Internal Medicine

0521779407-20 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:22

Trypanosomiasis, African 1455

Signs & Symptoms

■T.b. rhodiense: Chancre at site of Tsetse fly bite, 5–15 days after bite,

which is red, indurated, raised, often with local adenopathy. Shortly

thereafter, sudden onset of fever, chills, headache, lymphadenopa-

thy, and often serpiginous erythematous skin lesions.

■T.b. gambiense: gradual onset weeks or months after bite of lethargy,

headaches, fatigue, myalgias, malaise, followed by progressive dete-

rioration of mental function. Lymphadenopathy, especially of pos-

terior cervical nodes, is common. Gradual progress to death with

psychosis, seizures, coma, etc. on the way.

tests

■Basic tests: blood:T.b. rhodiense: CBC may show anemia, thrombo-

cytopenia. High sed rate. LFTs normal or mildly abnormal.

■T.b. gambiense: CBC shows anemia, maybe thrombocytopenia. High

IGM (up to 4 times normal), mild LFT abnormalities.

■Basic tests: urine: not helpful

■Specific tests:T.b. rhodiense: thick blood smear stained with Giemsa

for trypanosomes, or (more sensitive) examine buffy coat by Giemsa

stain for trypanosomes.

➣T.b. gambiense: same smear techniques, but parasites are scarce,

multiple smears may be needed. Lymph node (usually posterior

cervical) aspirate usually positive for trypanosomes.

➣Other tests: CSF shows increased lymphocytes and protein, and

centrifuged specimen often shows trypanosomes in gambiense,

only later in rhodesiense. High CSF IGM ingambiense. No sero-

logy available in U.S.

differential diagnosis

■T.b. rhodiense: any acute fever, such as malaria, African tick typhus,

dengue fever, possibly typhoid fever.

■T.b. gambiense: chronic and subacute causes of fever, deterioration

of mental function, such as syphilis, tuberculous meningitis, HIV-

associated diseases.

management

What to Do First

■Stabilize patient, may need IV fluids, fever control. Spinal tap.

General Measures

■Same.