African Trypanosomiasis

Question 1

This was obtained from a Malawi man. Parasites were absent in the CSF.

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 1

1. Trypanosoma brucei rhodesiense
2. Features:
   * Geographic location for rhodesiense
   * Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
   * Cattle, sheep, and goat
   * Game animals including carnivores
5. Suramin - 1st stage rhodesiense as no parasites in the CSF

Question 2

This was obtained from a SE Ugandan man. Parasites were present in CSF.

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 2

1. Trypanosoma brucei rhodesiense
2. Features:
   * Geographic location for rhodesiense
   * Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
   * Cattle, sheep, and goat
   * Game animals including carnivores
5. Melarsoprol - 2nd stage rhodesiense as parasites found in the CSF

Question 3

This was obtained from a DRC man with mild disease.

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 3

1. Trypanosoma brucei gambiense
2. Features:
   * Geographic location for gambiense
   * Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
   * Pigs, dogs, cattle and other wild animals
   * Importance of reservoirs for gambiense is not understood (unlike rhodesiense where it is part of the transmission cycle)
5. Fexinidazole - Adult with no suspicion of severe disease therefore no LP needed and fexinidazole is recommended

Question 4

Obtained from an Angolan man with severe disease. CSF WBC is <100/uL

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 4

**1. Trypanosoma brucei gambiense
2. Features:
* Geographic location for gambiense
* Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
* Pigs, dogs, cattle and other wild animals
* Importance of reservoirs for gambiense is not understood (unlike rhodesiense where it is part of the transmission cycle)
5. Fexinidazole - Adult with suspicion of severe disease but with CSF WBC <100/uL then fexinidazole is recommended

Question 5

Obtained from an Angolan man with severe disease. CSF WBC is >100/uL

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 5

1. Trypanosoma brucei gambiense
2. Features:
   * Geographic location for gambiense
   * Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
   * Pigs, dogs, cattle and other wild animals
   * Importance of reservoirs for gambiense is not understood (unlike rhodesiense where it is part of the transmission cycle)
5. Nifurtimox/Eflornithine Combination Therapy- Adult with suspicion of severe disease and with CSF WBC >100/uL then NECT is recommended

Question 6

Obtained from a 5yo NE Ugandan child. LP needed and CSF WBC is <5/uL

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 6

1. Trypanosoma brucei gambiense
2. Features:
   * Geographic location for gambiense
   * Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
   * Pigs, dogs, cattle and other wild animals
   * Importance of reservoirs for gambiense is not understood (unlike rhodesiense where it is part of the transmission cycle)
5. Pentamidine - Child <6 yo or <20 kg with suspicion of severe disease and with CSF with WBC <5/uL and no trypanosomes then pentamidine is recommended

Question 7

Obtained from a 5yo child from Chad. LP needed CSF WBC is >5/uL

1. Name this parasite
2. State your reasons
3. Name the vector to the genus level for this parasite
4. Name one reservoir for this parasite
5. What is the recommended treatment for this infection?

Answer 7

1. Trypanosoma brucei gambiense
2. Features:
   * Geographic location for gambiense
   * Trypomastigote with a small posterior kinetoplast
3. Glossina spp (Tsetse fly)
4. Reservoir
   * Pigs, dogs, cattle and other wild animals
   * Importance of reservoirs for gambiense is not understood (unlike rhodesiense where it is part of the transmission cycle)
5. Nifurtimox/Eflornithine Combination Therapy - Child <6 years or <20 kg with suspicion of severe disease and with CSF with WBC >5/uL or with trypanosomes then NECT is recommended