Weekend Digest
Peripheral blood smear of a woman from Guinea who presented with headache, itchy skin and lymphadenopathy (photo credit CDC)
Name the pathogen, its vector and its treatment.
Peripheral blood smear of a woman from Guinea who presented with headache, itchy skin and lymphadenopathy (photo credit CDC)
Name the pathogen, its vector and its treatment.
2/
#SleepingSickness due to #Trypanosoma brucei
Vector: Tsetse fly (Glossina sp)
Gambiense
- West and Central Africa (including Guinea, such as this case)
- 98% of cases
- More chronic presentation
Rhodesiense
- East Africa
- 2% of cases
- More acute presentation
#SleepingSickness due to #Trypanosoma brucei
Vector: Tsetse fly (Glossina sp)
Gambiense
- West and Central Africa (including Guinea, such as this case)
- 98% of cases
- More chronic presentation
Rhodesiense
- East Africa
- 2% of cases
- More acute presentation
3/
#Trypanosoma brucei #gambiense
1. Early: hemolymph stage (HA, fevers, LN, pruritus, rash); Rx: #pentamidine, #suramin, #fexinidazole
2. Late: CNS involvement; Rx: #eflornithine-nifurtimox, #melarsoprol, fexinidazole
cdc.gov
#Trypanosoma brucei #gambiense
1. Early: hemolymph stage (HA, fevers, LN, pruritus, rash); Rx: #pentamidine, #suramin, #fexinidazole
2. Late: CNS involvement; Rx: #eflornithine-nifurtimox, #melarsoprol, fexinidazole
cdc.gov
4/
#Trypanosoma brucei #rhodesiense
1. More rapid clinical course
2. Dx: smear - higher levels of parasitemia
3. Rx: early - #suramin
4. Rx: late - #melarsoprol
5. Note: pentamidine and eflornithine not active vs. T rhodesiense!
doi.org
#Trypanosoma brucei #rhodesiense
1. More rapid clinical course
2. Dx: smear - higher levels of parasitemia
3. Rx: early - #suramin
4. Rx: late - #melarsoprol
5. Note: pentamidine and eflornithine not active vs. T rhodesiense!
doi.org
Bonus Question: One month after returning from a photograph safari in Kenya and Tanzania, a 61 y/o woman presents with fever and headache. PE shows βtrypanidsβrash in groin. Blood smear: trypomastigotes. CSF TNC 164; 78%L, protein 191.
What is the recommended Rx?
What is the recommended Rx?
Case diagnosis for this returned 61F traveler:
#Trypanosomiasis brucei #rhodesiense
Travel to East Africa
Clinical course: more rapid
Note: CNS involvement (late stage)
So what is Rx for late stage T. brucei rhodesiense #sleepingsickness?
doi.org
#Trypanosomiasis brucei #rhodesiense
Travel to East Africa
Clinical course: more rapid
Note: CNS involvement (late stage)
So what is Rx for late stage T. brucei rhodesiense #sleepingsickness?
doi.org
What is the Rx of T. brucei rhodesiense CNS disease
Rx is #melarsoprol
(Suramin is Rx for early non-CNS disease; pentamidine and eflornithine is Rx of T. brucei gambiense; pentamidine and eflornithine are not active vs. T. brucei rhodesiense)
doi.org
Rx is #melarsoprol
(Suramin is Rx for early non-CNS disease; pentamidine and eflornithine is Rx of T. brucei gambiense; pentamidine and eflornithine are not active vs. T. brucei rhodesiense)
doi.org
Finally, the diagnosis of the first case in this thread is Trypanosoma brucei gambiense.
These 2 cases illustrate differences between gambiense and rhodesiense in epidemiology, clinical course and Rx choices.
Thanks for participating! Happy #MedEd #IDTwitter learning!
These 2 cases illustrate differences between gambiense and rhodesiense in epidemiology, clinical course and Rx choices.
Thanks for participating! Happy #MedEd #IDTwitter learning!
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