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. CASE PRESENTATION: 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. RECOMMENDATIONS: 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.