Cases reported "Trypanosomiasis, African"

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11/14. The clinical manifestations of Rhodesian trypanosomiasis: an account of cases contracted in the Okavango swamps of botswana.

    Over 100 years ago, David Livingstone reported the presence of tsetse flies in the Okavango swamps in northern botswana. They have persisted in the region and recently have been responsible for many cases of Rhodesian sleeping sickness caused by Trypanosoma rhodesiense in visitors to the area. The clinical manifestations in illustrative cases of this disease are described. One patient who refused treatment died five months after being infected. One patient died of encephalopathy complicating treatment with melarsoprol (Mel B) and one died in a hemorrhagic state associated with a heavy parasitemia early in his illness. Most patients treated early respond well to treatment with specific drugs, usually suramin, and are cured. In those with involvement of the central nervous system the treatment required is more hazardous, but usually is effective in curing the patient.
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12/14. Treatment of gambiense sleeping sickness in the sudan with oral DFMO (DL-alpha-difluoromethylornithine), an inhibitor of ornithine decarboxylase; first field trial.

    Difluoromethylornithine (DFMO), a specific, irreversible inhibitor of polyamine biosynthesis shown to be curative in animal models inoculated with various Trypanosoma spp., was evaluated in the Southern sudan in a preliminary open clinical field trial in patients infected with trypanosoma brucei gambiense. 20 patients were studied including 18 with late-stage disease involving the central nervous system, 16 of whom were refractory to arsenical treatment. In late-stage disease monotherapy with oral DFMO doses of about 400 mg/kg/day for five to six weeks was associated with disappearance of parasites from cerebrospinal fluid (CSF), decreased CSF WBC counts and protein concentrations and reversal of clinical signs. Side effects associated with this dose regimen included diarrhoea, abdominal discomfort and anaemia, but were seldom sufficiently severe to prompt discontinuing therapy. In early-stage patients about 200 mg/kg/day for six weeks appears adequate to eliminate parasites and reverse clinical symptoms and is well tolerated. Three cases of late-stage sleeping sickness and two of early-stage disease followed up for approximately one and a half to two years after treatment indicated that DFMO monotherapy can be curative. Additional studies are needed to define optimal posology. Inhibition of polyamine biosynthesis is a promising new approach to therapy of trypanosomiasis.
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13/14. African sleeping sickness presenting in an American emergency department.

    A 27-year-old American man who had returned recently from East africa presented with African sleeping sickness, probably of the Rhodesian (East African) type. High fever, malaise, and watery diarrhea were his predominant symptoms. No trypanosomal chancre was noted. Treatment for malaria in africa had not been effective. In the emergency department, diagnosis was established by demonstrating trypanosomes on blood smear. Treatment with an IV course of suramin was successful.
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14/14. Use of a PCR assay for diagnosing African trypanosomiasis of the CNS: a case report.

    The diagnosis of African trypanosomiasis is parasitologic and often can be difficult, especially in patients infected with trypanosoma brucei gambiense, the cause of West African sleeping sickness. In the united states imported cases of sleeping sickness are rare, and most occur in tourists returning from East African game parks rather than among immigrants. I report here the use of a T. brucei specific PCR assay in a West African immigrant who presented with neurological symptoms more than 12 years after he had last been in africa. The patient's historical and physical findings, as well as abnormal cerebrospinal fluid (CSF) parameters, suggested a diagnosis of sleeping sickness. The diagnosis was confirmed when the PCR assay demonstrated the presence of parasite dna in CSF and blood. Several months after curative therapy the CSF continued to be positive by PCR. These findings suggest that the PCR assay may be useful for sensitive and specific diagnosis of sleeping sickness, but that it may not be helpful for assessing the effect of drug treatment.
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