[Treatment of sleeping disease caused by trypanosoma brucei gambiense with alpha-difluoromethylornithine (DFMO) in a rural hospital in Zaire].

The authors report the results of 32 patients with sleeping sickness due to Trypanosoma brucei gambiense treated with DFMO (DL-alpha-difluoromethylornithine), an inhibitor of polyamine biosynthesis. Between those patients, there were 5 new cases, 1 reinfection, and 26 cases with a primary, a secondary resistance or a relapse. 26 cases got DFMO only per os, but six others received first DFMO for two weeks by the intravenous way, followed by three weeks of DFMO per os. The secondary effects were never very severe and never prompted a definitive discontinuation of treatment. 12 cases were followed for a period of 24 months, 16 for a period between 1 and 18 months and 4 patients died during the study (3 during treatment and one 8 months afterwards), but we don't think that DFMO was the cause of death. Out of the 12 cases followed for two years, 11 were in perfect health at the end of this period (one case can be considered as a secondary resistance to DFMO, but it could have been a reinfection as well). For the 16 cases followed for a period less than two years, we found a very fast disappearance of trypanosomes from body fluids, immediately after the beginning of treatment, and a significant amelioration of clinical signs. After this study, the authors estimate that DFMO given orally provides as good results as DFMO given in a combined therapy. But the oral way seems much easier to administer and much cheaper in rural areas.(ABSTRACT TRUNCATED AT 250 WORDS)