A 61-year-old Polish man was admitted to the Department because of high-grade
fever and multi-organ dysfunction after a tourist trip to East Africa. He experienced a single tsetse fly
bite during a safari trip to the Queen Elizabeth National Park in Uganda. On admission, his clinical status was severe, with high
fever of 41ºC, preceded by
chills,
bleeding from the gums and oral mucosa, haemorrhages at the sites of venipuncture, numerous
ecchymoses, fine-spotted
skin rash,
tachycardia, hepatosplenomegaly,
dehydration,
jaundice, dyspnoea, hypoxaemia, generalised oedema and
oliguria. There was a typical non-painful trypanosomal
chancre with central
necrosis and peripheral
erythema on his left arm. Laboratory investigations showed leucopenia,
thrombocytopenia,
haemolytic anaemia, hyperbilirubinaemia, hypoglycaemia, elevated
creatinine and
urea, high activity of
aminotransferases, elevated levels of inflammatory markers, hypoproteinaemia,
proteinuria, abnormal clotting and bleeding times, low
fibrinogen level,
metabolic acidosis, and
electrolyte disturbances. A peripheral blood smear showed numerous Trypanosoma brucei trypomastigotes with a massive parasitaemia of 100,000/μl. T. brucei rhodesiense subspecies was finally identified on the basis of the characteristic serum resistance-associated gene using a polymerase chain reaction, and a seroconversion of specific
immunoglobulin M and G
antibodies in the peripheral blood by
enzyme-linked
immunosorbent assay. Serological tests for T. brucei gambiense subspecies were negative. A severe
clinical course of acute rhodesiense
trypanosomiasis with
renal failure, respiratory distress,
disseminated intravascular coagulation syndrome,
haemolysis,
liver insufficiency and
myocarditis was confirmed. Intensive anti-parasitic and symptomatic treatment was immediately instituted, including intravenous
pentamidine,
plasmaphereses,
oxygen therapy,
blood transfusion,
catecholamine administration, and fluid infusions, as well as haemostatic, hepatoprotective, anti-inflammatory,
antipyretic and
diuretic drugs. The final outcome was a full recovery with no late sequelae.
CONCLUSION: