African Trypanosomiasis in Two Travelers from the United States

Abstract

African trypanosomiasis is a rare but well-documented cause of fever in United States travelers returning from areas where it is endemic. We report two recently diagnosed cases that involved tourists who went on safari in Tanzania. Review of these and 29 other published cases indicates that disease in returning United States travelers is nearly always of the East African form, a fulminant illness for which prompt diagnosis is necessary. In the United States, timely and appropriate therapy for this disease has resulted in favorable outcomes for most patients. Chemoprophylaxis for East African trypanosomiasis is not recommended, but travelers visiting areas of endemicity should practice appropriate preventive measures to prevent tsetse fly bites.

Efficacy of the Novel Diamidine Compound 2,5-Bis(4-Amidinophenyl)- Furan-Bis- O -Methlylamidoxime (Pafuramidine, DB289) against Trypanosoma brucei rhodesiense Infection in Vervet Monkeys after Oral Administration

“…The clinical signs described in this report for acute infection mirror those described in previous reports for syringe passage of T. brucei rhodesiense infections in vervet monkeys (15,21), tsetse-transmitted infections in vervet monkeys (28), and earlystage infections in sleeping sickness patients (16,18,22). These clinical manifestations are evidence of hemolymphatic system involvement.…”

Human African trypanosomiasis in endemic populations and travellers

“…rhodesiense HAT has a short incubation period of a few days in travellers (less than 3 weeks). It is an acute, life-threatening disease with the cardinal symptoms of high fever, headache, and a trypanosomal chancre [7,10,11,[42][43][44][45][46][47]. For T.b.…”

Options for Field Diagnosis of Human African Trypanosomiasis

“…No more than 50 cases of HAT are diagnosed yearly outside Africa (56). Visitors to some game parks in eastern Africa are at particular risk for T. b. rhodesiense HAT (47,115). Migrants from countries where T. b. gambiense is highly endemic can have HAT that remains unrecognized for years (108).…”

“…Most patients are therefore diagnosed by examination of a stained thin or thick blood smear (26,47). Trypanosomes are sometimes detected by chance while searching for Plasmodium spp (34,115). Trypanosomes can also be found in the chancre by microscopic examination of an aspirate, but other methods such as lymph node aspiration or blood concentration techniques are needed less often.…”