Date: Tue 1 Oct 2019
From: John Frean <email@example.com> [edited
The patient is a 23-year-old male international student, who has been studying in South Africa since late July 2019. Between [6 and 16 Sep 2019] he was on vacation in Uganda.
Places visited in Uganda were:
Entebbe: Jinja music festival for 3 days
Sipi Falls: hiking/waterfalls/homestay
Moroto: visited tribes
Murchison Falls: 2 days
Masindi: 1 day
Entebbe, then back to South Africa.
He did not see any tsetse flies, nor was he aware of any insect bites.
On [Sun 22 Sep 2019] he felt unwell and noticed a lesion on his chin. He was admitted to hospital and on [26 Sep 2019] underwent surgery for a presumed submandibular abscess. No abscess was found but histological examination of tissue removed at surgery showed some areas of necrosis, and evidence of fibrin thrombi compatible with disseminated intravascular coagulopathy. No organisms were seen.
The white cell count was about 3 x 109/L and platelets were 34 x 109/L, then 29 x 109/L, and postoperatively dropped to 4 x 109/L.
Blood films were examined and numerous trypanosomes were seen, estimated density of about 56,000/microlitre. On review of the blood sample from [26 Sep 2019], scanty trypanosomes were seen.
The patient was transferred to the care of an infectious diseases physician on [Sat 28 Sep 2019]. On admission he was very ill with unrelenting fever, tachycardia, periodically hypotensive, dyspnoeic, renal dysfunction (creatinine 300 micromol/L), jaundiced with raised transaminases, and slightly confused. Test dose and 1st dose of suramin were well tolerated, and the 2nd dose was given on [30 Sep 2019]. Clinically the patient is slightly improved today (1 Oct 2019), with a platelet count now 12 x 109/L and creatinine around 200 micromol/L.
According to WHO EAT [East African trypanosomiasis] experts, the infection was most likely acquired at Murchison Falls, where there have been sporadic cases; alternatively at Moroto [both in northern Uganda].
This is the 4th case of EAT evacuated to Johannesburg in 2019. The other cases acquired the infection in Zambia and Malawi.
John Frean <firstname.lastname@example.org>
National Institute for Communicable Diseases, GeoSentinel Site,
Evan Shoul (infectious diseases specialist);
Pieter Ekermans (Ampath Laboratories)
[ProMED-mail thanks Lucille Blumberg, John Frean, Evan Shoul, and Pieter Ekermans for their submission. - Mod.ML]
Trypanosomiasis is endemic in the national parks in southern Africa, where there are tsetse flies and a reservoir of the trypanosomes in the wildlife. It is important to consider trypanosomiasis in febrile travellers to these national parks with negative tests for malaria. - ProMED Mod.EP]
[HealthMap/ProMED-mail map of South Africa:
Murchison Falls (Uganda):