Last reviewed: November 2017
Last updated: September  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • previous stay in rural west and central Africa (T b gambiense)
  • previous stay in game parks in east and southern Africa (T b rhodesiense)
  • enlarged cervical lymph nodes/Winterbottom's sign (T b gambiense)
  • chancre (T b rhodesiense)
  • disturbances of consciousness and sleep

Other diagnostic factors

  • hx of several treatments against malaria with no improvement
  • headache
  • fever
  • fatigue and general malaise
  • women: history of infertility, menstrual disorders, high miscarriage rate
  • men: reduced libido, impotence
  • pruritus
  • oedema
  • impaired motor functions
  • mental changes
  • signs of cardiac failure (T b rhodesiense)
  • rash
  • hepatosplenomegaly
  • sensory disorders

Risk factors

  • exposure to tsetse fly
  • living or working in an area with people infected with Gambiense trypanosomiasis
  • living or working in an area with animals infected with Rhodesiense trypanosomiasis

Diagnostic investigations

1st investigations to order

  • FBC
  • ESR
  • serum immunoglobulins
  • card agglutination test for trypanosomiasis (CATT)
  • rapid diagnostic tests
  • immunofluorescence
  • ELISA
  • chancre aspirate microscopy
  • lymph node aspirate microscopy
  • blood microscopy
  • microhaematocrit centrifugation technique
  • quantitative buffy coat technique
  • mini-anion exchange centrifugation technique (mAECT)
Full details

Investigations to consider

  • ECG
  • CSF WBC count
  • CSF microscopy
  • double centrifugation of CSF
  • modified single centrifugation of CSF
  • CSF protein
Full details

Emerging tests

  • PCR
  • intrathecal immunoglobulin production
  • stage biomarkers
  • immune trypanolysis
  • MRI of brain
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Director of Research

Institut de Recherche pour le Développement

Montpellier

France

Disclosures

VL is an author of several references cited in this monograph. VL declares that he has no competing interests.

Medical Officer

Control of Neglected Tropical Diseases

Human African Trypanosomiasis Control Program

World Health Organization

Geneva

Switzerland

Disclosures

JRF is an author of several references cited in this monograph. JRF declares that he has no competing interests.

Former head of WHO HAT control and surveillance programme

WHO temporary advisor

World Health Organization

Geneva

Switzerland

Disclosures

PPS is an author of several references cited in this monograph.

Peer reviewers VIEW ALL

Professor of Molecular Parasitology and Medicine

Centre for Infection

Division of Cellular and Molecular Medicine

St. George's

University of London

London

UK

Disclosures

SK is a consultant for the Foundation for Innovative Diagnostics, a non-profit organization developing diagnostics for neglected diseases such as HAT. SK is an author of a reference cited in this monograph.

Professor

Division of Infection and Immunity

Institute of Biomedical and Life Sciences

The Glasgow Biomedical Research Centre

University of Glasgow

Glasgow

UK

Disclosures

MB declares that he has no competing interests.

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