African trypanosomiasis in a British soldier.
BACKGROUND
Sleeping sickness (human African trypanosomiasis) is a parasitic infection transmitted by day-biting tsetse flies. The diagnostic standard is microscopy of blood, lymph node aspirates, or cerebrospinal fluid. The disease is invariably fatal if not treated. There are >300,000 new cases of sleeping sickness each year and approximately 100,000 deaths.


METHODS
We describe a British soldier who acquired sleeping sickness in Malawi. He gave no history of a painful insect bite but presented with classic early signs of sleeping sickness (a primary chancre, regional lymphadenopathy, circinate erythema, and a cyclical fever pattern). His condition worsened in the next week, and trypanosomes were observed in a blood sample. The patient was aeromedically evacuated to Johannesburg, where stage 1 Trypanosoma brucei rhodesiense infection was confirmed; he also had renal and liver failure, pancytopenia, and heart block. He was treated with intravenously administered suramin, and he recovered fully over the next 5 months.


CONCLUSIONS
Medical officers deploying to eastern and southeastern Africa must be familiar with the common presenting signs and symptoms of T. b. rhodesiense sleeping sickness and should have 24-hour access to a reliable, local, clinical microscopy service. Confirmed sleeping sickness requires immediate transfer to a tertiary diagnostic and treatment center, where suramin (for T. b. rhodesiense infection), pentamidine (for Trypanosoma brucei gambiense infection), and melarsoprol (for stage 2 disease) must be immediately available.
Croft
Ashley M
AM
Headquarters Fifth Division, Shrewsbury, United Kingdom.
Kitson
Martin M
MM
Jackson
Christopher J
CJ
Minton
Elizabeth J
EJ
Friend
Howard M
HM
D000328:Adult; D000818:Animals; D006801:Humans; D008295:Malawi; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D010272:Parasitic Diseases; D013498:Suramin / Q000627:therapeutic use; D016833:Trypanosoma brucei rhodesiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000188:drug therapy; D006113:United Kingdom
D013498:Suramin