Tripanossomíase africana
Resumen
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- estadia anterior na África rural ocidental e central (Trypanosoma brucei gambiense)
- estadia prévia em reservas de caça na África oriental e meridional (T b rhodesiense)
- linfonodos cervicais aumentados/sinal de Winterbottom (T b gambiense)
- cancro (T b rhodesiense)
- distúrbios da consciência e do sono
Other diagnostic factors
- história de vários tratamentos contra a malária, porém, sem melhora
- cefaleia
- febre
- fadiga e mal-estar geral
- história de infertilidade, transtornos menstruais, alto índice de aborto espontâneo (mulheres)
- libido reduzida, impotência (homens)
- prurido
- edema
- comprometimento das funções motoras
- alterações mentais
- sinais de insuficiência cardíaca (T b rhodesiense)
- erupção cutânea
- hepatoesplenomegalia
- distúrbios sensoriais
Risk factors
- exposição à mosca tsé-tsé
- morar ou trabalhar em áreas com pessoas infectadas com tripanossomíase gambiense
- morar ou trabalhar em áreas com animais infectados com tripanossomíase rhodesiense
Diagnostic tests
1st tests to order
- hemograma completo
- velocidade de hemossedimentação
- imunoglobulinas (Ig) séricas
- testes diagnósticos rápidos
- teste de aglutinação em cartão para tripanossomíase (CATT)
- imunofluorescência
- ensaio de imunoadsorção enzimática (ELISA)
- microscopia do aspirado do cancro de inoculação
- microscopia do aspirado de linfonodos
- microscopia do sangue
- técnica de centrifugação de micro-hematócrito
- quantitative buffy coat technique
- técnica de centrifugação de minitroca de ânion (mAECT)
Tests to consider
- eletrocardiograma
- celularidade do líquido cefalorraquidiano (LCR)
- microscopia do LCR
- centrifugação dupla do LCR
- centrifugação única modificada de LCR
- nível de proteína no LCR
Emerging tests
- reação em cadeia da polimerase
- reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real
- produção de imunoglobulina intratecal
- biomarcadores de estágios
- teste imunológico de tripanólise
- ELISA de inibição de T b gambiense (g-iELISA)
- ressonância nuclear magnética (RNM) cranioencefálica
Treatment algorithm
tripanossomíase humana africana (THA) gambiense
tripanossomíase africana humana (THA) rhodesiense
recidiva
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 topic. VL declares that she 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 topic. 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 topic.
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 organisation developing diagnostics for neglected diseases such as HAT. SK is an author of a reference cited in this topic.
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
World Health Organization. Guidelines for the treatment of human African trypanosomiasis. Jun 2024 [internet publication].Full text
Centers for Disease Control and Prevention. Clinical care of human African trypanosomiasis. Apr 2024 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Malária
- Febre tifoide
- Febre recorrente
More DifferentialsGuidelines
- Guidelines for the treatment of human African trypanosomiasis
- Clinical care of human African trypanosomiasis
More Guidelines
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