African trypanosomiasis: Difference between revisions
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==Background== | ==Background== | ||
* | *AKA sleeping sickness | ||
*Caused by ''Trypanosoma brucei gambiense'' and ''Trypanosoma brucei rhodesiense'' | |||
*Transmitted by the tsetse fly | |||
==Clinical Features== | ==Clinical Features== | ||
*initial features | |||
**Localized inflammatory reaction after tsetse fly bite | |||
**Painless chancre 2-3 days later, lasts 2-3 weeks | |||
*Systemic disease | |||
**Intermittent [[Fever]] | |||
**Malaise, wasting | |||
*CNS involvement | |||
**Behavioral changes | |||
**[[Encephalitis]] | |||
**[[Coma]] | |||
**Death | |||
*Other complications | |||
**Hemolysis, [[anemia]] | |||
**Pancarditis | |||
**[[Meningoencephalitis]] | |||
*Winterbottom's sign: posterior cervical LAD (Gambiense) | *Winterbottom's sign: posterior cervical LAD (Gambiense) | ||
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==Evaluation== | ==Evaluation== | ||
*Blood smear to identify parasite | |||
*Parasites can also be found in lymph nodes, chancres, bone marrow, or CSF | |||
==Management== | ==Management== | ||
*Consult ID early! | |||
*No CNS involvement | |||
**[[Pentamidine]] or suramin | |||
*CNS involvement | |||
**Melarsoprol, eflornithine, or a combination of nifurtimox and eflornithine | |||
==Disposition== | ==Disposition== | ||
Revision as of 18:13, 27 March 2017
Background
- AKA sleeping sickness
- Caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
- Transmitted by the tsetse fly
Clinical Features
- initial features
- Localized inflammatory reaction after tsetse fly bite
- Painless chancre 2-3 days later, lasts 2-3 weeks
- Systemic disease
- Intermittent Fever
- Malaise, wasting
- CNS involvement
- Behavioral changes
- Encephalitis
- Coma
- Death
- Other complications
- Hemolysis, anemia
- Pancarditis
- Meningoencephalitis
- Winterbottom's sign: posterior cervical LAD (Gambiense)
Differential Diagnosis
- Papules
- Insect bites
- Scabies
- Seabather's eruption
- Cercarial dermatitis (Swimmer's Itch)
- Macular
- Sub Q Swelling and Nodules
- Ulcers
- Tropical pyoderma
- Leishmaniasis
- Mycobacterium marinum
- Buruli ulcer
- Dracunculiasis (Guinea Worm disease)
- Linear and Migratory Lesions
- Cutaneous larvae migrans
- Photodermatitis
See also domestic U.S. ectoparasites
Evaluation
- Blood smear to identify parasite
- Parasites can also be found in lymph nodes, chancres, bone marrow, or CSF
Management
- Consult ID early!
- No CNS involvement
- Pentamidine or suramin
- CNS involvement
- Melarsoprol, eflornithine, or a combination of nifurtimox and eflornithine