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The protozoan Trypanosoma brucei gambiense, transmitted by tsetse fly bites, causes sleeping sickness. Endemic in several sub-Saharan countries, this disease is universally fatal if left untreated. Very few therapies are available, and the most commonly used drug, melarsoprol, has poor (and diminishing) effectiveness and unacceptable toxicity. Investigators recently described their experience using eflornithine, an ornithine decarboxylase inhibitor, as first-line therapy at a treatment center in southern Sudan.
From September 2001 through December 2002, 1055 patients with newly diagnosed second-stage African trypanosomiasis (i.e., trypanosomes in cerebrospinal fluid [CSF], CSF leukocyte counts >5×109/L and trypanosomes in blood or lymph node…