Human African Trypanosomiasis in a Spanish traveler returning from Tanzania

• Published in: PLoS neglected tropical diseases 2017-03, Vol.11 (3), p.e0005324-e0005324
• Main Authors: Gómez-Junyent, Joan, Pinazo, María Jesús, Castro, Pedro, Fernández, Sara, Mas, Jordi, Chaguaceda, Cristian, Pellicé, Martina, Gascón, Joaquim, Muñoz, José
• Format: Article
• Language: English
• Subjects: African trypanosomiasis; Africans; Biology and Life Sciences; Blood; Clinics; Countries; Diagnosis, Differential; Diagnostic systems; Epidemiology; Expatriates; Family medical history; Female; Fever; Health aspects; Hospitals; Human diseases; Humans; Inland waters; Intensive care; Lakes; Malaria; Medical diagnosis; Medicine and Health Sciences; Middle Aged; National parks; Nucleotide sequence; Parasites; Parks & recreation areas; Patients; Pentamidine - administration & dosage; Pentamidine - therapeutic use; People and Places; Polymerase chain reaction; Protozoan diseases; Protozoosi; Refugees; Risk factors; Serology; Serum; Signs and symptoms; Spain - epidemiology; Sub-Saharan Africa; Suramin - administration & dosage; Suramin - therapeutic use; Symposium; Symptoms; Tanzania - epidemiology; Travel; Travelers; Tropical diseases; Trypanocidal Agents - administration & dosage; Trypanocidal Agents - therapeutic use; Trypanosoma brucei rhodesiense - isolation & purification; Trypanosomiasis; Trypanosomiasis, African - diagnosis; Trypanosomiasis, African - drug therapy; Trypanosomiasis, African - epidemiology; Trypanosomiasis, African - parasitology; Vector-borne diseases; Viatgers; Àfrica subsahariana
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0005324

[...]g-HAT cases in nonendemic countries mainly occur in expatriates or refugees, who are usually diagnosed in the second stage and after a protracted diagnostic process [4]. Since it is rare in nonendemic countries, physicians may not suspect or find it difficult to diagnose this disease, especially if fever and/or unspecific complaints are the only presenting symptoms. An accurate anamnesis, including travel history and incubation and prodromal periods, together with a thorough physical examination, is helpful to guide the diagnostic workup. r-HAT is usually easy to diagnose by blood smear examination, as parasitaemia in these patients tends to be high [8]. Case description On 31 August 2015, a 49-year-old Spanish woman attended the Tropical Medicine Outpatient Clinic (OC) of the Hospital Clínic in Barcelona, Spain, presenting with fever. [...]she visited Lake Enyasi and Manyara National Park before returning to Arusha; from there, she travelled back to Barcelona on 30th August. During her OC visit, she was febrile with axillar temperature of 38°C and had a 1x1 cm erythematous nodule in the left side of her neck, suggestive of arthropod bite. A blood film did not show malaria parasites, and serum was collected for Dengue and Chikungunya serology and polymerase chain reaction, together with blood cultures.