Martin Grobusch and Bram Goorhuis from the Amsterdam GeoSentinel® site have reported a case of human African trypanosomiasis (HAT) in a 58-year old Caucasian man, 2 days after returning from a 12-day trip to Tanzania [3-14 May 2017]. He had travelled in a group of high school teachers and students, consisting of 3 adult teachers (including the patient) and 12 children aged between 15 and 17 years. The group had arrived in Tanzania on 3 May 2017 (Dar-Es-Salaam) and then traveled to Mwanza on 4 May 2017. On 5 May 2017, the group made a safari trip from Mwanza to the northwestern part of the Serengeti National Park (between Ndabaka Gate and Kirawira 2 Special Camp) returning to Mwanza the same day. They stayed in Mwanza from 6 – 9 May 2017 and made another car trip to the direct south of Mwanza on 10 May 2017. They remained in Mwanza until their return to Dar-Es-Salaam on 13 May 2017. The group returned in Netherlands on 14 May 2017. All the members of the group used malaria chemoprophylaxis as recommended. Before returning to The Netherlands, on 12 May 2017, the patient felt tired and on that day, he first noticed a swelling on the calf muscle of his left leg. During the return flight to The Netherlands on the night from 13 to 14 May 2017, he developed spiking fevers and chills. On 16 May 2017, his general practitioner referred him to the Gelre Hospital in Apeldoorn, the Netherlands, to rule out malaria. The thick blood smear showed no plasmodia, but moving structures, diagnosed as Trypanosoma brucei, upon which the patient was transferred to The Academic Medical Center (AMC) in Amsterdam for further diagnosis and treatment. Upon admission, he mentioned that he had suffered several insect bites, but did not recall a specific type of insect. He felt tired, but had no other specific complaints. Upon physical examination, he was not acutely ill, with a temperature of 38.4 deg C [approx. 101 deg F]. A sharply marked dark red colored inoculation chancre was present on the calf muscle of his left leg (3 x 3,5 cm). There were no clinical symptoms or signs of CNS involvement. Laboratory tests showed normal hemoglobin (8.7 mmol/l), thrombocytopenia (56 x 109/l) and leukopenia (2.0 x 109/l), with left-shift. ALAT (59 IU/l) and LDH (436 U/l) were slightly elevated, other liver enzymes were within normal range. Serum creatinine was normal (93 micromol/l). Thick and thin blood smear, as well as quantitative buffy coat examination all showed living trypanosomes. Additional molecular tests are pending. Lumbar puncture did not show a cell reaction and no trypanosomes were observed. The diagnosis of HAT by Trypanosoma brucei rhodesiense, in the early hematolymphatic stage, was made. A collaborate effort of many tropical medicine specialists, present at the 15th CISTM in Barcelona, Spain, led to rapid identification of available stock of the required treatment drug suramin, at the Swiss Tropical Institute in Basel, which was quickly dispatched within 12 hours to Amsterdam by Dr. Hatz and his team. Please be alert to possible HAT cases. This case has been posted on ProMed. Intending travelers, particularly safari groups, should be advised to use meticulous insect protection measures particularly impregnated waist and ankle length clothing. The tsetse fly is attracted by movement and color (especially blue) and skin repellents provide only partial protection.
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Martin Grobusch and Bram Goorhuis from the Amsterdam GeoSentinel® site have reported a case of human African trypanosomiasis (HAT) in a 58-year old Caucasian man, 2 days after returning from a 12-day trip to Tanzania [3-14 May 2017]. He had travelled in a group of high school teachers and students, consisting of 3 adult teachers (including the patient) and 12 children aged between 15 and 17 years. The group had arrived in Tanzania on 3 May 2017 (Dar-Es-Salaam) and then traveled to Mwanza on 4 May 2017. On 5 May 2017, the group made a safari trip from Mwanza to the northwestern part of the Serengeti National Park (between Ndabaka Gate and Kirawira 2 Special Camp) returning to Mwanza the same day. They stayed in Mwanza from 6 – 9 May 2017 and made another car trip to the direct south of Mwanza on 10 May 2017. They remained in Mwanza until their return to Dar-Es-Salaam on 13 May 2017. The group returned in Netherlands on 14 May 2017. All the members of the group used malaria chemoprophylaxis as recommended. Before returning to The Netherlands, on 12 May 2017, the patient felt tired and on that day, he first noticed a swelling on the calf muscle of his left leg. During the return flight to The Netherlands on the night from 13 to 14 May 2017, he developed spiking fevers and chills. On 16 May 2017, his general practitioner referred him to the Gelre Hospital in Apeldoorn, the Netherlands, to rule out malaria. The thick blood smear showed no plasmodia, but moving structures, diagnosed as Trypanosoma brucei, upon which the patient was transferred to The Academic Medical Center (AMC) in Amsterdam for further diagnosis and treatment. Upon admission, he mentioned that he had suffered several insect bites, but did not recall a specific type of insect. He felt tired, but had no other specific complaints. Upon physical examination, he was not acutely ill, with a temperature of 38.4 deg C [approx. 101 deg F]. A sharply marked dark red colored inoculation chancre was present on the calf muscle of his left leg (3 x 3,5 cm). There were no clinical symptoms or signs of CNS involvement. Laboratory tests showed normal hemoglobin (8.7 mmol/l), thrombocytopenia (56 x 109/l) and leukopenia (2.0 x 109/l), with left-shift. ALAT (59 IU/l) and LDH (436 U/l) were slightly elevated, other liver enzymes were within normal range. Serum creatinine was normal (93 micromol/l). Thick and thin blood smear, as well as quantitative buffy coat examination all showed living trypanosomes. Additional molecular tests are pending. Lumbar puncture did not show a cell reaction and no trypanosomes were observed. The diagnosis of HAT by Trypanosoma brucei rhodesiense, in the early hematolymphatic stage, was made. A collaborate effort of many tropical medicine specialists, present at the 15th CISTM in Barcelona, Spain, led to rapid identification of available stock of the required treatment drug suramin, at the Swiss Tropical Institute in Basel, which was quickly dispatched within 12 hours to Amsterdam by Dr. Hatz and his team. Please be alert to possible HAT cases. This case has been posted on ProMed. Intending travelers, particularly safari groups, should be advised to use meticulous insect protection measures particularly impregnated waist and ankle length clothing. The tsetse fly is attracted by movement and color (especially blue) and skin repellents provide only partial protection.