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)
- 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
References
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