Clinical management of East African trypanosomiasis in South Africa: Lessons learned.

Abstract

BACKGROUND:

East African trypanosomiasis is an uncommon, potentially lethal disease if not diagnosed and treated in a timely manner. South Africa, as a centre for emergency medical evacuations from much of sub-Saharan Africa, receives a high proportion of these patients, mostly tourists and expatriate residents.

METHODS:

The cases of East African trypanosomiasis patients evacuated to South Africa, for whom diagnostic and clinical management advice was provided over the years 2004-2018, were reviewed, using the authors' own records and those of collaborating clinicians.

RESULTS:

Twenty-one cases were identified. These originated in Zambia, Malawi, Zimbabwe, Tanzania, and Uganda. Nineteen cases (90%) had stage 1 (haemolymphatic) disease; one of these patients had fatal myocarditis. Of the two patients with stage 2 (meningoencephalitic) disease, one died of melarsoprol encephalopathy. Common problems were delayed diagnosis, erroneous assessment of severity, and limited access to treatment.

CONCLUSIONS:

The key to early diagnosis is recognition of the triad of geographic exposure, tsetse fly bites, and trypanosomal chancre, plus good microscopy. Elements for successful management are rapid access to specific drug treatment, skilled intensive care, and good laboratory facilities. Clinical experience and the local stock of antitrypanosomal drugs from the World Health Organization have improved the chance of a successful outcome in the management of East African trypanosomiasis in South Africa; the survival rate over the period was 90.5%.

• Authors: John Frean, Willi Sieling, Hussein Pahad, Evan Shoul, Lucille Blumberg
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 75 Pg. 101-108 (Oct 2018) ISSN: 1878-3511 [Electronic] Canada
• PMID: 30153486 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Antiprotozoal Agents

Topics

• Adult
• Aged
• Animals
• Antiprotozoal Agents (therapeutic use)
• Female
• Humans
• Male
• Middle Aged
• South Africa
• Trypanosoma (drug effects, genetics, isolation & purification, physiology)
• Trypanosomiasis, African (diagnosis, drug therapy, parasitology)