Human African Trypanosomiasis in a Traveler: Diagnostic Pitfalls

Meltzer, Eyal; Leshem, Eyal; Steinlauf, Shmuel; Michaeli, Shulamit; Sidi, Yechezkel; Schwartz, Eli

doi:10.4269/ajtmh.2012.11-0512

Cited by 13 publications

(7 citation statements)

References 10 publications

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“…The number of reported HAT cases is probably an underestimate. Some cases were probably never diagnosed correctly in developed countries, where doctors are familiar neither with the clinical manifestations of HAT, nor with the limitations of the various diagnostic modalities available today [46] . Death in such cases was probably erroneously attributed to other causes.…”

Section: Discussionmentioning

confidence: 99%

The Changing Epidemiology of Human African Trypanosomiasis among Patients from Nonendemic Countries –1902–2012

Neuberger¹,

Meltzer²,

Leshem³

et al. 2014

PLoS ONE

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BackgroundAlthough human African trypanosomiasis (HAT) is uncommon among patients from non-endemic countries (NEC), there has been an increase in the number of cases reported in recent years.MethodsA systematic review of the literature was performed. The number of incoming tourists to HAT endemic countries was obtained from the United Nations World Tourism Organization. All HAT cases diagnosed in patients from NEC were included. Immigrants and refugees were excluded. We compared patients during and after the colonial period, and analyzed the relationship between the number of incoming travellers and the number of HAT cases.ResultsBetween 1902 and 2012, HAT was reported in 244 patients. Most HAT cases were reported before 1920, and after the year 2000. In the colonial era the average age of patients was lower (32.5±7.8 vs. 43.0±16.1 years, P<0.001), the proportion of females was lower (10.0% vs. 23.9%, P<0.01], most cases were diagnosed in expatriates, missionaries and soldiers (74.3%), and Gambian trypanosomiasis accounted for 86/110, (78%) of cases. In the post-colonial era most patients 91/125 (72.8%) were short-term tourists to game parks in Eastern and South-Eastern Africa (mainly in Tanzania); Rhodesian trypanosomiasis accounted for 94/123 (76.4%) of cases. Between 1995 and 2010 there has been a constant linear increase in the number of incoming tourists to Tanzania, and HAT cases occurred in small outbreaks rather than following a similar linear pattern.ConclusionsIn recent decades HAT patients from NEC are older, and more likely to be tourists who acquired the disease while visiting game-parks in Eastern and South-Eastern Africa. While Rhodesian trypanosomiasis is relatively uncommon among Africans, it now accounts for most cases reported among patients from NEC. Returning febrile travellers without an alternative diagnosis should be evaluated for HAT. Cases among travellers may serve as sentinels for Rhodesian trypanosomiasis “hot spots” in Africa.

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Section: Discussionmentioning

confidence: 99%

The Changing Epidemiology of Human African Trypanosomiasis among Patients from Nonendemic Countries –1902–2012

Neuberger¹,

Meltzer²,

Leshem³

et al. 2014

PLoS ONE

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“…Among travelers returning from sub-Saharan Africa with a febrile illness, spotted fever rickettsiosis due to Rickettsia africae was a common cause, highlighting that a complete physical examination is needed to detect a necrotic eschar at the site of the tick bite (36). Fever with or without rash occurring soon after a safari trip to East Africa should lead to a prompt blood film for Trypanosoma brucei rhodesiense to facilitate rapid diagnosis and reduce the risks for neuroinvasion and death (37,38). Early referral of severely ill returned travelers to a clinician experienced in travel and tropical medicine may help mitigate the potential severe sequelae of these infections.…”

Section: Discussionmentioning

confidence: 99%

GeoSentinel Surveillance of Illness in Returned Travelers, 2007–2011

et al. 2013

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“…Elsen et al (1990) reported Glossina fuscipes fuscipes and G. morsitans submorsitans from southwestern Saudi Arabia. Meltzer et al (2012) in Israel reported T. brucei rhodesiense in a traveler returning from Tanzania with a relapsing febrile illness, and diagnosis was established by blood smear after nearly a month. Kong et al (2012) found that specificity of the 529 bp-LAMP assay was determined using the DNA samples of T. evansi, Plasmodium falciparum, Paragonimus westermani, Schistosoma japonicum, Fasciola hepatica and Angiostrongylus cantonensis, without cross-reactivity with DNA of any parasite.…”

Section: Review and Discussionmentioning

confidence: 99%