Orchitis as an unusual manifestation of human African trypanosomiasis

Ehrhardt, Stephan; Burchard, Gerd; Sudeck, Hinrich

doi:10.1016/j.jinf.2005.04.018

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…Trypanosomes may potentially be seen in CSF if parasite load is high during the second stage of disease [ 8 ]. Examination of bone marrow is of low yield in detecting trypanosomes [ 6 ], and bone marrow smear as a means of diagnosis is rare [ 9 , 10 ]. Polyclonal activation of B cells is a hallmark of HAT, resulting in elevated IgG and IgM levels, as well as false-positive antibodies for pathogens, and autoantibodies [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Wandering Missionary’s Burden: Persistent Fever and Progressive Somnolence in a Returning Traveler

Yagnik

Pezo-Salazar

Rosenbaum

et al. 2021

Open Forum Infectious Diseases

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Human African trypanosomiasis incidence has declined, but diagnosis remains difficult, especially in nonendemic areas. Our patient presented with fever, progressive lethargy, and weight loss for 5 months and had previously traveled to Ghana and Cameroon but had not been to areas with recently reported African trypanosomiasis. Extensive workup was negative, except for lymphocytic pleocytosis in cerebrospinal fluid; ultimately, a bone marrow aspiration revealed necrotizing granulomatous inflammation with 2 trypanosomes discovered on the aspirate smear, consistent with Trypanosoma brucei. The patient was treated with combination nifurtimox and eflornithine with full recovery.

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Section: Discussionmentioning

confidence: 99%

A Wandering Missionary’s Burden: Persistent Fever and Progressive Somnolence in a Returning Traveler

Yagnik

Pezo-Salazar

Rosenbaum

et al. 2021

Open Forum Infectious Diseases

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“…gambiense infection in humans has been associated with various reproductive disorders including amenorrhoea, infertility, spontaneous abortions and impotence [ 8 , 41 ], which have previously been attributed to parasite invasion of the CNS [ 42 ]. In addition, a single case of orchitis as a symptom of HAT has been reported [ 43 ]. In light of the present study, it is necessary to examine whether the presence of parasites in the reproductive organs themselves contributes to these pathologies.…”

Section: Discussionmentioning

confidence: 99%

Trypanosoma brucei gambiense Infections in Mice Lead to Tropism to the Reproductive Organs, and Horizontal and Vertical Transmission

et al. 2016

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Trypanosoma brucei gambiense, transmitted by the tsetse fly, is the main causative agent of Human African trypanosomosis in West Africa and poses a significant health risk to 70 million people. Disease progression varies depending on host immunity, but usually begins with a haemo-lymphatic phase, followed by parasite invasion of the central nervous system.In the current study, the tropism of T. b. gambiense 1135, causing a low level chronic ‘silent’ infection, was monitored in a murine model using bioluminescence imaging and PCR. A tropism to the reproductive organs, in addition to the central nervous system, after 12–18 months of infection was observed. Bioluminescent analysis of healthy females crossed with infected males showed that 50%, 62.5% and 37.5% of the female mice were subsequently positive for parasites in their ovaries, uteri and brain respectively. Although PCR confirmed the presence of parasites in the uterus of one of these mice, the blood of all mice was negative by PCR and LAMP. Subsequently, bioluminescent imaging of the offspring of infected female mice crossed with healthy males indicated parasites were present in the reproductive organs of both male (80%) and female (60%) offspring.These findings imply that transmission of T. b. gambiense 1135 occurs horizontally, most probably via sexual contact, and vertically in a murine model, which raises the possibility of a similar transmission in humans. This has wide reaching implications. Firstly, the observations made in this study are likely to be valid for wild animals acting as a reservoir for T. b. gambiense. Also, the reproductive organs may act as a refuge for parasites during drug treatment in a similar manner to the central nervous system. This could leave patients at risk of a relapse, ultimately allowing them to act as a reservoir for subsequent transmission by tsetse and possibly, horizontally and vertically.

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“…2) sowie bei unklarer neurologischer oder psychiatrischer Erkrankung. Nach Deutschland wurden seit dem Jahr 2000 3 Fälle der Ostafrikanischen und 2 Fälle der Westafrikanischen Schlafkrankheit importiert und der WHO gemeldet [4][5][6][7][8]. Im Juni 2019 erkrankte eine 19-jährige Deutsche in Sambia an der ostafrikanischen Form nach einem Besuch im Luangwa National Park [9].…”

Section: Seltene Aber Wichtige Differenzialdiagnoseunclassified

Fexinidazol zur oralen Therapie der Westafrikanischen Schlafkrankheit: wesentliche Änderungen für die klinische Praxis

Lindner

Stich

2020

Flug u Reisemed

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ZUSAMMENFASSUNGDie Schlafkrankheit (Afrikanische Trypanosomiasis) führt ohne Behandlung in der Regel zum Tod. Mit Fexinidazol steht eine rein orale Monotherapie für die westafrikanische Form zur Verfügung, welche von der Europäischen Arzneimittel-Agentur im November 2018 positiv bewertet wurde. Im August 2019 veröffentlichte die Weltgesundheitsorganisation eine neue Therapieleitlinie. Fexinidazol wird als Erstlinientherapie für die Westafrikanische Schlafkrankheit im Stadium I und im Stadium II bei < 100 Leukozyten/µl im Liquor für Patienten ≥ 6 Jahre und ≥ 20 kg empfohlen. NECT (nifurtimox-eflornithine combination therapy) ist weiterhin Erstlinientherapie für Patienten mit ≥ 100 Leukozyten/µl im Liquor – neu definiert als schweres Stadium II. Fexinidazol ist in diesem Stadium deutlich weniger effektiv. Ohne den klinischen Verdacht auf ein schweres Stadium II kann auf eine Lumbalpunktion verzichtet und eine Therapie mit Fexinidazol unter Beaufsichtigung der Einnahme durchgeführt werden.

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Orchitis as an unusual manifestation of human African trypanosomiasis

Cited by 7 publications

References 5 publications

A Wandering Missionary’s Burden: Persistent Fever and Progressive Somnolence in a Returning Traveler

A Wandering Missionary’s Burden: Persistent Fever and Progressive Somnolence in a Returning Traveler

Trypanosoma brucei gambiense Infections in Mice Lead to Tropism to the Reproductive Organs, and Horizontal and Vertical Transmission

Fexinidazol zur oralen Therapie der Westafrikanischen Schlafkrankheit: wesentliche Änderungen für die klinische Praxis

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