Human African trypanosomiasis in non-endemic countries.

Human African trypanosomiasis (HAT) or sleeping sickness is a parasitic disease, acquired by the bite of an infected tsetse fly. In non-endemic countries HAT is rare, and therefore the diagnosis may be delayed leading to potentially fatal consequences. In this article the clinical presentation, diagnosis and treatment of the two forms of HAT are outlined. Rhodesiense HAT is an acute illness that presents in tourists who have recently visited game parks in Eastern or Southern Africa, whereas Gambiense HAT has a more chronic clinical course, in individuals from West or Central Africa.

[Double trypanosomal chancre revealing West African trypanosomiasis in a Frenchman living in Gabon]. / Chancres cutanés révélant une trypanosomose africaine à Trypanosoma brucei gambiense chez un résident français au Gabon.

BACKGROUND: Human African trypanosomiasis (sleeping sickness), an endemic disease, is currently reemerging in Africa with an estimated incidence of 45,000 new cases per year. It is caused by Trypanosoma brucei subspecies and transmitted by day-biting tsetse flies. PATIENTS AND METHODS: We report a case of West African trypanosomiasis due to Trypanosoma brucei gambiense involving a Frenchman living in Libreville, Gabon. The patient presented with fever and polyadenopathies as well as two skin ulcerations highly suggestive of trypanosomiasis. Microscopic examination of cutaneous and peripheral blood smears confirmed the diagnosis of haemolymphatic infection with T. b. gambiense with trypanosomal chancres. Examination of the cerebrospinal fluid was normal. The patient was successfully treated with pentamidine isethionate. CONCLUSIONS: Recognition of cutaneous manifestations may allow a rapid diagnosis of African trypanosomiasis that is essential for timely and efficient treatment and survival.

African trypanosomiasis in a British soldier.

BACKGROUND: Human African trypanosomiasis (sleeping sickness) is a parasitic infection transmitted by day-biting tsetse flies. The diagnostic gold standard is microscopy of blood, lymph node aspirates or CSF. The disease is invariably fatal, if not treated. There are over 300 000 new cases of sleeping sickness each year, and approximately 100,000 deaths. CASE PRESENTATION: We describe a British soldier who acquired trypanosomiasis in Malawi. He gave no history of a painful insect bite but presented with classical early signs of sleeping sickness (a primary chancre, regional lymphadenopathy, circinate erythema and a cyclical fever pattern). His condition worsened in the next week and trypanosomes were observed in a blood sample. He was aeromedically evacuated to Johannesburg, where Stage One Trypanosoma brucei rhodesiense infection was confirmed; he also had renal and liver failure, pancytopenia and heart block. He was treated with intravenous suramin. He recovered fully over the next 5 months. RECOMMENDATIONS: Medical officers deploying to eastern and southeastern Africa must be familiar with the common presenting signs and symptoms of T b rhodesiense sleeping sickness, and should have access to a reliable local microscopy service at all times. Confirmed sleeping sickness requires immediate transfer to a tertiary diagnostic and treatment centre, where suramin (for T b rhodesiense infection) or pentamidine (for T b gambiense) and also melarsoprol (for Stage Two disease) must be immediately available.