Correspondence

Laboratory-Acquired Gambian Trypanosomiasis

N Engl J Med 1993; 329:209-210July 15, 1993

Article

To the Editor:

Gambian trypanosomiasis is rarely reported to result from a needle stick in the laboratory. We report such a case. On March 5, 1992, a 50-year-old laboratory technician accidentally stuck her left hand with a needle containing Trypanosoma gambiense (strain FEO ITMAP-1893) after inoculating two mice with the organism. The strain is not considered very pathogenic. Local disinfection was performed immediately.

The technician was asymptomatic until March 13, when she noted the abrupt onset of fever (temperature, 39 °C). Two days later, the thenar region of her left hand became erythematous, warm, and swollen. Her temperature rose to 40 °C. On March 16, examination revealed a tender 1-cm left axillary lymph node and splenomegaly.

A complete blood count included a white-cell count of 2100 per cubic millimeter, with 1230 neutrophils, 603 lymphocytes, and 248 monocytes. There was also thrombocytopenia (60,000 cells per cubic millimeter). Trypanosomes were isolated from the chancre. Peripheral-blood examination after leukocyte concentration was negative. Trypanosomes, however, were also obtained by concentrating a sample of blood on diethylaminoethyl cellulose. Indirect immunofluorescence was initially negative but became positive on March 23 at a titer of 1:50. A week later the titer was 1:500. Bacterial blood cultures were negative.

The cerebrospinal fluid cell count and proteins were normal. Inoculation of a mouse with the cerebrospinal fluid was negative. The patient received one dose of pentamidine (280 mg) by intramuscular injection on March 16. Therapy with eflornithine (400 mg per kilogram of body weight per day) was initiated and continued for 12 days. By March 19, the patient was afebrile. Asthenia persisted for four weeks. She is currently asymptomatic.

Accidental infection with T. cruzi is well known to occur in the laboratory,1 but it is less common with T. gambiense. T. gambiense FEO is a special strain; it was isolated in 1961 from a patient in Togo. The patient had had the infection for more than 20 years without any central nervous system manifestations. The strain was resistant to all trypanocidal drugs known at the time, including pentamidine2. This strain has been maintained in the laboratory through the inoculation of mice.

At the stage of illness seen in our patient, T. gambiense infection is usually treated with intravenous pentamidine or intravenous melarsoprol. Eflornithine is another treatment for this infection3 that is well tolerated.

M.C. Receveur, M.D.
M. Le Bras, Ph.D.
Hopital Saint Andre, 33075 Bordeaux, France

P. Vincendeau, Ph.D.
Universite de Bordeaux, 33076 Bordeaux, France

3 References

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   Brener Z. Laboratory-acquired Chagas disease: comment. Trans R Soc Trop Med Hyg 1987;81:527-527
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   Lapierre J, Coste M. Contribution a l'etude d'une souche de Trypanosoma gambiense (Feo) isolee d'un cas humain caracterise par une duree de plus de 20 ans de parasitemie cliniquement inappreciable. Ann Parasitol (Paris) 1963;38:757-782
   Medline

3. 3

   Doua F, Boa FY, Schechter PJ, et al. Treatment of human late stage gambiense trypanosomiasis with alpha-difluoromethylornithine (eflornithine): efficacy and tolerance in 14 cases in Cote d'Ivoire. Am J Trop Med Hyg 1987;37:525-533
   Web of Science | Medline

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