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African trypanosomiasis gambiense, Italy.

Bisoffi Z, Beltrame A, Monteiro G, Arzese A, Marocco S, Rorato G, Anselmi M, Viale P - Emerging Infect. Dis. (2005)

Bottom Line: We report 2 cases diagnosed in the summer of 2004.Theses cases suggest an increased risk for expatriates working in trypanosomiasis-endemic countries.Travel medicine clinics should be increasingly aware of this potentially fatal disease.

View Article: PubMed Central - PubMed

Affiliation: Centre for Tropical Diseases, Sacro Cuore Hospital of Negrar, Verona, Italy. zeno.bisoffi@sacrocuore.it

ABSTRACT
African trypanosomiasis caused by Trypanosoma brucei gambiense has not been reported in Italy. We report 2 cases diagnosed in the summer of 2004. Theses cases suggest an increased risk for expatriates working in trypanosomiasis-endemic countries. Travel medicine clinics should be increasingly aware of this potentially fatal disease.

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Related in: MedlinePlus

Trypomastigote (arrow) in a Giemsa-stained cerebrospinal fluid smear of patient 1 (original magnification ×1,000).
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Figure 1: Trypomastigote (arrow) in a Giemsa-stained cerebrospinal fluid smear of patient 1 (original magnification ×1,000).

Mentions: Upon examination, he was oriented but irritable and apyretic. He had a blood pressure of 110/70 mm Hg and a pulse rate of 104/min. Enlarged lymph nodes were found in the axillae, groin, supraclavicular region, and posterior neck triangle. The liver and spleen were enlarged (spleen diameter 20 cm by ultrasound). Neurologic examination showed walking ataxia, decreased sensitivity to light touch in both legs, and no deep tendon reflexes. Laboratory tests showed pancytopenia, an increased ESR, and hypergammaglobulinemia with increased levels of immunoglobulin M (IgM) (Table). Giemsa-stained blood films showed trypomastigotes. Lumbar puncture showed clear cerebrospinal fluid (CSF) with increased leukocyte counts, protein and IgM levels, and a low glucose level (Table). Trypanosomes were also found in the CSF (Figure 1). An indirect hemagglutination (IHA) test result was positive for T. brucei (titer 1:64). Second-stage sleeping sickness (stage 2 HAT) was diagnosed, but treatment with eflornithine (obtained from the World Health Organization [WHO]) could not be initiated until 9 days after the diagnosis because of getting medication through customs. In this 9-day period, daily peripheral blood smears were negative, except on day 5. The patient was then given a standard dose of eflornithine (100 mg/kg intravenously 4×/day for 14 days), and his condition improved rapidly, lymphadenopathy resolved, and neurologic status normalized within 2 weeks. Lumbar puncture on day 14 of treatment did not show any trypanosomes, and all CSF parameters improved. Repeat peripheral blood smears were also negative, and he was discharged. Two weeks later he was still healthy. He was advised to remain in Italy for further follow-up, but he went back to Gabon and has not provided any subsequent medical information.


African trypanosomiasis gambiense, Italy.

Bisoffi Z, Beltrame A, Monteiro G, Arzese A, Marocco S, Rorato G, Anselmi M, Viale P - Emerging Infect. Dis. (2005)

Trypomastigote (arrow) in a Giemsa-stained cerebrospinal fluid smear of patient 1 (original magnification ×1,000).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3367368&req=5

Figure 1: Trypomastigote (arrow) in a Giemsa-stained cerebrospinal fluid smear of patient 1 (original magnification ×1,000).
Mentions: Upon examination, he was oriented but irritable and apyretic. He had a blood pressure of 110/70 mm Hg and a pulse rate of 104/min. Enlarged lymph nodes were found in the axillae, groin, supraclavicular region, and posterior neck triangle. The liver and spleen were enlarged (spleen diameter 20 cm by ultrasound). Neurologic examination showed walking ataxia, decreased sensitivity to light touch in both legs, and no deep tendon reflexes. Laboratory tests showed pancytopenia, an increased ESR, and hypergammaglobulinemia with increased levels of immunoglobulin M (IgM) (Table). Giemsa-stained blood films showed trypomastigotes. Lumbar puncture showed clear cerebrospinal fluid (CSF) with increased leukocyte counts, protein and IgM levels, and a low glucose level (Table). Trypanosomes were also found in the CSF (Figure 1). An indirect hemagglutination (IHA) test result was positive for T. brucei (titer 1:64). Second-stage sleeping sickness (stage 2 HAT) was diagnosed, but treatment with eflornithine (obtained from the World Health Organization [WHO]) could not be initiated until 9 days after the diagnosis because of getting medication through customs. In this 9-day period, daily peripheral blood smears were negative, except on day 5. The patient was then given a standard dose of eflornithine (100 mg/kg intravenously 4×/day for 14 days), and his condition improved rapidly, lymphadenopathy resolved, and neurologic status normalized within 2 weeks. Lumbar puncture on day 14 of treatment did not show any trypanosomes, and all CSF parameters improved. Repeat peripheral blood smears were also negative, and he was discharged. Two weeks later he was still healthy. He was advised to remain in Italy for further follow-up, but he went back to Gabon and has not provided any subsequent medical information.

Bottom Line: We report 2 cases diagnosed in the summer of 2004.Theses cases suggest an increased risk for expatriates working in trypanosomiasis-endemic countries.Travel medicine clinics should be increasingly aware of this potentially fatal disease.

View Article: PubMed Central - PubMed

Affiliation: Centre for Tropical Diseases, Sacro Cuore Hospital of Negrar, Verona, Italy. zeno.bisoffi@sacrocuore.it

ABSTRACT
African trypanosomiasis caused by Trypanosoma brucei gambiense has not been reported in Italy. We report 2 cases diagnosed in the summer of 2004. Theses cases suggest an increased risk for expatriates working in trypanosomiasis-endemic countries. Travel medicine clinics should be increasingly aware of this potentially fatal disease.

Show MeSH
Related in: MedlinePlus