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African Trypanosomiasis In A British Soldier
  1. Lt Col AM Croft, MA, MBBS, MSc, DMCC, DTM&H, FFPHM, RAMC, Commander Medical1,
  2. Col CJ Jackson, MBBS, MRCP, LRCS, DFFP, L/RAMC, Senior Medical Officer2,
  3. Dr HM Friend, MBBS, MRCGP, DCH, DRCOG, DTM, Regional Medical Officer for the British3 and
  4. Dr EJ Minton, FRCP, PhD, DTM&H, Consultant in Infection &Travel Medicine4
  1. 1Headquarters Fifth Division, Copthorne Barracks, Shrewsbury, Shropshire SY3 8LZ ashley.croft810{at}land.mod.uk
  2. 2Vimy Barracks Medical Centre, Scotton Road, Catterick, North Yorkshire DL9 3PS
  3. 3Foreign Office, British High Commission Clinic, P.O. Box 30042, Lilongwe, Malawi
  4. 4Infectious Diseases Department, St James’s University Hospital, Beckett Street, Leeds LS9 7TF

Abstract

Background Human African trypanosomiasis (sleeping sickness) is a parasitic infection transmitted by day-biting tsetse flies. The diagnostic gold standard is microscopy of blood, lymph node aspirates or CSF. The disease is invariably fatal, if not treated. There are over 300 000 new cases of sleeping sickness each year, and approximately 100,000 deaths.

Case presentation We describe a British soldier who acquired trypanosomiasis in Malawi. He gave no history of a painful insect bite but presented with classical 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. He was aeromedically evacuated to Johannesburg, where Stage One Trypanosoma brucei rhodesiense infection was confirmed; he also had renal and liver failure, pancytopenia and heart block. He was treated with intravenous suramin. 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 access to a reliable local microscopy service at all times. Confirmed sleeping sickness requires immediate transfer to a tertiary diagnostic and treatment centre, where suramin (for T b rhodesiense infection) or pentamidine (for T b gambiense) and also melarsoprol (for Stage Two disease) must be immediately available.

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