Galen writes:
Hello all,
Patient likely suffering from sleeping sickness caused by trypanosoma brucei rhodesiense. At elevation he lived care free from the tsetse flies but while on safari likely suffered a bite. Unfortunately from his symptoms it seems he may already have CNS involvement and may require toxic melarsoprol for treatment.
After many years of listening I finally got around to donating and plan to continue donating going forward. Thank you for all of your various productions. I’ve learned a lot and passed along the knowledge when giving lunch talks in residency and plugged your podcasts frequently.
Take care,
Galen
Rafid writes:
Hello TWIP team,
I have returned from Glasgow and am happy to say that my daughter will be doing her Masters degree at the University of Glasgow. As Christina predicted I did not have the privilege of experiencing smur. The weather was quite balmy, subtropical really compared to back home. I did not use my wool socks or my long underwear at all. Some of the locals, especially the young male Scotsmen were walking around Glasgow in flip flops and shorts which I will definitely bring on future visits.
My guess for this week would be East African trypanosomiasis with the species brucei rhodesiense. I base this on the trip to the game park, the painful bug bite, and the intensity of the symptoms.
May I suggest the book King Leopold’s Ghost which explores the colonial exploitation of Congo which led to the forced migration of peoples into Tse Tse fly infected jungles to harvest rubber trees which led to major outbreaks of sleeping sickness.
If you will permit me a quick anecdote, the province of Quebec where I live has french as its official language and has a policy of encouraging immigration from French speaking countries including French speaking parts of Africa. As a result we have many African immigrants. A few years ago our regional hospital in Gatineau admitted an African man , fleeing conflict with a case of severe refractory depression thought to be secondary to events he lived through. The patient was interviewed and videotaped. No medication or intervention seemed to help and the patient was transferred to the Douglass psychiatric hospital in Montreal where somebody looked at the Gatineau videos where the doctor would repeatedly ask the patient “sir do you know why you are admitted here” and the sleepy patient would open his eyes and say “ yes I am here so that you can cure me of my sleeping sickness “ and despite that no one listened to the patient at our regional hospital. Not our proudest moment. This video clip has been shown for years at McGill when Michael Libman would teach his parasitology lectures.
Let this be lesson to all trainees out there. Keep your mouth closed and your ears open and your patients will give you your diagnosis. No example could be clearer than this one.
Anyhoo it is getting late and i should really be getting of too sleep.
Rafid returning Champion
Paul writes:
A Returning book winner.
Diagnosis: East Africa Sleeping sickness caused by Trypanosoma brucei rhodesiense
Supporting clues:
History of visiting game parks where the parasite is known to be carried by wild mammals and the mention of a painful insect bite. Altitude may be a reference to decreased malaria transmission at higher altitudes. The geographic clues support East Africa Sleeping Sickness.
Symptoms: while very non-specific, the symptoms are consistent with sleeping sickness, and the timing is consistent as disease caused by T.b. rhodesiense has a shorter incubation period of 1-3 weeks, in contrast to T.b. gambiense which is much longer.
Diagnosis: the lack of findings on the initial blood smear leading to repeat smears is characteristic. The finding of an extracellular organism on the smear is a critical, diagnostic finding.
East Africa Sleeping Sickness is very uncommon, the vast majority of sleeping sickness is West African caused by T.b. gambiense.
Treatment should be started promptly as this disease progresses over a few weeks.
Matt writes:
Hello,
In hearing the clinical presentation and history, we immediately thought of Trypanosoma, which is in-line with the extra-erythrocytic parasite on blood smear. Based on the geographic location and time to onset of symptoms, we favor Trypanosoma brucei rhodensiense.
A quick Google search reveals CDC travel advisories and a few papers regarding Trypanosoma cases in people visiting Tanzanian game parks.
My wife (an infectious disease doctor) and I (a veterinary pathologist) enjoy your podcast and discussing the overlap in our cases!
Thanks,
-Matt
Steve writes:
Hello Prestigious Purveyors of Parasitic Plots,
The 26 year old visiting game parks in Tanzania most likely has African Trypanosomiasis, caused by T. brucei and spread to humans via the bite of the tsetse fly.
The diagnostic extra erythrocitic forms seen on the blood smear would be the trypomastigote stage of the parasite which are quite visible on a giemsa stain.
T. brucei has two subspecies, the eastern rhodesiensie, and the western gambiense. The CDC claims that there is no range overlap, however, this paper from Emerging Infectious Diseases back in 2002:
https://pmc.ncbi.nlm.nih.gov/articles/PMC2738477
notes that, despite a historic incidence of nearly exclusive eastern African trypanosomiasis, there have been cases with gambiense from game parks in Tanzania.
Given statistical likelihood and the relative rapid progression of the disease, the patient most likely was infected with the rhodesiensie subspecies. A lumbar puncture should be performed to determine if the patient is still in the primary phase (most likely) or if it has spread to the CNS and is now in the secondary phase.
Identifying which of the two subspecies is present as well as the stage of the disease is important, because it will determine which medications can be used to treat the patient. Suramin can be used in early stages for either form, pentamidine being preferred for the western. With CNS involvement, melarprosol is the only effective treatment for rhodesiensie, while eflornithine and nifurtimox or eflorthinine alone for gambiense. Serological testing is available in endemic areas, but likely would not be useful in differentiating between the two due to crossreactivity. Molecular tests are available but rare in endemic areas. The patient would most likely be assumed to have rhodesiensie and, if CNS involvement was not present, be given suramin.
When evaluating the patient, a differential dx would include malaria, arbovirus infections, and bacterial infections (including though not excepting Rickettsia, Bartonella, and Borellia). A cbc with differential would have been collected to guide diagnostic direction, as well as blood cultures. Thick and thin smears for parasites obviously were collected on two occasions for this patient.
Well, I managed two case submissions in a row, maybe I’ll make it to 3! I have not received a book yet and would love one if I am fortunate enough to win.
Thanks for all the hard work!
Steve in the Eastern Sierra
Eugene writes:
Dear TWiP,
My wife and I discovered TWiP a year ago and look forward to every new episode. This case brought back a memory from a social studies class in high school 35 years ago describing sleeping sickness in Africa and the tsetse fly that spreads it. My wife teaches high school social studies and is disappointed that I don’t remember much of that curriculum that doesn’t have an exotic sounding insect name associated with it.
Thank you very much for the inspirational science communication you do.
-Eugene
San Jose, CA
Loren writes:
Dear esteemed parasitological gurus,
My thoughts for the case of the young man recently returned from vacationing in east African wildlife parks is:
Trypanosoma brucei rhodesiense (aka East African sleeping sickness)
It causes fast onset acute trypanosomiasis in humans (unlike west African Trypanosoma brucei gambesiense). A highly zoonotic parasite, it is prevalent in southern and eastern Africa, where game animals and livestock are thought to be the primary reservoir.
It is spread by bites from a tsetse fly carrying the parasite T. b. rhodesiense. The disease progresses in severity very quickly (one to several weeks after exposure).
Tourists visiting and others working in game parks were identified by the US CDC as being at risk.
The initial blood smears were looking for malaria (negative), subsequent blood smear with (malaria ruled out) revealed something extra erythrocytic. The parasite can be found in the blood plasma during the acute phase of illness, which seems to be what we have here. Your patient must have won the tsetse fly lottery.
Thanks for another interesting case! I keep learning. I love having to get out my maps and think about the larger landscape to think about what makes sense.
Loren, RETURNING CHAMPION, so I already got to read about this in my excellent book!
Michelle and Alexander from the First Vienna Parasitology Passion Club write:
Dear Twip-anosomes,
We believe that the 28 year old patient is suffering from the african sleeping sickness, medically known as African Trypanosomiasis.
There is a small number of parasitic diseases, which produce extra-erythrocytic forms that can be seen in the blood smear. African Trypanosomiasis is a prominent example, which fits the symptoms described in this case. Filarial infections may also be detected on blood smear, although patients suffering from filariasis are not generally as systemically ill as the patient in this case. Finally, the gametocytes of plasmodium can also sometimes be seen on a blood smear, though malaria has been excluded in our patient. African Trypanosomiasis is caused by Trypanosoma brucii, most likely T. brucii rhodesiense judging by the geography. It is transmitted by the bite of the tsetse fly, which is often described as quite painful, consistent with the case. T. brucii rhodesience is associated with severe disease and a higher mortality rate than T. brucii gambiense.
Two recent clinical cases came to mind, which we would like to share with you. First was the diagnosis of exflagellated male microgametocytes of P. vivax via blood smear in a young woman who returned to Austria from a work trip to Ethiopia. This stage of the parasite’s life cycle is normally only seen strictly within the anopheles mosquito. Its occurrence in the human blood is extremely rare and the reason for it is not clear (image.1). The second case is not a parasitic one, but a case of louse-borne relapsing fever, caused by borrelia recurrentis. Diagnosis was also made via blood smear, where spirochetes were visible in the extra-erythrocytic space (“image2.”) Both of the attached images were taken by attendings from our department in Vienna – we hope you find this as cool as we do!
Thank you for this great case! All the best,
Michelle and Alexander from the First Vienna Parasitology Passion Club
Felix writes:
Dear hosts
This was a fun one, especially since I spent part of my intern year in Moshi, a small town close to Arusha. I have some first hand experience fighting Tse-tse flies that always somehow find their way inside a jeep. My guess for this case is sleeping sickness caused by Trypanosoma brucei, probably rhodesiense. Maybe the hero of this episode should be David Bruce, as he discovered not one but two zoonoses.
Greetings
Felix
Kimona writes:
Dear TWiP Team!
Let it be known that Kimona has received NO such signed copy of PD-7 despite nearly 3 years of trying. But fear ye not – she owns both a 2nd and a 7th edition. Dickson’s drumroll now elicits a somber sense of doom….it seems that simple probability and chance should have allotted me one. And then, Vincent removes my name from the drawing! Guys – it’s not the book – it’s the autographs I need. I’m counting on its valued appreciation when most of our northern hemisphere reaches tropical temperatures and brings many of the parasitic diseases upon us! A signed copy will be priceless!
On to the case – I believe this young man is suffering an HAT infection, from the protozoan, Trypanosoma brucei rhodesiense.
He is in East Africa and recently visited game parks who’s animals can serve as reservoirs. His rather rapid onset of somnolence indicates an early spread to the CNS, (unlike T.b. gambiense which is much slower in CNS progression). The extra-erythrocytic ‘thing’ in his blood smear is likely a long squiggly organism with an undulating membrane, central nucleus and small kinetoplast: a trypomastigote. I presume he will recall a painful bite and a chancre somewhere on his body a few weeks earlier, from the bite of a Tsetse fly. The CDC and WHO now recommend fexinidazole as first line for both early and CNS stage t.b. rhodesiense infection. Suramin, which used to be used in early stages and the toxic melarsoprol in late/CNS stage disease, are now only used for those under age 6. Maybe Daniel can comment on whether fexinidazole is readily available and affordable in areas of need.
Warmly, Kimona
Ps – Perhaps Daniel can bring along a signed PD-7 to Panama in March and I will make an extra donation above my sustainer contributions. I have recruited a group of my favorite colleagues to join me in their CME week at Floating Doctors….and even tried tempting Christina… nudge, nudge!
Hazel writes:
Salutations dear TWIPsters!
I am writing from snowy London Ontario, where we’ve just come out of a wicked cold snap, so the temperature is a balmy -8 celsius with a windchill of only -16. Hurray!
For me this episode’s case diagnosis was between falciparum malaria, and trypanosomiasis. Neither of the vectors for these parasites, the anopheles mosquito and tsetse fly respectively, would be likely to be found at 1800 m in Arusha (although with climate change, who knows how that might be shifting), but the patient’s recent travel to parks at lower elevations would expose him to both. The not-terribly-specific symptoms could also be indicative of either malaria or trypanosomiasis; and extra-erythrocytic parasites *could* be found in either case – recently escaped merozoites for malaria, and extracellular trypanosomes for trypanosomiasis. However, one week would be a bit short for malaria incubation; and Daniel’s admission that there had been a painful insect bite tipped the scales over to trypanosomiasis. His none-too-subtle advice to ‘sleep on it’ sealed the deal for me. My diagnosis would be African Sleeping Sickness, most likely caused by Trypanosoma brucei rhodesiense. According to my PDF copy of PD7, treatment in early stages would be with IV Suramin.
Thanks once again for all you do; now more than ever we need people like you fighting the good fight for science and education.
All the best,
Hazel, who has yet to win a book 😉
Jason writes:
Greetings TWiP hosts!
In TWiP 251’s Sub-Saharan Somnolence case, the patient appears to present with acute-stage disease caused by Trypanosoma brucei rhodesiense. This flagellated parasite causes east African trypanosomiasis. The eastern African species of trypanosomiasis exists mainly in eastern Uganda, the eastern shores of Tanzania’s Lake Tanganyika, and along the western shores of Lake Malawi.
West of the African Rift Valley, the western species of human African trypanosomiasis – Trypanosoma brucei gambiense – predominates.
A patient complaining of fever, malaise, headache, body aches, somnolence and with recent history of an insect bite in Africa should be screened for both malaria and trypanosomiasis. Presence of trypomastigotes in the blood provides confirmation of trypanosomiasis – more popularly known as African Sleeping Sickness – and the insect bite bite may now be referred to as a trypanosomal chancre. The offending insect in cases of African trypanosomiasis is the Glossina genus tsetse fly.
According to the WHO’s 2024 guidelines (link below), our adult patient (assumed to weigh > 35 kg) is best treated with a regimen of fexinidazole, with a loading phase of 1800 mg PO for 4 days, followed by a maintenance dose of 1200 mg PO for 6 days. For children aged > 6 years old or for patients weighing 20-34 kg, fexinidazole is given at a reduced dose.
Patients aged < 6 years old or with a body weight of < 20 kg should undergo lumbar puncture for white blood cell count and presence of trypomastigotes in the cerebrospinal fluid; suramin or melarsoprol is then prescribed depending upon the test results.
Worm regards,
Jason
Seattle, WA
WHO guidelines for the treatment of human African trypanosomiasis:
https://iris.who.int/bitstream/handle/10665/378083/9789240096035-eng.pdf?sequence=1&isAllowed=y
Pietro writes:
HATs off to you dear Twippers,
Greetings from foggy Pavia, Italy. Thank you for all the amazing cases provided in your podcast. Apparently last time I didn’t submit my guess on time so I’m rushing trying to solve the case of the patient with fever and malaise from Tanzania.
As suggested by the hint of a painful bite, I suspect a case of sleeping sickness or human African trypanosomiasis (HAT) caused by T. brucei (rhodesiense as we are in Tanzania) and transmitted by the painful bite of tsetse flies of the Glossinia species.
As in this case, extra-erythrocytic trypanosomes can be seen on Giemsa staining and provide the diagnosis. Although the symptoms reported are suggestive for the first stage of the disease, the patient is experiencing some kind of somnolence and CSF examination is necessary to rule out neurological involvement.
Treatment is stage and species specific and consist of suramin for first stage disease or melarsoprol for second stage disease assuming this is a case of T.b. rhodesisense.
Hoping to make it on time and win a book, I really appreciated the inside joke about “sleeping on it”.
Best wishes,
Pietro
Justin writes:
Hello wonderful hosts,
For the case of the sleepy 28-year-old patient visiting the Safari, my guess would be African sleeping sickness (Trypanosoma brucei). Likely he encountered a Tsetse fly which are more highly concentrated in wildlife preserves.
I wonder if time-of-day of the first blood smear impacted the likelihood of detecting the parasite, as some parasites can only be detected in the time that the vector is active, in this case the day. Otherwise, it was simply too early in the infection to detect.
Treatment likely began immediately as untreated this illness is very often fatal.
Thank you for another great episode and case,
Still hoping to win a book one day,
Yours,
Justin
Victoria writes:
Hello TWIPpers,
I’m a long-time listener to TWIV and a new listener to TWIP. Love your podcasts!
Based on the location and activities, I’m afraid that your patient has Human African trypanosomiasis, aka sleeping sickness, which he has acquired via a tsetse fly bite.
Specifically, he’s infected with Trypanosoma brucei rhodesiense, which the WHO fact sheet at https://www.who.int/news-room/fact-sheets/detail/trypanosomiasis-human-african-(sleeping-sickness) says is found in 13 countries of eastern and southern Africa.
I’ve done a small amount of travel in that region and we were definitely warned about the tsetse flies, so sleeping sickness was my first thought.
I hope his treatment goes well! The WHO fact sheet lists only two treatments for this disease and they don’t seem like any picnic either:
“In rhodesiense-HAT
- Suramin, intravenous: in first stage. May provoke adverse effects including nephrotoxicity and allergic reactions.
- Melarsoprol, intravenous: in second stage. An arsenic derivate, it has many adverse effects, the most dramatic being the reactive encephalopathy which is 3–10% fatal.”
Thanks for all the information you put out into the world!
Victoria
Nathan writes:
Dear TWIP Team,
Greetings from chilly Montreal, where it is currently -21°C. I was late for the last TWIP case study guess – hoping to win the book this time!
This week’s interesting case involves a 28-year-old man in Arusha, Tanzania, visiting one of its hospitals at an elevation of 1,800m. The patient comes from a well-off socio-economic background and has visited game parks during the last three weeks (potentially at lower altitudes). He is experiencing fevers, malaise, severe headaches, generalized body aches, and some somnolence, with symptoms appearing one week before admission. After conducting several blood smears, malaria was ruled out, and something extraerythrocytic was observed.
I would guess that the patient is infected with Trypanosoma brucei rhodesiense, a common pathogen found in East African game parks (causative agent of East African sleeping sickness). It is known for its rapid progression from infection to disease, and if left untreated, CNS involvement occurs within 3–4 weeks after infection. Treatment for the early hemolymphatic stage of East African sleeping sickness is suramin, which is effective only in the early stage due to its inability to cross the blood-brain barrier. (Source: Parasitic Diseases, 7th ed., pages 61–65)
TWIP has become my favourite podcast, and I listen to it every day while going to campus. Besides keeping up with the latest episodes, I am also catching up on older ones – I have reached episode 149: Stranger in a Strange Land.
P.S. I have noticed that courses on parasitic diseases are quite limited in healthcare programs. I truly appreciate your efforts in providing free resources that make this important knowledge accessible to everyone! Whenever possible, I try to share this podcast with peers and professors in my program.
Best regards,
Nathan M.
Pharmacy student at Université de Montréal
Matthew writes:
Hello TWIP hosts,
I really enjoy the show. First time emailer, long time listener. I used to TA human parasitology at OU (Boomer! Sooner!) during grad school. This one came right to mind!
My answer for the mystery case would be HAT or Human African Trypanosomiasis. This disease is also known as Africa Sleeping Sickness. In the case presented it’s likely caused by Trypanosoma brucei rhodesiense (TbR), based on the location of the patient. The two major points that brought me to this conclusion were first, the extra-erythrocytic parasite, and second, the high likelihood of a recent history of a painful insect bite. The patient is likely in the first stage based on the presented symptoms which is treatable with anti-parasitic drugs, specifically Suramin for TbR.
Thanks! Looking forward to hearing the answer soon.
Best,
Matt
Matthew Wersebe, PhD
Henrik writes:
Dear hosts,
thank you again for your podcast. I am glad I finally got a guess right, but somehow I did not make it in the show.
Now I try to be early:
Staying in east Africa near wild animals could be a hint to human African trypanosomiasis, caused by the two subspecies Trypanosoma brucei gambiense and rhodesiense.
Trypanosomes show as extraerythrocytic flagellated organisms.
The primary affect would be the trypanosomic chancre (it is funny that treponema look similar and also make chancres but are completely different than the protozoa).
As we are in east Africa and the onset was rather fast I would assume an infection with the subtype rhodesiense.
Wearing dark blue could have attracted the vector – the tsetse fly. As far as I understood it repellents do not work against the fly as it mainly is directed by sight and not by smell.
To be honest I was quite overwhelmed by the former matrix (west/east) and (cns symptoms/none) and am quite happy that DNDi and the Gates Foundation and many others have established fexinidazole which (to my knowledge) can be used for both subtypes regardless of infection stage.
Thank you, looking forward to hearing more from you in the future!
Best wishes
Henrik
John writes:
Seeking to win the book
African Trypanosomiasis or sleeping sickness comes in two distinct diseases, T.b. gambiense and T.b. rhodesiense and because of differences in treatments it is important to distinguish but regionally these fall east/west with different animal reservoirs which I will get to. The textbook suggested ruling out syphilis, leishmaniasis & malaria, and we are given that blood smear returned negative malaria and another blood smear returned something erythrocytic which pointed me to Trypanosomiasis.
While I wasn’t able to find elevation impacts on the tsetse fly vector other than temperature range as a factor, I imagine it must be cooler and a different environment that makes it a rare occurrence in Arusha. But, the patient’s recent visits of game parks are a known dwelling of the animals that carry the east African T.b. rhodesiense. And, the insect bite, fevers, malaise, bad headaches, body aches, and somnolence are all correlated with this disease. The rest of the family not getting sick can make sense with this diagnosis since they may not have gotten bit or the textbook suggested some tolerance can occur with locals since out of country visitors tend to have a rougher experience with it.
Incubation of T.b. rhodesiense is 2-3 weeks and can swell the posterior cervical nodes as a sign (Winterbottom’s sign), blood smear, lymph node aspirates, and CSF can be used for diagnosis and it looks like blood smear was enough here so with the timing, it sounds like this is early stage.
Treatment with Suramin needs a test dose because it is associated with hypersensitivity for the early hemolymphatic stage but does not cross the blood brain barrier so it is only effective in early stage. Late or encephalitic stage has one treatment, melarsoprol, but it didn’t sound like it was necessary here. That’s good because it is associated with encephalopathy in 3% of cases. I took Dr. Griffin’s advice and “slept” on it but this was my first instinct and I am sticking to it. Cheers
—
John
Rod writes:
Hi all at TWiP,
I am a retired science teacher and studied parasitology as an undergraduate and entomology as an undergraduate and postgraduate in London.
Having slept on it my educated guess is that the 28 year old that had visited Tanzania has acquired trypanosomiasis- transmitted by a bite from a tsetse fly – Glossina spp.- most likely while visiting areas inhabited by large herbivores which are a reservoir for these parasites- specifically Trypanosoma bruceii rhodesiense – the East African sub species.
If only suffering from the early stage he could be treated with pentamidine.
I was fortunate enough to visit Ngoro ngoro crater many years ago- a beautiful spot- thriving with wildlife both large and small!
Thanks again to all at TWiP for keeping us entertained, informed and educated.
Rod
North Portugal.
Courtney writes:
Hi everyone! Tricky case on our hands this week… Lots of details to sort through to make a correct diagnosis. For me, this one came down to the geography, the quick onset of symptoms, including somnolence, and the memory of a painful insect bite. With that, my guess is the man has African sleeping sickness, or trypanosomiasis, caused by the parasite trypanosoma brucei rhodesiense.
Thanks, and I’ll see you all next episode,
Courtney
Ben writes:
Hello all,
Sleeping sickness/African Trypanosomiasis.
Consult Dr. Barrett for the latest drugs (Twip 238).
Call the game reserves and suggest they go kill the tsetse to protect the next person and their own animals. Tsetse, unlikely nearly all other insects, can be eliminated with traps.
Thank you,
-Ben in Liverpool (returning champion)
Hafthor writes:
Greetings from Atlanta!
Long time listener of the TWiX podcasts, since well before COVID. I am not in the medical field, but parasitology and virology fascinate me to the point where I had to buy the Principles of Virology, 4th Ed. set when I found them used. I also bought the very inexpensive electronic copy of Parasitic Diseases, 7th Ed. on Amazon, but it doesn’t work on Kindle and just doesn’t feel as good to read as a real book would (hint, hint). After listening to TWiP 251, I opened up PD7 and did a search for “Tanzania”. At first, I was a little worried because there were quite a few matches, but the first one, on page 57, seems like the right diagnosis. African trypanosomiasis or sleeping sickness, caused by the painful bite of the tsetse fly, transmits the Trypanosoma brucei gambiense or, more likely in this case, T. b. rhodesiense protozoan parasite which has game animals as its reservoir. Differential diagnosis includes syphilis, malaria which was explicitly excluded and our most recent pick, leishmaniasis. Treatment depends on the clinical stage of the disease, and in this case seems like treatment with melarsoprol may be required, which has arsenic and antifreeze and a 3% mortality rate, which I suppose is better than the untreated 100%. Suramin can work if disease is caught before CNS involvement (WBC < 5 cells/µL) Well, that’s my lay-person non-ChatGPT diagnosis. I watched the relevant House episode (S1E7 “Fidelity”) which featured a sexual transmitted case of HAT. According to the WHO, this has only been reported once.
Best regards,
Hafthor
P.S. You should remind people to check with their employer to see if they can do donation matching. My employer uses the Benevity donation/matching platform and we now have Microbe.TV registered and eligible for match.
Karin writes:
East African trypanosomiasis?
James writes:
Bite of tsetse fly. Trypanosomiasis. Most likely he was bit while visiting Tarangire park. That’s the park with the highest number of tsetse flies. TANAPA actually puts up blue impregnated sheets in the bush so animals can get some protection from the flies and therefore decrease the risk of humans being bitten. The bite is a little painful and like a deer fly bite here in USA. The blue sheets have deltamethrin on them. Serengeti has some cases but Tarangire worse.
Jay writes:
Dear TWiP,
I learned at least 3 important lessons on the most recent episode.
Lesson #1: Get my TWiP guess in on time.
Lesson #2: Don’t give a one-word answer as I was tempted to do.
I’ll get to lesson #3 at the end.
I suspect this 28 year-old gentleman who lives with his family at around 6,000 feet of elevation in Tanzania was bit by a tsetse fly when at lower elevation visiting game parks. He developed fevers and bad headaches within a couple of weeks of his return, and he was somnolent on exam. I suspect the extra-erythrocytic forms seen on blood smear were trypomastigotes from Trypanosoma brucei rhodesiense, one of the causes of Human African Trypanosomiasis.
Since I need to keep lesson #1 in mind (get my guess in on time), I’ll be brief. WHO released a summary of treatments this month in The Lancet. I’m no expert in the treatment of HAT, but fexinidazole or melarsoprol might be the best treatment options. Consultation with healthcare providers well-versed in HAT is needed urgently, and that it what it sounds like this gentleman got. I hope he did well, and I look forward to hearing about that later this month.
Lesson #3: I loved the way you discussed the question of immunity to Leishmania in the last episode. You approached it from a standpoint of wonder and curiosity, and that is what science and learning are all about. So lesson 3 is that all of you at TWiP are masters of cultivating that space of wonder and curiosity among yourselves and your listeners. Please keep it up.
Thank you,
Jay
Jay Gladstein, M.D. | Chief Medical Officer
APLA Health & Wellness
Olympic Medical Clinic |Los Angeles, CA 90036