Following therapy of Stage II African trypanosomiasis some patients develop a potentially fatal encephalopathy termed post-treatment reactive encephalopathy (PTRE).
Process: meningoencephalitis
PTRE appears in 10% of patients treated with melarsoprol and is fatal in 50% of these (overall 5%).
The mechanism is uncertain. Various hypotheses have included:
(1) adverse reaction to melarsoprol
(2) subcurative treatment with persistent trypanosomiasis in the CNS
(3) macrophage activation with cytokine release
(4) astrocyte activation with release of substance P
(5) autoimmune response
It is necessary to exclude other causes of meningoencephalitis (virus, toxoplasmosis, etc).
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