Indiana University Infectious Diseases Fellowship
13 Jan,
9 tweets, 5 min read
#idboardreview 40 M originally from Cameroon, also travel to Ghana & Mali, now w/6 mo progressive weakness requiring wheelchair use,lethargy, 30lb wt loss, confusion. CSF lymphocytic pleocytosis. dx? #meded #idmeded #IDtwitter 
Human African #trypanosomiasis endemic to sub-Saharan Africa & fatal when untreated. parasite Trypanosoma #brucei transmitted by tsetse fly (Glossina spp) vector
2 dz forms T #brucei #gambiense West/Central Africa: slowly progressive illness leading to progressive sx & death over mo-yrs
-T brucei #rhodesiense eastern/ southern Africa: more acute illness that evolves over a span of wks, leading to death w/in months
-T brucei #rhodesiense eastern/ southern Africa: more acute illness that evolves over a span of wks, leading to death w/in months
#trypanosoma CATT is a fast and sensitive test to screen for T brucei gambiense antibodies in blood, plasma, or serum 10.1128/CMR.18.1.133-146.2005
PCR in blood is highly sensitive and specific
PCR in blood is highly sensitive and specific
#trypanosoma definitive dx
If lymphadenopathy is present: observation of motile trypanosomes on wet mount of fresh lymph node aspirate (sensitivity 40-80%)
-Giemsa-stained peripheral blood smear sensitivity is very low (10%–30%), especially when level of parasitemia is low
If lymphadenopathy is present: observation of motile trypanosomes on wet mount of fresh lymph node aspirate (sensitivity 40-80%)
-Giemsa-stained peripheral blood smear sensitivity is very low (10%–30%), especially when level of parasitemia is low
#trypanosoma Fexinidazole is now considered drug of choice in most cases of #gambiense
-WHO interim guidelines for treatment of severe T #brucei gambiense +detected CSF trypanosomes (or CSF WBC >100) recommend chemotherapy with #nifurtimox-eflornithine (NECT)
-WHO interim guidelines for treatment of severe T #brucei gambiense +detected CSF trypanosomes (or CSF WBC >100) recommend chemotherapy with #nifurtimox-eflornithine (NECT)
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