Two unrelated professional hunters in different locations in a concession area in the Luangwa Valley in Eastern Province, Zambia (both at game management areas close to the South Luangwa National Park) presented to a hospital in Lusaka with an acute febrile illness with rapidly progressive renal and hepatic dysfunction associated with profound thrombocytopenia.
Malaria rapid tests were negative, but trypanosomiasis was suspected as a result of a history of tsetse fly bites in an area where East African trypanosomiasis has been well described, a negative malaria rapid test, and no response to empiric antimalarial self-treatment. Neither patient had a characteristic trypanosomal chancre.
The first patient began to have symptoms began on August 21st; these included poor sleep, headaches, fever, and painful lymph nodes. He presented to a hospital in Lusaka on August 24th where he was diagnosed with African trypanosomiasis on a blood smear. Treatment with fexinidazole was commenced on August 25th. He remains on fexinidazole and continues to improve.
The second patient began to have fevers, headaches and myalgias on August 21st. He noticed a bite on his arm and commenced empiric self-administered malaria treatment. Ongoing symptoms prompted transfer and admission to a Lusaka hospital on August 25th where he was diagnosed with East African trypanosomiasis complicated by renal and hepatic dysfunction. Fexinidazole was commenced.
Both patients were transferred by air ambulance to a Johannesburg ICU for further treatment on August 27th. The second patient has required ongoing dialysis for renal failure. In this patient fexinidazole was stopped temporarily (not recommended if glomerular filtrate rate is < 30mL/min since the processing and clearance levels are unknown in severe renal failure) and suramin was started in the interim with modification of the dose and dosing interval. Both patients are progressing well.
Before independence, Northern Rhodesia (now Zambia) had an active tsetse fly control program that led to the near complete interruption of transmission of East African trypanosomiasis. These programs were not continued after independence and recent decades have seen sporadic cases among Zambians (especially hunters in rural areas of the Luangwa Valley and Zambezi River basin) and travelers. GeoSentinel has previously identified cases of East African trypanosomiasis in travelers to Zambia including three in 2019 and one in September 2025. Travelers and expatriates planning to spend time in rural areas of the country including the North and South Luangwa National Park must be aware of the risk and take measures to avoid tsetse fly bites.
Reported by GeoSentinel – JNB site including Drs. Lucille Blumberg, Evan Shoul, and Albie de Frey.
EVENTS
FAQ
Two unrelated professional hunters in different locations in a concession area in the Luangwa Valley in Eastern Province, Zambia (both at game management areas close to the South Luangwa National Park) presented to a hospital in Lusaka with an acute febrile illness with rapidly progressive renal and hepatic dysfunction associated with profound thrombocytopenia.
Malaria rapid tests were negative, but trypanosomiasis was suspected as a result of a history of tsetse fly bites in an area where East African trypanosomiasis has been well described, a negative malaria rapid test, and no response to empiric antimalarial self-treatment. Neither patient had a characteristic trypanosomal chancre.
The first patient began to have symptoms began on August 21st; these included poor sleep, headaches, fever, and painful lymph nodes. He presented to a hospital in Lusaka on August 24th where he was diagnosed with African trypanosomiasis on a blood smear. Treatment with fexinidazole was commenced on August 25th. He remains on fexinidazole and continues to improve.
The second patient began to have fevers, headaches and myalgias on August 21st. He noticed a bite on his arm and commenced empiric self-administered malaria treatment. Ongoing symptoms prompted transfer and admission to a Lusaka hospital on August 25th where he was diagnosed with East African trypanosomiasis complicated by renal and hepatic dysfunction. Fexinidazole was commenced.
Both patients were transferred by air ambulance to a Johannesburg ICU for further treatment on August 27th. The second patient has required ongoing dialysis for renal failure. In this patient fexinidazole was stopped temporarily (not recommended if glomerular filtrate rate is < 30mL/min since the processing and clearance levels are unknown in severe renal failure) and suramin was started in the interim with modification of the dose and dosing interval. Both patients are progressing well.
Before independence, Northern Rhodesia (now Zambia) had an active tsetse fly control program that led to the near complete interruption of transmission of East African trypanosomiasis. These programs were not continued after independence and recent decades have seen sporadic cases among Zambians (especially hunters in rural areas of the Luangwa Valley and Zambezi River basin) and travelers. GeoSentinel has previously identified cases of East African trypanosomiasis in travelers to Zambia including three in 2019 and one in September 2025. Travelers and expatriates planning to spend time in rural areas of the country including the North and South Luangwa National Park must be aware of the risk and take measures to avoid tsetse fly bites.
Reported by GeoSentinel – JNB site including Drs. Lucille Blumberg, Evan Shoul, and Albie de Frey.