Ann IM 1977;86:633

Cause: Trypanosoma gambiense, rhodesiense

Pathophys: Vascular cuffing and obliteration in CNS; destruction of lymph nodes leading to fibrosis

Via tsetse fly (Glossina sp) from ungulate reservoir; Africa, occasionally seen in returning US visitors

Inoculation through bite of fly, local multiplication, parasitemia in 3 wk, sucked up by fly, develops in fly gut, then migrates to salivary glands

Sx: Fever, weight loss

Si:Edema of face, etc; hyperesthesia; splenomegaly; cervical lymph nodes; rash; chancre

Virulent (fatal in days), to chronic

Encephalitis w apathy and somnolence punctuated by intermittent mania

Lab:

Hem and CSF: Wet smear shows many polymorphic, squirming organisms

Serol:Comp-fix or agglutination antibody elevations

Rx:

Prevent w insecticide, use to clear brush around homes of tsetse fly; relocation to urban areas

Prophylaxis w suramin or pentamidine, but risk of disease is less than the toxicity of drugs (Ann IM 1972;77:797)

of early disease, above drugs; of late, melarsoprol, eflorinthine