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Archive Number 20090724.2613
Published Date 24-JUL-2009
Subject PRO/AH/EDR> Trypanosomiasis - Netherlands ex Tanzania (SE)
TRYPANOSOMIASIS - NETHERLANDS ex TANZANIA (SERENGETI)
******************************************************
A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 23 Jul 2009
Source: TropNetEurop [edited]
<http://www.tropnet.net/index_2.html>


Trypanosomiasis in a Dutch tourist infected in Serengeti National Park
----------------------------------------------------------------------
On [Sun 12 Jul 2009], a 25-year-old Dutch woman was admitted to a 
hospital in the Netherlands because of fever and cellulitis of the 
left forearm.

She had returned the same day from her holiday to Tanzania. Eight 
days before she had been bitten by gray brown flies during her visit 
to the Serengeti Park.

Four days before admission a red papule developed, which became 
larger with a central blister. The day of admission she developed 
fever and headache. She appeared moderately ill. Body temperature was 
39.4 deg C [102.9 deg F]; pulse rate 108 per min; blood pressure 
140/70 mmHg.

On her left arm a large soft swelling was seen with a central dark 
blue center covered by a blister. Later a distinct lymphangitis was 
seen. The was no lymphadenopathy. Laboratory examination showed a 
leukocyte count of 5.4 x 10e9/L; thrombocyte count 279 x 10e9/L.

In the blood film 2 trypomastigotes were seen. Lumbar puncture 
revealed 1 leukocyte, protein concentration was normal. The diagnosis 
of stage 1 human African trypanosomiasis by _Trypanosoma brucei 
rhodesiense_ was made, and treatment with suramin was started.

--
Communicated by:
Tomas Jelinek
TropNetEurop
<jelinek@bctropen.info>

and

Leo Vlisser
Leiden, The Netherlands
<L.G.Visser@lumc.nl>

******
Comment from WHO
----------------
The last visitor infected in Serengeti was an American tourist 
treated in South Africa early June this year [2009]. Although he 
presented multi-organ failure and a borderline CSF [cerebrospinal 
fluid], he was treated with the same suramin regime (WHO technical 
report series 881, annex 1) and he recovered.

Due to recent reports on cases infected from Serengeti, WHO organized 
last April [2009] in Mugumu hospital a capacity building session on 
human African trypanosomiasis diagnosis and treatment for health 
facilities in and around Serengeti National Park. The training was 
conducted by staff of the WHO Collaborating Centre for Research and 
Training on Human African Trypanosomiasis Diagnostics (Parasite 
Diagnostics Unit, Department of Parasitology, Institute of Tropical 
Medicine Antwerp) and the National Institute for Medical Research, in 
Tanzania (Tabora Medical Research Centre). 14 health facilities were 
involved. After this training, in addition of cases from Serengeti, 
cases from Waso district in Ngorongoro have been also reported.

--
Dr Pere P Simarro
Human African Trypanosomiasis
Innovative and Intensified Disease Management
Control of Neglected Tropical Diseases
Telephone: +41.22.791.1345
Fax: +41.22.791.4777
<simarrop@who.int>

[Trypanosomiasis is endemic in Central Africa and has been emerging 
in the Congo DR over the past 15 to 20 years [see ProMED-mail 
Trypanosomiasis, African: emerging (02) 20000816.1363].

In 2001, ProMED-mail reported 10 cases of trypanosomiasis in tourists 
visiting Serengeti and Tarangire national parks, and an additional 2 
cases were reported in 2005. The case reported in October 2008 was 
not infected in the Serengeti National Park, but the report of this 
case and the comment from the WHO indicate that trypanosomiasis is a 
risk in the park. - Mod.EP]

Serengeti National Park can be located on the HealthMap/ProMED-mail 
interactive map of Tanzania at
<http://healthmap.org/r/00Cm>. - Sr.Tech.Ed.MJ]

[see also:
2008
----
Trypanosomiasis, African - Tanzania: (NW) 20081103.3455
2005
----
Trypanosomiasis - USA ex Tanzania (Serengeti): RFI 20050713.1989
2001
----
Trypanosomiasis - Africa 20011011.2477
Trypanosomiasis - Europe ex Tanzania 20010316.0535
Trypanosomiasis - Europe ex Tanzania (05) 20010624.1197
Trypanosomiasis - Kenya 20010511.0912
Trypanosomiasis - Uganda 20010414.0744
Trypanosomiasis - Uganda (03) 20010826.2029
2000
----
Trypanosomiasis, African - Australia ex Tanzania 20001107.1943
Trypanosomiasis, African - Tanzania 20001106.1935
Trypanosomiasis, African: emerging 20000808.1320
Trypanosomiasis, African: emerging (02) 20000816.1363]
...................................ep/mj/lm

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