Table 4.
Treatment of selected parasitic CNS infections.
| Disease | Treatment | Suppressive therapy required | Comments |
|---|---|---|---|
| Malaria | For suspected cerebral malaria due to Plasmodium species with chloroquine resistance or unknown resistance, treatment should include a 10-mg/kg iv loading dose of quinidine in normal saline for 1–2 h; then 0.02 mg/kg iv per min of quinidine until patient can swallow; then quinine tablets, administered at 30 mg/kg for3–7 daysa | No | Use of steroids and prophylactic anticonvulsants in patients with cerebral malaria have been associated with worse outcome; elevated intracranial pressure should be treated with mannitol |
| Microsporidiosis | Albendazole 400 mg b.i.d. | Unknown | HAART therapy for HIV-positive patients |
| Trypanosoma rhodesiense infection | Melarsoprol 2–3.6 mg/kg per day for 3 days; after 7 days, 3.6 mg/kg per day for 3 days; repeat after 7 days | No | Early stage: intravenous suramin 100–200 mg (test dose), then 1 g iv administered on days 1, 3, 7, 14, and 21 |
| Trypanosoma gambiense infection | Eflornithine 100 mg/kg q.i.d. for 2 weeks or melarsoprol 2.2 mg/kg q.d. for 10 days | No | Early stage: pentamidine 4 mg/kg im per day for 10 days or suramin 100–200 mg (test dose) iv, then 1 g iv administered on days 1, 3, 7, 14, and 21 |
| Leishmaniasis | Sodium stibogluconate 20 mg/kg iv or im per day for 28 days or amphotericin B 0.5–1 mg/kg iv daily or every second day for up to 8 weeks or liposomal amphotericin B 3 mg/kg iv per day (days 1–5) and 3 mg/kg iv per day (days 14 and 21) or pentamidine 4 mg/kg iv or im daily or every second day for 15–30 doses | Yes | Amphotericin B is recommended for HIV-infected people and pregnant women |