21 November 2008

African trypanosomiasis in travellers to Tanzania

Two cases of African trypanosomiasis (also known as sleeping sickness) in travellers to Tanzania have been recently recognised.

The first case occurred in a 32 year old woman who was 20 weeks pregnant and had been on safari in the Serengeti National Park of Tanzania [1]. She was cared for at the Hospital for Tropical Diseases in London in August 2008. She presented with a chancre on her forehead, fever, lymphadenopathy and had trypanosome parasites on blood smear. She was treated with suramin and had complete resolution of symptoms with the baby developing normally. 

The second case was in an American tourist who was travelling in the Kigoma and Kagera regions of northwest Tanzania [2]. He was transported from this area for medical evaluation and care to the IST Medical Scheme Clinic in Dar es Salaam on 30 October 2008. On arrival he was confused and dehydrated, with evidence of two chancres on his left leg and trypanosome parasites on blood smear. He was scheduled to be evacuated to Nairobi for further treatment.

Advice for travellers

Trypanosomiasis is rare in travellers although there have been cases in European travellers to the Serengeti and Tarangire national parks in Tanzania in 2001 [3] and to Kasunga and Vwasa Marshes National Parks in Malawi in 2005 and 2007 [4]. The IST Medical Scheme Clinic also reports that they diagnosed trypanosomiasis in a German traveller in 2007 [2]. Travellers working or visiting woodland and savannah areas, particularly in game parks in Central and East Africa, are at risk.

Insect bite avoidance measures should be practised. Tsetse flies are capable of biting through loose weave fabrics and are unaffected by many insect repellents. Travellers are advised to wear insecticide treated close weave clothing that is khaki or olive coloured, as tsetse flies are attracted to very dark or bright colours. Travellers to areas endemic for trypanosomiasis who experience a bite from a tsetse fly and/or become unwell with fever, headache or malaise should seek prompt medical care.

References

1. Personal communication, B Nadjm & PL Chiodini. 19 November 2008.

2. ProMED-mail. Trypanosomiasis, African – Tanzania (North West). ProMED-mail 200811; 3 Nov:20081103.3455

http://apex.oracle.com/pls/otn/f?p=2400:1001:81396618477193

9::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_

ID:1010,74610

3. Jelinek T, Bisoffi Z, Bonazzi L et al. Cluster of African trypanosomiasis in travellers to Tanzanian national parks. Emerging Infect Dis 8:634-5, 2005.

4. National Travel Health Network and Centre. Trypanosomiasis in travellers to Malawi. 15 February 2007. [Accessed 20 November 2008]. Available at: http://www.nathnac.org/pro/clinical_updates/trypanosomiasis15

0207.htm

Links

NaTHNaC: Trypanosomiasis information sheet

Centers for Disease Control and Prevention: African trypanosomiasis information sheet

World Health Organization: African trypanosomiasis fact sheet