Case presentation in infectious disease 地點:檢驗科會議室 時間: 94/12/26 10:00 AM Supervisor : 盧章智主任

Chief complain headache, anorexia, diarrhea, vomiting, chills, fever, night sweats, and increasing sleepiness for weeks

Present illness A 25-year-old woman recently returned to USA from a 2-week safari vacation in Tanzania (East Africa) Visit several game parks during stay in Africa ask help to ER complaining of as mentioned for weeks experience of many bug bites during her to game parks

Past and personal Hx No mentioned in the case

Physical exam a pale, emaciated woman with a painless, erythemtous lesion located on shoulder No adenopathy was noted

Lab data B/R : systemic inflammatory response Platelet :75000 (15*10 3 -40*103 ) CRP: 210 mg/l (<0.3) Hgb: 8.5 g/dl (anemic ,which type ?)

Blood smear Slender type Stumpy type Slender type A arge number of pleomorphic hemo-fkgellates, some being slender and some being stumpy, were visible

Differential diagnosis

Morphology of hemoflagellate of human

Single promastigote form

pleomorphism

Differential diagnosis

Differential diagnosis African trypanosomiasis (sleeping sickness) , which type?

Difference between T .brucei rhodesiense and gambience T. brucei gambience T. Brucei rhodesience Toxicity Lower to human and livestock Higher to human and livestock Host reservoir Human ,most Animal ,most vector G .palpalis(帕舌蠅) (tsetse fly) G.Morsitans(毛舌蠅) geographic location West Africa East Africa habitat River Grassland and park Clinical feature Chancre Winterbottom”sign Rapid progression of symptoms (within several weeks)

Geographic distribution

Winterbottom ‘ sign Posterior neck Ln enlargement

Final diagnosis Trypanosoma .brucei rhodesience

Treatment Suramin (germanin)-early stage Melarsoprol (Mel B -arsenical) –CNS toxicity

Diagnosis criteria Detection parasite in bloodstream Enlarged lymph node aspirate CSF fluid study –protein and cell content Complement fixation test Fluorescence antibody test Elevated IgM count conc in blood and CSF

Thanks for your attention!