Chemoprophylaxis of Amebiasis and African Trypanosomiasis

Abstract

Other than malaria, only two protozoal diseases, amebiasis and African trypanosomiasis, are preventable with currently available drugs. Amebiasis can be prevented with a luminal amebicide, such as a hydroxyquin and glycobiarsol (Milibis®); however, the former is associated with occasional irreversible neurologic disease and the latter with the risk of arsenic toxicity. In view of these risks and the estimate that only 2% of travelers acquire amebic infection, chemoprophylaxis cannot be recommended. Millions of Africans at risk of Trypanosoma gambiense infection have been protected by pentamidine administration at 6-month intervals; no similar data are available regarding prophylaxis against T. rhodesiense. In the traveler, drug toxicity and the possibility of cryptic infection, although rare, exceed the risk of disease, which is less than 0.01%. Except for certain occupational groups at high risk of Gambian sleeping sickness, chemoprophylaxis is not recommended for travelers to Africa.