title: Human African trypanosomiasis with 7-year incubation period: clinical, laboratory and neuroimaging findings.
abstract: Human African trypanosomiasis (HAT), also referred to as "sleeping sickness", is caused by the parasite Trypanosoma brucei. Diagnosing imported HAT outside endemic areas is difficult and diagnosis is often delayed. We report a case of imported human African trypanosomiasis caused by Trypanosoma brucei gambiense with an unusually long incubation period of at least 7 years. A 33 year old male African patient, a former resident of Cameroon, presented with a 4-month history of progressive personality changes. A few weeks before presentation the patient had first been admitted to a psychiatric ward and received antidepressant treatment, until a lumbar puncture showed pleocytosis and then antibiotic treatment for suspected neuroborreliosis was initiated. The patient continued to deteriorate during antibiotic treatment and became increasingly lethargic. Under antiparasitic and anti-inflammatory treatment, the condition of the patient gradually improved over the following months and he recovered completely after 24 months of follow-up. This well-documented case illustrates typical difficulties in establishing the correct diagnosis outside endemic areas and provides an overview of typical clinical, neuropathological and neuroimaging findings in T. b. gambiense trypanosomiasis, guiding the clinician in establishing the correct diagnosis in this rare disease.
authors.affiliation: Department of Neurology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: oliver.wengert@charite.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Wengert
authors.affiliation: Department of Neurology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: marcel.kopp@charite.de.
authors.forename: Marcel
authors.initials: M
authors.lastname: Kopp
authors.affiliation: Department of Neuroradiology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: eberhard.siebert@charite.de.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Siebert
authors.affiliation: Department of Neuropathology, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: werner.stenzel@charite.de.
authors.forename: Werner
authors.initials: W
authors.lastname: Stenzel
authors.affiliation: Bernhard Nocht Institute for Tropical Medicine, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany. Electronic address: guido.hegasy@hu.hamburg.de.
authors.forename: Guido
authors.initials: G
authors.lastname: Hegasy
authors.affiliation: Department of Infectious Diseases and Respiratory Medicine, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: norbert.suttorp@charite.de.
authors.forename: Norbert
authors.initials: N
authors.lastname: Suttorp
authors.affiliation: Department of Tropical Medicine, Medical Faculty, University of Würzburg, 97074 Würzburg, Germany. Electronic address: august.stich@mail.uni-wuerzburg.de.
authors.forename: August
authors.initials: A
authors.lastname: Stich
authors.affiliation: Department of Infectious Diseases and Respiratory Medicine, Charité, Charitéplatz 1, 10117 Berlin, Germany. Electronic address: thomas.zoller@charite.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zoller
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002163:Cameroon; D000518:Eflornithine / Q000627:therapeutic use; D005858:Germany; D006801:Humans; D008297:Male; D059906:Neuroimaging; D016896:Treatment Outcome; D014344:Trypanocidal Agents / Q000627:therapeutic use; D014347:Trypanosoma brucei gambiense / Q000302:isolation & purification*; D014353:Trypanosomiasis, African / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology
chemical_list: D000893:Anti-Inflammatory Agents; D014344:Trypanocidal Agents; D000518:Eflornithine
keywords: Cerebrospinal fluid; Chronic encephalitis; Human African trypanosomiasis; Magnetic resonance imaging; Sleeping sickness; Trypanosoma brucei gambiense; Trypanosomiasis