African trypanosomiasis
Summary
Definition
History and exam
Key diagnostic 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 sign (T b gambiense)
- chancre (T b rhodesiense)
- disturbances of consciousness and sleep
Other diagnostic factors
- history of several treatments against malaria with no improvement
- headache
- fever
- fatigue and general malaise
- history of infertility, menstrual disorders, high miscarriage rate (women)
- reduced libido, impotence (men)
- pruritus
- edema
- 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
- complete blood count
- erythrocyte sedimentation rate
- serum immunoglobulins
- card agglutination test for trypanosomiasis (CATT)
- rapid diagnostic tests
- immunofluorescence
- ELISA
- chancre aspirate microscopy
- lymph node aspirate microscopy
- blood microscopy
- microhematocrit centrifugation technique
- quantitative buffy coat technique
- mini-anion exchange centrifugation technique (mAECT)
Investigations to consider
- electrocardiogram
- cerebrospinal fluid (CSF) white blood cell (WBC) count
- CSF microscopy
- double centrifugation of CSF
- modified single centrifugation of CSF
- CSF protein
Emerging tests
- polymerase chain reaction (PCR)
- intrathecal immunoglobulin production
- stage biomarkers
- immune trypanolysis
- MRI brain
Treatment algorithm
T b gambiense infection
T b rhodesiense infection
Contributors
Authors
Veerle Lejon, PhD
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.
José Ramón Franco, MD, MPH
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.
Pere P. Simarro, MD, PhD
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
Sanjeev Krishna, MA (Cantab), BMChB (Oxon), DPhil, FRCP, ScD (Cantab), FMedSci
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.
Mike Barrett, BSc, PhD
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.
Differentials
- Malaria infection
- Typhoid fever
- Relapsing fever
More DifferentialsGuidelines
- CDC yellow book: infectious diseases related to travel - trypanosomiasis, African (sleeping sickness)
- Parasites - African trypanosomiasis (also known as sleeping sickness), resources for health professionals: diagnosis and treatment
More Guidelines
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