Lucille Blumberg at the Johannesburg GeoSentinel® site has reported a case of East African trypanosomiasis, confirmed on peripheral blood smear, in a 52-year-old male tourist who visited South Luangwa National Park, Zambia. This case has been posted as a ProMed mail. He stayed in a number of lodges over a 14-day period, and received numerous tsetse fly bites. Ten days after entering the Park, he developed an acute progressive febrile illness, received antibiotics for suspected infected insect bites, and was airlifted to a hospital in Johannesburg, South Africa, for diagnosis and management. A typical trypanosomal chancre was observed (see attached) and a peripheral blood smear showed numerous trypomatigotes of Trypanosoma brucei rhodesiense. There was laboratory evidence of leukopenia, moderate thrombocytopenia, liver dysfunction with raised transaminases and bilirubin, and mild renal dysfunction. Suramin was obtained from a strategic supply (provided by WHO) held in Johannesburg and commenced after an initial test dose was well tolerated. The patient has responded very well to treatment and all haematological and biochemical abnormalities have resolved. The examination of the CSF did not reveal any evidence of CNS involvement. The patient will complete a full course of suramin. Travelers intending to visit Zambia and other African safari areas should be advised on arthropod bite prevention, in particular tsetse fly bites. Skin repellents are not effective against the tsetse fly (as she is attracted by motion and color rather than by olfactory cues) and impregnated clothing should be recommended.
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Lucille Blumberg at the Johannesburg GeoSentinel® site has reported a case of East African trypanosomiasis, confirmed on peripheral blood smear, in a 52-year-old male tourist who visited South Luangwa National Park, Zambia. This case has been posted as a ProMed mail. He stayed in a number of lodges over a 14-day period, and received numerous tsetse fly bites. Ten days after entering the Park, he developed an acute progressive febrile illness, received antibiotics for suspected infected insect bites, and was airlifted to a hospital in Johannesburg, South Africa, for diagnosis and management. A typical trypanosomal chancre was observed (see attached) and a peripheral blood smear showed numerous trypomatigotes of Trypanosoma brucei rhodesiense. There was laboratory evidence of leukopenia, moderate thrombocytopenia, liver dysfunction with raised transaminases and bilirubin, and mild renal dysfunction. Suramin was obtained from a strategic supply (provided by WHO) held in Johannesburg and commenced after an initial test dose was well tolerated. The patient has responded very well to treatment and all haematological and biochemical abnormalities have resolved. The examination of the CSF did not reveal any evidence of CNS involvement. The patient will complete a full course of suramin. Travelers intending to visit Zambia and other African safari areas should be advised on arthropod bite prevention, in particular tsetse fly bites. Skin repellents are not effective against the tsetse fly (as she is attracted by motion and color rather than by olfactory cues) and impregnated clothing should be recommended.