African trypanosomiasis

Background

The life cycle of Trypanosoma brucei.

• AKA sleeping sickness
• Caused by Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
• Transmitted by the tsetse fly

Clinical Features

Cervical LAD in African trypanosomiasis

Typical fine-spotted pink rash of acute African trypanosomiasis on the skin of the abdomen (”trypanid rash”).

Petechiae of leg in a person infected with T. b. rhodesiense

• 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

Travel-related skin conditions

• Papules
  • Insect bites
  • Scabies
  • Seabather's eruption
  • Cercarial dermatitis (Swimmer's Itch)
• Macular
  • Chikungunya
• Sub Q Swelling and Nodules
  • Myiasis
  • Tungiasis
  • Loa loa
  • African Trypanosomiasis
  • Onchocerciasis
• 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

MRI of patient with African trypanosomiasis demonstrating extensive white matter involvement.

• 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

See Also

• Parasitic Diseases
• Travel Medicine