Wüstenschiff

TRYPANOSOMIASIS - USA ex ZAMBIA: (EASTERN)
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Date: Mon 13 Sep 2010
Source: GeoSentinel [edited]
<http://www.geosentinel.org>


Trypanosomiasis (sleeping sickness) in a traveler visiting Zambia
-----------------------------------------------------------------
GeoSentinel, the global surveillance program of the International
Society of Travel Medicine (ISTM) wishes to report a case of African
trypanosomiasis due to _Trypanosoma brucei rhodesiense_ in a traveler
who returned from Zambia in August [2010].

The diagnosis was proven by peripheral blood film and there was no
involvement of the central nervous system. The patient was treated
with suramin and has recovered.

Dr Devon Hale of the Salt Lake City (UTH) GeoSentinel Site reports
that the US traveler was on a hunting safari in a reserve in the
South Luangwa river valley in Eastern [province] Zambia just south of
the South Luangwa National Park. Of note, another case of
travel-related trypanosomiasis was reported in August [2010] in the
monthly bulletin of the South African National Institute of
Communicable Diseases (Communicable Diseases Communique
<http://www.nicd.ac.za>). That case was diagnosed in a Zambian
national living in southeastern Zambia and who had experienced
multiple tsetse fly bites on visits to his game ranch also in the
South Luangwa valley.

The last published case of travel-related trypanosomiasis from Zambia
was one acquired in the 1990s [Emerg Infect Dis. 2002 Jan; 8(1): 74-6
<http://www.cdc.gov/ncidod/eid/vol8no1/01-0130.htm>] and an enquiry
to the US CDC indicated that the last case in an American traveler
returned home from Zambia was in 1986. These 2 cases in close
temporal proximity may represent sentinel events for increased focal
activity in the South Luangwa valley, a known endemic area, or may
represent increased incursions by hunters and travelers into the
sparsely populated area.

Although most travel related cases of _T. brucei rhodesiense_ in
recent years have been acquired in Tanzania this is likely related to
the large numbers of photo safari tourists to Tanzania. The South
Luangwa valley sees more specialized tourism but may represent a
focus of risk that would be meaningful to the individual traveler.

We would be interested in hearing of any further recent cases from Zambia.

--
Communicated by:
David O Freedman, MD (Birmingham, Alabama, USA)
DeVon C Hale, MD (Salt Lake City, Utah, USA)
for GeoSentinel
<geosentinel@geosentinel.org>

[Tsetse (_Glossina morsitans_) is widespread in most of Eastern and
Northern Zambia (see FAO map of distribution at
<http://www.fao.org/AG/AGAInfo/programme ... _morsV.pdf>
and _Trypanosoma_ has a reservoir in wild game, for instance
buffaloes. It is therefore not surprising that a hunter in close
contact with game in an area with tsetse flies becomes infected.
ProMED thanks Drs. Freedman and Hale for submitting this report. -
Mod.EP]

[Photos of tsetse flies can be seen at
<http://www.raywilsonbirdphotography.co. ... nidae.html>.

A map showing the provinces of Zambia and the Luangwa River can be seen at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>.
South Luangwa National Park can be located via the
HealthMap/ProMED-mail interactive map at
<http://healthmap.org/r/07G9>. - Sr.Tech.Ed.MJ]

Sambia - Schlafkrankheit
08.10.2010

Mitte September ist eine 55-jährige Engländerin an den Mana Pools in der Nähe des Kariba-Sees mit Trypanosomen infiziert worden. Sie wird in London behandelt. Bei einem amerikanischen Reiserückkehrer aus Sambia wurde im August die Schlafkrankheit nachgewiesen. Er war Teilnehmer einer Jagdsafari im South Luangwa River Valley Reservat (südlich des South Luangwe Nationalparks). Zuvor war ein weiterer Fall eines Einheimischen gemeldet worden. Schutz vor Tsetse-Fliegen beachten. / Quelle: crm

TRYPANOSOMIASIS, AFRICAN - UK: ex ZAMBIA, ZIMBABWE
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In this posting:

[1] UK ex Zambia
[2] UK ex Zimbabwe

******
[1] UK ex Zambia
Date: Wed 20 Oct 2010
From: Mike Beadsworth <Mike.Beadsworth@rlbuht.nhs.uk> [edited]


African trypanosomiasis due to _Trypanosoma brucei rhodesiense_ in a
traveller returning from Zambia
----------------------------------------------------------------------
The 49 year old female was camping in Zambia for 15 days. Her
itinerary was as follows:
29 Sep 2010 flew from UK to Malawi; 30 Sep 2010 in Lilongwe (Malawi);
1-3 Oct 2010 in South Luangwa National Park; 4 Oct 2010 in Bridge
Camp (en route to Lower Zambezi); 5-7 Oct 2010 in Lower Zambezi
National Park; 8 Oct 2010 in Lusaka; 9-11 Oct 2010 in Kafue National
Park (north part); 12-14 Oct 2010 in Kafue National Park (south
part); 15 Oct 2010 in Livingstone; 16 Oct 2010 returned to UK.

The patient experienced numerous tsetse fly bites during her trip.
She developed fever and headache on day 10 (13 Oct 2010) and received
empirical treatment for malaria. 5 days later, upon her return to the
UK, she presented with ongoing symptoms and was transferred to the
Tropical and Infectious Diseases Unit at the Royal Liverpool
University Hospital. Trypanosomiasis was diagnosed at the Liverpool
School of Tropical Medicine after examination of a peripheral blood
film, which indicated a high parasitaemia. The patient is currently
receiving a treatment course of suramin with lumbar puncture awaited.

This report follows the communication 1 month ago to ProMED-mail of a
US traveller who similarly developed African trypanosomiasis while on
a hunting safari in the South Luangwa river valley in Zambia [see
ProMED-mail Trypanosomiasis - USA ex Zambia: (EA) 20100915.3338].

As members of the GeoSentinel Surveillance Network we are also
reporting this case to GeoSentinel.

--
Lucy E Cottle
Berti Squire
Jo Peters
Wendi Bailey
Nicholas J Beeching
Mike Beadsworth
Tropical and Infectious Disease Unit
Royal Liverpool University
Hospital, Liverpool
and the Liverpool School of Tropical Medicine
United Kingdom
<Mike.Beadsworth@rlbuht.nhs.uk>

[The HealthMap/ProMED-mail interactive map of Zambia is available at
<http://healthmap.org/r/017r>.
A map of Zambia showing the parks mentioned can be seen at
<http://lcafrica.org/images/uploaded/map_of_zambia.jpg>.

******
[2] UK ex Zimbabwe
Date: Wed, 20 Oct 2010
From: Jane A Jones <Jane.Jones@hpa.org.uk> [edited]


Trypanosomiasis (sleeping sickness) in a traveller visiting Zimbabwe/Zambia
----------------------------------------------------------------------
The Health Protection Agency in England wishes to report a case of
African trypanosomiasis in a traveller who visited Zimbabwe/Zambia
between 29 Aug 2010 and 12 Sep 2010.

The patient presented with fever and confusion; diagnosis was proven
by peripheral blood film showing a heavy parasitaemia. The clinical
and travel history, and degree of parasitaemia are consistent with
_Trypanosoma brucei rhodesiense_. The patient is currently being
treated with suramin pending further investigations.

The patient stayed in the Mana Pools National Park in Zimbabwe (which
is close to the Lake Kariba region in Zimbabwe in Mashonaland West,
and on the border with the Southern province of Zambia) from 1-8 Sep
2010 and was reportedly heavily bitten by tsetse flies during this
stay. The patient had also stayed in and around Lusaka in Zambia
during the trip, but tsetse flies were not reported from these
locations.

This travel associated case has been notified to WHO and through them
to the Zimbabwean Public Health Authorities.

--
Dr Jane A Jones
Centre for Infections
Health Protection Agency
United Kingdom
<Jane.Jones@hpa.org.uk>

[The HealthMap/ProMED-mail interactive map of Zimbabwe is available at
<http://healthmap.org/r/0d*5>.
Mana Pools National Park in northern Zimbabwe can be located on the map at
<http://lcafrica.org/images/uploaded/map_of_zimbabwe.jpg>. - Sr.Tech.Ed.MJ]

[Photos of tsetse flies can be seen at
<http://www.raywilsonbirdphotography.co. ... nidae.html>.
Several recent cases of trypanosomiasis have been reported in
travellers to the South Luangwa valley area, which is in the Eastern
province of Zambia.

A 2007 WHO report on human African trypanosomiasis stated that "South
Africa and Great Britain sporadically report cases, generally
tourists visiting the Kariba lake region, along the border between
Zambia and Zimbabwe. A total of 9 cases were reported in 1997; since
then, only in 2004, 4 cases were treated in South Africa coming from
Kariba lake region." (Source:
<http://whqlibdoc.who.int/hq/2007/WHO_CD ... .6_eng.pdf>).

It is difficult to ascertain whether an increasing number of cases
reflect an increased risk or an increased number of visitors to risk
areas. Our thanks to the individuals reporting these cases. - Mod.EP]

TRYPANOSOMIASIS, AFRICAN - ZAMBIA: (EASTERN)
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Date: Wed 10 Nov 2010
From: Lucille Blumberg <lucilleb@nicd.ac.za> [edited]


Trypanosomiasis from Luangwa river, Eastern Zambia
--------------------------------------------------
Trypanosomiasis was confirmed in Johannesburg in a young woman resident in
Lusaka, Zambia who presented with an acute febrile illness 4 days after
returning from a 5 day visit to the Luangwa river area in Eastern Zambia.

She experienced multiple tsetse fly bites while hiking in the area, but did
not travel into the National Park. The diagnosis of trypanosomiasis was not
initially suspected and she received treatment with artemisinin combination
therapy for suspected malaria and then doxycycline for suspected tick bite
fever based on the presence of an 'eschar' and macular papular rash.

The patient developed profound leucopenia and thrombocytopaenia, and a
transaminitis and was transferred to Johannesburg for further medical care.
East African trypanosomiasis was suspected on the basis of the history of
exposure to tsetse flies in an area with well- documented trypanosomiasis,
and the finding of a typical trypanosomal chancre.

Her illness has been complicated by acute respiratory distress syndrome,
disseminated intravascular coagulation, and hepatic dysfunction. Suramin
treatment has been commenced, supportive care initiated, and a
cerebrospinal fluid examination will follow.

--
Lucille Blumberg, John Frean, Hussein Pahad, Marc Mendelson
National Institute for Communicable Diseases
National Health Laboratory Service
Number 1 Modderfontein Road,
Sandringham Johannesburg
South Africa
<lucilleb@nicd.ac.za>

[This case was infected in the same area -- Luangwa river -- as the
previous case in a US traveler, which ProMED-mail reported on 13 Sep 2010.
Two cases were imported to the UK, one had visited Zambia and the other
Mana Pools National Park in Zimbabwe (close to the Lake Kariba region in
Zimbabwe in Mashonaland West, and on the border with the Southern province
of Zambia.)

The US traveler was on a hunting safari in a reserve in the South Luangwa
river valley in eastern Zambia just south of the South Luangwa National Park.

Of note, another case of travel-related trypanosomiasis was reported in
August 2010 in the monthly bulletin of the South African National Institute
of Communicable Diseases (Communicable Diseases Communique
<http://www.nicd.ac.za/pubs/communique/2 ... l09_08.pdf>,
page 5). - Mod.EP

Photos of tsetse flies can be seen at
<http://www.raywilsonbirdphotography.co. ... nidae.html>.

A map showing the provinces of Zambia and the Luangwa River can be seen at
<http://www.un.org/Depts/Cartographic/ma ... zambia.pdf>. The
HealthMap/ProMED-mail interactive map of Zambia can be found at
<http://healthmap.org/r/0fJ4>. - Sr.Tech.Ed.MJ]

Schlafkrankheit: Erreger beherrscht drei verschiedene Schwimmarten

Der Erreger der Schlafkrankheit, die in Afrika und Südamerika jährlich tausende Todesopfer fordert, gehört zu den mobilen Einzellern: Eigenständig schwimmt er durch den Blutkreislauf seines Wirtes, bis er im letzten Stadium der Krankheit die Blut-Hirn-Schranke überwindet und ins Gehirn seines Opfers vordringt. mehr...

Grüsse
Alexander

TRYPANOSOMIASIS - ANGOLA
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Date: Thu 7 Jul 2011
Source: Angola Press [edited]
<http://www.portalangop.co.ao/motix/es_e ... 4f7be.html>


Sleeping sickness reported in Luanda
------------------------------------
A total of 76 cases of sleeping sickness were diagnosed in the 1st
half of this year [2011] in the 6 endemic provinces of the country --
that is, Malanje, Uije, Kwanza Norte, Kwanza Sul, Bengo, and Zaire.

According to the national supervisor of the Institute of Combat and
Control Trypanosomiasis (ICCT), Daniel Mafuta, the patients were in
the 32 thousand people tested in 220 diagnostic centers and 6 teams.

The 6 mobile teams carried out a campaign tracking in June [2011],
where 20 000 people were examined, and 7 new cases of sleeping
sickness diagnosed.

The teams worked in the districts of Calculation and Kahango (Bengo),
San Pedro of Kilembe and the municipality of Lucala (Kwanza Norte),
Kizemga (Malanje) Kimari and Lukunga (Uije) and NPAL and Lufico
(Zaire).

Under a campaign against the tsetse fly which started in March and
will end in August [2011], 6518 traps were placed and captured 1 341
072 flies.

This campaign is associated with fumigation and spraying areas hit,
or infested by the tsetse fly.

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[Programme Against African Trypanosomosis
(PAAT)<http://www.fao.org/ag/againfo/programme ... /home.html>):

Trypanosomosis affects both people and animals and occurs in 37
sub-Saharan countries covering more than 9 million square kilometers
[3 474 919 square miles], an area which corresponds approximately to
one third of the Africa's total land area. The infection threatens an
estimated 60 million people and about 50 million head of cattle.

Currently, between 50 000 and 70 000 people are estimated to be
infected. Every year, African trypanosomosis causes about 3 million
deaths in cattle while about 35 million doses of trypanocidal drugs
are administered. The economic losses in cattle production alone are
in the range of USD 1.0 - 1.2 billion. A ponderated evaluation
extrapolated for the total tsetse-infested lands values total losses,
in terms of agricultural gross domestic product, at USD 4.75 billion
per year.

HealthMap location: <http://healthmap.org/r/11pz>. â&#128;&#147; Mod.EP]

Nebenwirkungsfreies Mittel gegen Schlafkrankheit
07.09.2011 - spektrumdirekt

Schätzungsweise 30 000 Menschen sind laut WHO mit der tödlichen Afrikanischen Schlafkrankheit (Trypanosomiasis) infiziert. Im späten Stadium der ostafrikanischen Form ist die einzige Behandlungsmöglichkeit derzeit die Arsenverbindung Melarsoprol. Allerdings führt Melarsoprol bei fünf Prozent der Behandelten zum Tod und hinterlässt viele weitere Patienten mit bleibenden Hirnschäden. Dank einer Weiterentwicklung des Präparats ist nun Besserung in Sicht: In einer Modellstudie an Mäusen heilte es alle Tiere ohne offensichtliche Nebenwirkungen ... mehr

Gruß
Birgitt

TRYPANOSOMIASIS - ANGOLA: (CUANZA NORTE)
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Date: Wed 25 Jan 2012
Source: Angop Health [edited]
http://www.portalangop.co.ao/motix/en_u ... 201ad.html


At least 47 new cases of trypanosomiasis were diagnosed from January to December 2011 in northern Kwanza Norte province, with no deaths.

According to the director of the provincial health department, Manuel Duarte Varela, who reported the fact to ANGOP, the above mentioned figure indicates one case more than in the same period of the previous year [2010]. He explained that the positive cases resulted from 44 020 tests performed during that period [January-December 2011]. Manuel Varela explained that in the period under analysis, 44 patients received treatment, and 33 were completely cured.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Human trypanosomiasis, or sleeping sickness, is endemic in northern Angola. For background information on human trypanosomiasis in Africa see the ProMED posting "Trypanosomiasis - Angola 20110709.2081." - Mod.EP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1iGj.]

Ein Deutscher Urlauber ist nach einem Ausflug in die Massai Mara an Trypanosomiasis erkrankt -
die Safari war vom 18.-19.01.2012. Er wird derzeit in einer Klinik in Frankfurt a.M. behandelt.


TRYPANOSOMIASIS, HUMAN - GERMANY ex KENYA: MASAI MARA
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Date: Tue Jan 31 2012
From: Timo Wolf [edited]


A case of trypanosomiasis imported from Masai Mara, Kenya was diagnosed in Frankfurt, Germany.

A 61-year-old male patient had returned from Kenya on 28 Jan 2012. Two hours after arrival, he developed a high fever and admitted himself to a local hospital on 29 Jan 2012. Treatment was started for suspected malaria tropica [_Plasmodium falciparum_], and the patient was transferred to Frankfurt University Hospital the following day. Malaria could not be confirmed, but trypanosomes were seen in thick blood stain, QBC and Giemsa. Treatment was started with Suramin.

Clinically, the patient suffered from high fever, cephalgia [headache] and fatigue. There was a marked inoculation eschar [scar from insect bite] on the tibia.

The patient had travelled to Mombasa where he stayed at a beach resort the entire time except for a 2-day excursion to Masai Mara for a safari on 18-19 Jan 2012. The night was spent at a camp. The other member of the travel party does not show any symptoms of trypanosomiasis to date.

--
Dr. Timo Wolf
Prof. Dr. G. Just-Nuebling
Prof. Dr. T. Wichelhaus
Dept. of Infectious Diseases / Institute of Hygiene Microbiology
Hospital of the J. W. Goethe University
Frankfurt, Germany


[It has been almost 11 years since ProMED-mail last reported on trypanosomiasis in Kenya (see the posting from 11 May 2001 below). At that time, there had been several reports of tourists being infected in the national parks in Tanzania, and the Kenyan authorities reported the spread of tsetse flies to Kenya. The report shows that there is a risk, although small, to tourists in the Kenyan game park. - Mod.EP]

[African trypanosomiasis is also known as sleeping sickness, and is spread by the bite of tsetse flies; photo at:
http://www.sciencephoto.com/image/36948 ... rm-SPL.jpg
Life cycle of trypanosome:
http://microbewiki.kenyon.edu/images/c/ ... eCycle.gif
Geographic range of tsetse fly:
http://analarcher.files.wordpress.com/2 ... tsemap.jpg
According to Kenya statistics, there were 2.385 million visitors to its Parks & Game reserves in 2009, most from outside Africa -- see:
http://www.tourism.go.ke/ministry.nsf/p ... ts_figures
- Mod.JW

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1zkN.]

Ein Belgischer Urlauber ist nach einem Ausflug in die Massai Mara an Trypanosomiasis erkrankt -
die Safari war vom 07.-09.02.2012. Er wird derzeit in einer Klinik in Antwerpen behandelt.


TRYPANOSOMIASIS - BELGIUM ex KENYA: (MASAI MARA)
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Date: Wed 22 Feb 2012
From: Emmanuel Bottieau [edited]


Early stage _Trypanosoma rhodesiense_ HAT in a Belgian traveler visiting Masai Mara, Kenya
----------------------------------------------------------------------
A Belgian adult male traveler had stayed in Kenya from 30 Jan to 13 Feb 2012 to Kenya, and visited Masai Mara from 7 Feb until 9 Feb 2012. Details about the places visited in that game park will follow soon.

He had fever from 16 Feb 2012 onwards and a diagnosis of human African trypanosomiasis (HAT) was made on a thick film in another Belgian hospital on 19 Feb 2012. The patient was transferred the next day to the inpatient ward for tropical diseases of the Institute of Tropical Medicine, University Hospital Antwerp, Belgium, for treatment.

He had a painless chancre on his left upper arm and had fever, malaise, and headache on admission.

The prepatent period lasted thus 7 to 9 days, and the hematogenic phase of the acute disease before diagnosis (and treatment) was 4 days. This short period precludes brain invasion, which may occur from the 3rd week after the blood stage becomes apparent.

The patient was promptly treated with suramin soon after transfer on 20 Feb 2012. Pretreatment blood analysis showed a high parasitemia, marked thrombocytopenia (47.000/=B5L), ALAT/ASAT 3x UNL, and moderately increased CRP. An ECG showed diffuse S-T elevation. So far no other complications occurred, and patient's condition is not life-threatening.

Acute rhodesiense trypanosomiasis has to be regarded as a medical emergency, requiring immediate treatment with suramin or, when suramin cannot be obtained within a day, with pentamidine. Treatment delay results often in a rapidly progressive multi-organ dysfunction with high mortality.

--
Jan Clerinx, MD
Emmanuel Bottieau, MD, PhD

Institute of Tropical Medicine of Antwerp
Belgium

[This is the 2nd case of HAT in a tourist visiting Masai Mara within a month (see ProMED-mail posting Trypanosomiasis, human - Germany ex Kenya: Masai Mara 20120202.1031130).

A review of cases imported into trypanosomiasis non-endemic countries identified 95 cases from 19 countries (Simarro PP et al: Human African Trypanosomiasis in Non-Endemic Countries (2000-2010). J Trav Med 2012; 19(1): 44-53; available at http://onlinelibrary.wiley.com/doi/10.1 ... 576.x/full).
Cited from the paper: "Cases of Rhodesiense HAT were mainly diagnosed in tourists after short visits to DECs [disease endemic countries], usually within a few days of return. The majority of them were in 1st stage. Initial misdiagnosis with malaria or tick-borne diseases was frequent. Cases of Gambiense HAT were usually diagnosed several months after initial examination and subsequent to a variety of misdiagnoses. The majority were in 2nd stage. Patients affected were expatriates living in DECs for extended periods and refugees or economic migrants from DECs."

The paper concludes that "the risk of HAT in travelers and migrants, albeit low, cannot be overlooked."

A map of the geographic range of tsetse flies can be found in ProMED-mail posting 20120202.1031130.

A HealthMap/ProMED-mail interactive map of Kenya can be seen at http://healthmap.org/r/1J6F. - Mod.EP]

Kenia - Schlafkrankheit
23.02.2012

Innerhalb eines Monats ist der zweite Tourist erkrankt, nachdem er sich während einer Urlaubsreise im Februar drei Tage in der Masai Mara aufgehalten hatte. Es handelt sich um einen Belgier, 3 Tage nach Rückkehr entwickelte er Fieber, Kopfschmerzen, Abgeschlagenheit, aktuell wird er in einer tropenmedizinischen Abteilung in Antwerpen behandelt. Am 28. Januar erkrankte ein 61-jähriger Deutscher, ebenfalls nach Rückkehr aus der Masai Mara. Safari-Reisende in Ostafrika, speziell in Wildreservate, sollten auf das potenzielle Übertragungsrisiko und die Primärsymptome hingewiesen werden, Schutz vor Tsetse-Fliegen beachten und bei verdächtigen Symptomen sofort einen Arzt aufsuchen. Die weitere Diagnostik und Therapie sollte durch einen Tropenmediziner erfolgen. / Quelle: crm

Gruß
Birgitt

Ein Bakterium, das in Endosymbiose mit der Tsetsefliege lebt, könnte helfen, die Afrikanische Schlafkrankheit zu bekämpfen. Belgische Forscher berichten in Microbial Cell Factories (2012, 11: 23), wie sie das Bakterium Sodalis glossinidius gentechnisch so modifizierten, dass es Nanobodies gegen Oberflächenen-Antigene der Trypanosomen bildete.

Schlafkrankheit: „Trojanische“ Bakterien sollen Parasiten stoppen
15.02.2012 - Ärtzteblatt

Gruß
Birgitt

TRYPANOSOMIASIS – KENYA: (MASAI MARA): CDC ALERT
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[1] Date: Fri, Mar 16, 2012
Source: Examiner
http://www.examiner.com/infectious-dise ... g-sickness


CDC issues travel alert concerning African Trypansomiasis
---------------------------------------------------------
The US Centers for Disease Control and Prevention (CDC) issued a travel notice Monday [12 Mar 2012] concerning the prevention of African trypanosomiasis -- see [2] below.

This notice comes after 2 European tourists contracted the deadly parasitic disease after a holiday in Kenya, which included a two day excursion to the Masai Mara National Reserve -- see ProMED archives below.

A study published in the Journal of Travel Medicine last year [2011-- see ref. at end] shows that during the last decade, cases of human African trypoanosomiasis were
reported in travelers who [had visited] national parks, wildlife reserves and
game parks in Tanzania, Malawi, Zambia, and Zimbabwe.

The CDC reports that, on average, the infection is reported in one US
traveler per year; it is usually acquired in East African game parks.

[Byline: Robert Herriman
Infectious Disease Examiner]

[Communicated by:
ProMED-mail from HealthMap Alerts
promed@promedmail.org]

*****
[2] Date: Sat, 17 Mar 2012
Source: CDC: http://wwwnc.cdc.gov/travel/notices/in- ... -kenya.htm


African Trypanosomiasis in Kenya
--------------------------------
What Is the Current Situation?

The form of trypanosomiasis seen in eastern and southeasthern Africa (rhodesiense) was recently reported in two European tourists who visited the Masai Mara National Reserve in Kenya. From 2000 to 2010, cases of human African trypoanosomiasis were reported in travelers who traveled to national parks, wildlife reserves, and game parks in Tanzania, Malawi, Zambia, and Zimbabwe.i Trypanosomiasis is a disease that has been historically found in this region of East Africa.

What Is African Trypanosomiasis (African sleeping sickness)?

African trypanosomiasis, also called African sleeping sickness, is caused by a parasite that is transmitted by an infected tsetse fly. The tsetse fly is found only in sub-Saharan Africa. Symptoms include fatigue, high fever, headaches, and muscle aches. If the disease is not treated, it is fatal. On average, the infection is reported in one US traveler per year; it is usually acquired in East African game parks.

How Can Travelers Protect Themselves?

***No vaccine or drug can prevent African trypanosomiasis. You can prevent the disease by avoiding tsetse flies.

Tsetse flies are found in woodland and savannah areas, and they bite during daylight hours. If you are touring or hunting in a game park, you are most likely to be exposed to tsetse flies. Travelers to cities are not at risk.

Take the following steps to avoid tsetse fly bites:
•Wear protective clothing, including long-sleeved shirts and pants. The tsetse fly can bite through thin fabrics, so clothing should be made of medium-weight material.
•Wear neutral-colored clothing. The tsetse fly is attracted to bright colors, very dark colors, metallic fabric, and the color blue.
•Inspect vehicles for tsetse flies before entering. The flies are attracted to moving vehicles.
•Avoid bushes. The tsetse fly is less active during the hottest period of the day. It rests in bushes but will bite if disturbed.
•Use insect repellent. Although insect repellents have not proven effective in preventing tsetse fly bites, they are effective in preventing other insects from biting and causing illness.

If you are bitten by a tsetse fly during your trip (the bite is often painful), watch for symptoms and see your doctor immediately if you get sick. Be sure to mention that you have been traveling in Africa and that you were bitten by a tsetse fly.

Clinician Information

There are two types of African trypanosomiasis. East African trypanosomiasis is caused by the _Trypanosoma b. rhodesiense_ parasite, which is spread by tsetse flies in eastern and southeastern Africa. West African trypanosomiasis caused by the _T.b. gambiense_ parasite, which is spread by tsetse flies in in western Africa.

With East African trypanosomiasis, illness progresses more rapidly and symptoms generally appear within 1-3 weeks of the bite. Symptoms may include high fever, a sore at the site of the infective bite, skin rash, headache, muscle aches, and less commonly, enlargement of the spleen, kidney failure, or heart problems. Central nervous system involvement can occur within the first month of infection. If untreated it is fatal.

People infected with West African trypanosomiasis may remain without symptoms for many months after the bite. Symptoms and signs may include fever, headache, discomfort, muscle aches, facial swelling, itching, and weight loss. Central nervous system involvement occurs after months of infection and is characterized by drowsiness, severe headache, and a wide range of other symptoms, including mood disorders, behavior change, and endocrine disorders. If untreated, it is eventually fatal.

Diagnosis is made by microscopic identification of parasites in specimens of blood, chancre fluid or tissue, lymph node aspirate, or cerebrospinal fluid. Buffy-coat preparations concentrate the parasite. Parasitemias are higher in T. b. rhodesiense than in T. b. gambiense infection. Serologic tests are not helpful for diagnosis of T. b. rhodesiense. CDC can help arrange serologic testing for T. b. gambiense, which is not available in the United States. Diagnostic assistance is available through CDC’s Division of Parasitic Diseases and Malaria (http://www.dpd.cdc.gov/dpdx).

Medical treatment of East African trypanosomiasis should begin as soon as possible, based on the infected person’s laboratory results. Medication for the treatment of East African trypanosomiasis is available through CDC. Hospitalization for treatment is usually necessary. Periodic follow-up exams that include a spinal tap are required for 2 years.

Additional Information
•African Trypanosomiasis (from Yellow Book)
•African trypanosomiasis (from Division of Parasitic Diseases and Malaria)
•WHO Report on Global Surveillance of Epidemic-prone Infectious Diseases—African trypanosomiasis (Background of Surveillance with Map)

[The article in the Journal of Travel Medicine referred to in the text is:

Simarro PP et al: Human African Trypanosomiasis in Non-Endemic Countries (2000-2010). J Trav Med 2012; 19(1): 44-53; available at http://onlinelibrary.wiley.com/doi/10.1 ... 576.x/full. – Mod. EP

HealthMap location: http://healthmap.org/r/1J6F]

Kenia - Schlafkrankheit
19.03.2012

Innerhalb eines Monats sind zwei Touristen erkrankt, nachdem sie sich während einer Urlaubsreise im Februar drei Tage in der Masai Mara aufgehalten hatten. Es handelt sich um einen Belgier und um einen 61-jährigen Deutschen. Zwischen 2000 und 2010 waren vereinzelt Fälle aufgetreten bei Reisenden, die Nationalparks in Tansania, Malawi, Sambia und Simbabwe besucht hatten. Safari-Reisende in Ostafrika, speziell in Wildreservate, sollten auf das potenzielle Übertragungsrisiko und die Primärsymptome hingewiesen werden, Schutz vor Tsetse-Fliegen beachten und bei verdächtigen Symptomen sofort einen Arzt aufsuchen. Die weitere Diagnostik und Therapie sollte durch einen Tropenmediziner erfolgen.

Gruß
Birgitt

Blutsaugende Fliegen gehören zu den eher unterschätzt leistungsfähigen Insektenmodellen: Ihr auf Fliegen und Fortpflanzung hochgezüchter Körper lebt bei jeder Schleichattacke auf den wachsamen Wirt extrem gefährlich; zudem mussten sich die Blutschmarotzer allerlei physiologische Spezialanpassungen leisten, um vom hart erkämpften Lebenssaft der Opfer auch gut leben zu können. Eine Anpassung ist dabei aber bisher zu wenig gewürdigt worden, finden Joshua Benoit von der Yale University und seine Kollegen: Die sonst fast nur von Säugetieren bekannte Errungenschaft, den Nachwuchs mit Muttermilch groß und kräftig aufzupäppeln. Bekannt war die fürsorgliche Muttermilchproduktion von Glossina-Arten bereits: Die weiblichen Tsetsefliegen produzieren nur ein einziges statt vieler Eier und legen es nicht ab, sondern behalten es in einer Fliegenvariante des Uterus.

Muttermilch - die Achillesferse der Tsetsefliege?
20.04.2012 - spektrum

Gruß
Birgitt