African sleeping sickness presenting in an American emergency department

Ginsberg, Richard S.; Ackley, Alexander; Stoner, Ed; Lee, Leung

doi:10.1016/s0196-0644(86)80496-6

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…In a case reported in the United States to CDC internal records, a diabetic patient with African trypanosomosis required less insulin during the acute phase of his illness (Ackley A., personal communication, quoted by Nieman [ 12 , 25 ]).…”

Section: Discussionmentioning

confidence: 99%

Refractory hypoglycaemia in a dog infected withTrypanosoma congolense

Deschamps¹,

Desquesnes²,

Dorso³

et al. 2016

Parasite

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A 20 kg German shepherd dog was presented to a French veterinary teaching hospital for seizures and hyperthermia. The dog had returned 1 month previously from a six-month stay in Senegal and sub-Saharan Africa. Biochemistry and haematology showed severe hypoglycaemia (0.12 g/L), anaemia and thrombocytopenia. Despite administration of large amounts of glucose (30 mL of 30% glucose IV and 10 mL of 70% sucrose by gavage tube hourly), 26 consecutive blood glucose measurements were below 0.25 g/L (except one). Routine cytological examination of blood smears revealed numerous free extracytoplasmic protozoa consistent with Trypanosoma congolense. PCR confirmed a Trypanosoma congolense forest-type infection. Treatment consisted of six injections of pentamidine at 48-hour intervals. Trypanosomes had disappeared from the blood smears four days following the first injection. Clinical improvement was correlated with the normalization of laboratory values. The infection relapsed twice and the dog was treated again; clinical signs and parasites disappeared and the dog was considered cured; however, 6 years after this incident, serological examination by ELISA T. congolense was positive. The status of this dog (infected or non-infected) remains unclear. Hypoglycaemia was the most notable clinical feature in this case. It was spectacular in its severity and in its refractory nature; glucose administration seemed only to feed the trypanosomes, indicating that treatment of hypoglycaemia may in fact have been detrimental.

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Section: Discussionmentioning

confidence: 99%

Refractory hypoglycaemia in a dog infected withTrypanosoma congolense

Deschamps¹,

Desquesnes²,

Dorso³

et al. 2016

Parasite

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show abstract

“…African sleeping sickness is 2 distinct entities: West African (Gambian) sleeping sickness caused by Trypanosoma brucei gambiense has a much more indolent central nervous system (CNS) phase than East African [20][21][22][23][24][25] and all of the cases in US citizens have been the East African form. [21][22][23][24][25] Since the 1960s, screening for trypanosomiasis by the World Health Organization has been drastically reduced. As a result, infested individuals are not being identified, especially with the more chronic Gambian form, and the incidence of African trypanosomiasis has greatly increased.…”

Section: African Trypanosomiasismentioning

confidence: 99%

“…24 The incubation period could not be determined in 1 tourist who traveled extensively in Africa for 4 months and presented within 10 days of symptom onset to an emergency department in Princeton, NJ, in 1984. 25 Almost immediately upon maturation of the chancre, headache, fever, malaise, chills, diarrhea, anorexia, and myalgias begin as the trypanomastigotes move into the bloodstream. An immune response to the flagellates does develop, but the parasites avoid the immune response through periodic antigenic shifts for the duration of the illness and are never fully eliminated from the blood-stream.…”

Section: African Trypanosomiasismentioning

confidence: 99%

“…Gambian (West Fever in the Returning Traveler, Part I African) trypanosomiasis infestation follows the bite of the Glossina palpalis species found in the dense river valley vegetation of west-central Africa, while the Rhodesian (East African) disease is transmitted on the dry, open savanna by Glossina morsitans. Most cases treated in the United States since 1968 [20][21][22][23][24][25] and all of the cases in US citizens have been the East African form. [21][22][23][24][25] Since the 1960s, screening for trypanosomiasis by the World Health Organization has been drastically reduced.…”

Section: African Trypanosomiasismentioning

confidence: 99%

“…The chancre was present, or reported, in 16 of 19 infections in American travelers. [21][22][23][24][25] Between 1929 and 1968, no African sleeping sickness was reported in the United States. However, since 1968, 31 African sleeping sickness infestations have been diagnosed in the United States.…”

Section: African Trypanosomiasismentioning

confidence: 99%

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