Internal Medicine

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

1454 Trousseau Syndrome Trypanosomiasis, African

specific therapy

■IV heparin loading dose followed by continuous IV infusion of hep-

arin to prolong the APTT to twice normal baseline value:

■As soon as Dx of thrombosis (thrombophlebitis) is made; after a

baseline PT, TT, APTT, FDP-fdp & fibrinogen have been obtained

(as well as any other blood study needed [e.g., hem-8, M-12])

■IV heparin must be continued until underlying neoplasm is identi-

fied & completely removed

■If neoplasm can be completely removed: prompt return of all lab

values to normal without any other treatment. As this takes place, IV

heparin can be discontinued.

■If neoplasm cannot be found or found & cannot be removed: pt must

remain on IV heparin for life

■Only way to successfully treat this disease: complete elimination of

the neoplastic disease

■All other therapeutic maneuvers are palliative.

■If continuous IV heparin is being employed: may be possible to dis-

charge pt home where pt receives continuous IV heparin via battery-

driven pump attached to pt with waist belt. Pt & family must be thor-

oughly instructed in detail about all aspects of pump use, etc. before

discharge home.

■Pt should be seen by the attending physician at least once/wk – if as

outpt everything is in excellent functional order, pt can be managed

without hospitalization. Close monitoring is needed to achieve this.

follow-up

n/a

complications and prognosis

n/a

TRYPANOSOMIASIS, AFRICAN

J. GORDON FRIERSON, MD

history & physical

History

■Exposure: bite of tsetse fly in tropical Africa. The fly transmitsTry-

panosoma brucei rhodiensein E. and S. Africa, andTrypanosoma

brucei gambiensein Central and W. Africa.