Suramin and metronidazole in the treatment of Trypanosoma brucei rhodesiense

TRANSACTIONS OF THE ROYAL

SCCIETY

OF

Suramin and metronidazole treatment of Trypanosoma rhodesiense J. Arroz and M. Djedje 28, Tete, Mozambique

Provincial

TROPICALMEDICINEANI> HYGIENE(1988) 82, 421

in the brucei Hospital,

C.P.

We haverecently experimentedwith a combination of suraminand metronidazolein a moribund patient with multidrug-resistant Trypanosoma brucei rhodesknse. This combinationhasshownpromisein mice (RASEROKA & ORMEROD, 1985, 1986).

The patient, a 30year-old-male,wasfirst diagnosed in 1982.He had receivedrepeatedcoursesof suramin and melarsoprol,aswell asnitrofuraxone, nifurtimox (120 d) and difluoromethylornithine. At the end of 1985 his condition deteriorated and he failed to respondto severalcoursesof melarsoprol.Cerebrospinal fluid (CSF) examinationshowedtrypanosomes + ++, 133 cells/rnm3,and protein 56 mg%. As he wasexpectedto die within weeks,we decided to usethe combinationof suraminandmetronidazole. Intravenous suraminwas given on days 1 (0*2g), 2 (0.5g), 3, 7, 14 and 21 (20 m&g) and oral metronidazolein a daily doseof 40 mg/kg for 10 d. On the

1 ANNOUNCEMENT Innate resistance, h

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11th day CSF examinationshowedno trypanosomes (after double centrifugation), 27 cells/mm3, and protein 22 mg%. Metronidazole wascontinuedat the same dose for a further 10 d. On day 21 CSF examinationshowedno trypanosomes,cells 18/mm3, and protein 11 mg%. Examination of blood for trypanosomesby the microhaematocrithuffy-coat microscopytechniquewasconsistentlynegative.The patient wasmuch improvedclinically, gainingl-5 kg in weight. He continued to improve clinically, gaining a further 4 kg. But 3 weeksafter finishing treatment trvnanosomesreannearedin the CSF, with a cell -_ c&t of 138/rnrn3*andprotein 31 mg%. Despitethe relapse,we feel that the initial response to suramin and metronidazolewas promising, and justifiesfurther research.The useof lesstoxic drugs than thosecurrently availablewould be a welcome advance in the treatment of late-stagetrypanosomiasis. References Raseroka, B. H. & Ormerod, W. E. (1985). Suramini metronidazole combination for African sleeping sickness. Lancet, ii, 784-785. Raseroka, B. H. 81Ormerod, W. E. (1986). The trypanccidal effect of drugs in different parts of the brain. Transactions of the Royal Sociery of Tropical Medicine and Hygiene, 80, 634-641. Received 26 October 1987; accepted for publication December 1987

1 tolerance

and acquired

protective

immunity

to trypanosomatid

Colloquium organized by and held at the Institute of Tropical Antwerp, Belgium from September H-16,1988

parasites Medicine,

A number of host defence mechanismsprovide variable resistanceagainst infections with trypanosomesand leishmanias.Somehosts,by nature, arecompletelyrefractory to a given parasite. Others undergo transient infection, becomeasymptomaticcarriers, or develop severe clinical manifestations.Moreover, infectivity, and pathogenicityvary considerablywith species,subspecies, and even strain of parasites.The main topics of the colloquium will include trypanocidal and leishmanicidaldefencemechanisms and factors correlatedwith the pathogenicity of the infection. For further information pleasecontact: Prof. M. Van Meirvenne, Institute for Tropical Medicine, Nationalestraat155, B-2000 Antwerp, Belgium. Telex 31468 tropic b

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