1. 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

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

3. 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

4. Past and personal Hx
No mentioned in the case

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

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

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

8. Differential diagnosis

9. Morphology of hemoflagellate of human

10. Single promastigote form

11. pleomorphism

12. Differential diagnosis

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

14. 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)

15. Geographic distribution

16. Winterbottom ‘ sign
Posterior neck Ln
enlargement

17. Final diagnosis
Trypanosoma .brucei rhodesience

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

19. 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

20. Thanks for your attention!