans
Male
Melarsoprol / administration & dosage,  adverse effects*
Middle Aged
Predictive Value of Tests
Risk Factors
Syndrome
Time Factors
Treatment Outcome
Trypanocidal Agents / administration & dosage,  adverse effects*
Trypanosomiasis, African / complications*,  drug therapy*,  mortality
Chemical
Reg. No./Substance:
0/Trypanocidal Agents; 494-79-1/Melarsoprol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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