Trypanosoma brucei

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Key Points

  • Trypanosoma brucei
    • Note: Contrast vs. Trypanosoma cruzi (Chagas disease)
    • Characteristics
      • Protozoan parasite
    • Transmission
      • Transmitted by Tsetse fly
        • Endemic in Africa
          • T. b. gambiense: West and Central Africa
          • T. b. rhodesiense: East Africa
          • Seen in travelers or immigrants
    • Presentation: African trypanosomiasis
      • Also known as African sleeping sickness
        • Early infection
          • Chancre at bite site
            • Red, painful, indurated, nodular swelling
          • Lymphadenopathy 
            • Typically involve posterior cervical nodes (Winterbottom Sign)
            • Caused by migration of trypomastigotes from skin through regional lymphatics, where they proliferate
          • Intermittent headache and fevers, hepatomegaly may be seen
        • Late infection
          • Meningoencephalitis
            • Parasitic involvement of CNS is 100% fatal if untreated
            • Presents with fever, headaches, seizures, neurologic deficits, and altered mentation
            • Sleeping disturbance is often seen
              • Daytime somnolence develops into coma
    • Diagnosis
      • Trypanosomes visualized under microscopy
        • Required for definitive diagnosis
        • Usually in peripheral blood smear
        • May be seen in biopsies of infected tissue
        • May be seen in CSF in late infection
    • Treatment
      • Pentamidine is first-line for acute infection
        • Suramin is second-line
      • Eflornithine and nifurtimox is first-line for late infection
        • Melarsoprol is second-line