The treatment of sleeping sickness (mainly due to Trypanosoma rhodesiense) with melarsoprol : I. Reactions observed during treatment

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1. 1) Though the physical and mental state of patients with sleeping sickness due to T. rhodesiense and T. gambiense is usually markedly improved during melarsoprol therapy, unwanted drug-effects are common. 2. 2) In a total of 110 patients treated with melarsoprol, central nervous system reactions, mainly reactive encephalopathy, occurred in 14 cases (12.7 per cent.). 3. 3) Five deaths (4.5 per cent.) occurred during treatment. One was due to haemorrhagic encephalopathy, probably caused by relative overdosage, and three were primarily due to trypanosomal meningo-encephalitis. In the remaining patient, not examined at autopsy, death was attributed speculatively to a severe reactive encephalopathy. 4. 4) Angioneurotic or skin reactions occurred in five cases (4.5 per cent.). 5. 5) Agranulocytosis occurred once. 6. 6) Erythema nodosum leprosum reaction (preferably called erythema induratum leprosum) occurred once in a patient with both leprosy and trypanosomiasis treated with melarsoprol. 7. 7) Other reactions (5.5 per cent.) included arthralgia and renal and hepatic effects. The pyrexial reaction, occurring especially in parasitaemic cases, on initial treatment is similar to the Jarisch-Herxheimer effect in syphilis. 8. 8) Though aetiological diagnosis of a melarsoprol toxic reaction is readily made, the importance of endeavouring to make a pathogenetic diagnosis is emphasized.