Images in Clinical Medicine

African Trypanosomiasis in Australia

Susan Maddocks, M.B., B.S., D.T.M.H., and Rowan O'Brien, B.Sc.

N Engl J Med 2000; 342:1254April 27, 2000

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Figure 1 The day after returning to Australia from a four-week trip to East Africa, a 30-year-old woman began to have fevers, rigors, and a severe headache. Routine hematologic and biochemical studies were normal, a urine culture was negative, and a peripheral-blood film for malaria was negative. The symptoms persisted, and nausea, vomiting, and myalgia developed. A second peripheral-blood film for malaria was also negative. On examination, the patient had a fever (temperature, 39.5°C), tachycardia, and postural hypotension. The spleen was palpable 1 cm below the costal margin, and there was a macular, erythematous lesion on her inner right thigh that measured 5 by 6 cm and was not tender (Panel A). She did not have lymphadenopathy. Although the patient had had many insect bites while in Africa, none were particularly painful, and she did not recall being bitten at the site of the skin lesion. Examination of another peripheral-blood film revealed the motile parasites of Trypanosoma brucei rhodesiense (Panel B; Giemsa stain, ×1250). Treatment with pentamidine was begun, pending the arrival of suramin from South Africa. Anemia, thrombocytopenia, hypoxia associated with widespread lung infiltrates, and coagulopathy consistent with the presence of disseminated intravascular coagulation subsequently developed, and the results of liver-function tests were abnormal. Analysis of cerebrospinal fluid, however, was normal, with no trypanosomes. Treatment with suramin was started within three days after admission. The patient's symptoms rapidly resolved, and she was discharged on day 7.

Susan Maddocks, M.B., B.S., D.T.M.H.
Rowan O'Brien, B.Sc.
Westmead Hospital, Sydney, NSW, Australia

Citing Articles (5)

Citing Articles

1. 1

   Stephanie J. Migchelsen, Philippe Büscher, Andy I.M. Hoepelman, Henk D.F.H. Schallig, Emily R. Adams. (2011) Human African trypanosomiasis: a review of non-endemic cases in the past 20 years. International Journal of Infectious Diseases 15:8, e517-e524
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2. 2

   DAVID WEEDON, GEOFFREY STRUTTON, ADAM I RUBIN. 2010. Protozoal infections. , 633-639.
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3. 3

   2010. 27 Protozoal infections. , 539-545.
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4. 4

   Jonathan D. Darby, Martin G.P. Huber, Willi L. Sieling, Denis W. Spelman. (2008) African Trypanosomiasis in Two Short-Term Australian Travelers to Malawi. Journal of Travel Medicine 15:5, 375-377
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5. 5

   D. Ripamonti, M. Massari, A. Claudio, G. Ermanno, F. Claudio, M. Brini, C. Capatti, F. Suter. (2002) African Sleeping Sickness in Tourists Returning from Tanzania: The First 2 Italian Cases from a Small Outbreak among European Travelers. Clinical Infectious Diseases 34:1, e18-e22
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