African Sleeping Sickness Now In Maryland

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African Sleeping Sickness Now In Maryland

By Patricia Doyle PhD
12-28-16

Hello Jeff - Now we have a case of Trypanosomiasis African - Sleeping Sickness - brought to the US ex Africa and the patient was a 'traveler' from East Africa. I do not know if he is a citizen of either Botswana and Zambiaor who works in the US…or if he is an American tourist.

The main vector of Trypanosomiasis African is the tse tse fly which does not exist in the US.

I often wondered if the parasite could be carried by another insect, maybe the Kissing Bug. There is no literature on such a theory. The speculation is that it's probably not, i.e. kissing bugs won't be able to vector the African parasite. Hopefully not, as Obama has seen to it that the US is now swamped with imported African savages.

Patty

Published Date: 2016-12-26
Subject: PRO/AH/EDR> Trypanosomiasis, African - USA: (MD) ex Botswana, Zambia
Archive Number: 20161226.4723752

TRYPANOSOMIASIS, AFRICAN - USA: (MARYLAND) ex BOTSWANA AND ZAMBIA
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Date: Thu 22 Dec 2016
Source: The Washington Post (edited)
https://www.washingtonpost.com/news/to-your-health/wp/2016/12/22/medical-detectives-raced-to-save-a-man-from-a-rare-universally-lethal-disease/

A Baltimore [Maryland] software engineer got sick the day after he returned from a safari in Botswana and Zambia last month [November 2016]. He was hospitalized after about a week of fever and chills.

The patient spent about 4 weeks this fall in Botswana and Zambia with his family. They roamed game parks without guides, and returned to the United States on [19 Nov 2016]. The man developed fever the following day, got progressively worse and by [1 Dec 2016] the patient had nausea and was having bad night sweats. His wife drove him to the Greater Baltimore Medical Center in Towson, Maryland, where he was admitted to the intensive care unit.

Clinicians took a detailed travel history and microscopy of a blood film showed that he was infected with trypanosomes causing sleeping sickness [African trypanosomiasis]. The disease has 2 forms, both transmitted by the tsetse fly, which lives only in rural Africa. The parasites for both forms look identical.

West African trypanosomiasis accounts for virtually all reported cases of sleeping sickness, according to the World Health Organization. A person can be infected for months or years without major signs or symptoms of the disease. If left untreated, death will eventually occur after several years of infection.

Initial symptoms include fever, headache, and muscle and joint aches. Left untreated, the disease progresses to the central nervous system, leading to personality changes, daytime sleepiness and progressive confusion, according to the CDC.

East African trypanosomiasis is more rare but kills within months. Nearly all cases of East African trypanosomiasis are reported in parts of eastern and southeastern Africa, including Uganda, Tanzania, Malawi, and Zambia. People at greatest risk are tourists, hunters and others working in or visiting game parks, where hoofed animals are the main reservoirs for the parasite that causes the disease and tsetse flies are common.

Over the past century, the disease has caused several epidemics in Africa, and those hardest hit live in the most remote parts of the continent. In the United States, most cases of sleeping sickness have been in travelers such as this patient, on safari in East Africa.

Which medicines to use? Suramin, discovered in 1920, is used to treat patients with the East African form if the parasites are only in blood. But if the parasites have reached the central nervous system, a much more toxic medication is the only treatment. Called melarsoprol, it is basically arsenic.

The patient was transferred to Hopkins, an academic medical center with more resources and expertise, where treatment was started with suramin and within days the patient was feeling better. On [8 Dec 2016], he was discharged, one week after he showed up in the emergency room.

[Byline: Lena H Sun]

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Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the latest map of distribution from the WHO, Zambia reported fewer than 50 cases in 2014, but data are lacking from Botswana (http://www.who.int/trypanosomiasis_african/country/en/).

ProMED has published reports of African trypanosomiasis (see below): in 2015 a similar case was reported in a Canadian tourist who had also been on safari in Zambia. A small outbreak was reported in April 2014 in Rufunsa District in Lusaka Province (Zambia) with 8 cases. In 2010 ProMED reported 3 cases in travellers who had visited game parks in Zambia, like this patient, and diagnosed in South Africa, USA, and UK respectively.

The cases in Zambian nationals further emphasize that trypanosomiasis is still a risk in rural areas and game parks in Zambia. Visitors to game parks should be aware of the risk posed by tsetse flies and avoid being bitten. - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/promed/p/170.]