15 February 2007

Trypanosomiasis in travellers to Malawi

On 12 February 2007, the National Institute for Communicable Diseases in South Africa reported four cases of trypanosomiasis associated with travel to Malawi during January and February 2007 [1].  

The travellers were from Canada, United Kingdom and Australia and each had visited the Kasunga National Park in Malawi in the one to three weeks prior to presentation. Two had also travelled to Vwasa Marshes National Park in northern Malawi. All travellers presented with a history of fever and one developed a trypanosomal chancre. Diagnosis was confirmed on blood smear. All travellers had normal cerebrospinal fluid. To date, each patient has responded to treatment administered in South Africa.

Trypanosomiasis

Trypanosomiasis (also known as sleeping sickness) is caused by parasitic protozoa of the genus Trypanosoma and is transmitted by the bite of a tsetse fly. There are two types of African trypanosomiasis; east African caused by Trypanosoma brucei rhodesiense, and west African caused by T. brucei gambiense. East African trypanosomiasis tends to be a rapidly progressive illness, often characterised by a chancre at the site of the tsetse fly bite, with fever, headache, fatigue, muscle aches and pains, and swollen lymph nodes. Spread into the central nervous system can lead to confusion, seizures, coma and death. The clinical course of west African trypanosomiasis is more indolent.

Advice for travellers

Trypanosomiasis is rare in travellers; however cases were reported in European travellers to Tanzania in 2001 [2], and to Kasunga National Park in Malawi in 2005 [1]. Travellers working or visiting woodland and savannah areas, particularly in game parks in Central and East Africa, are at risk.

Insect bite avoidance measures should be practiced. Tsetse flies are capable of biting through loose weave fabrics and are unaffected by many insect repellents. Travellers are advised to wear insecticide treated close weave clothing that is khaki or olive coloured, as tsetse flies are attracted to very dark or bright colours.

References

1. ProMED-mail. Trypanosomiasis - South Africa ex Malawi.  ProMED-mail 20072; 12 Feb: 20070212.0532. http://www.promedmail.org/pls/promed/f?p=2400:1001:127625

07658992427819::NO::F2400_P1001_BACK_PAGE,F2400_

P1001_PUB_MAIL_ID:1010,36292. Accessed 14 February 2007.

2. Jelinek T, Bisoffi Z, Bonazzi L et al. Cluster of African trypanosomiasis in travellers to Tanzanian national parks. Emerging Infect Dis 8: 634-635, 2005.

Links

NaTHNaC Trypanosomiasis information sheet:

http://www.NaTHNaC.org/pro/factsheets/tryp.htm

Centers for Disease Control and Prevention East African Trypanosomiasis information sheet:

http://www.cdc.gov/ncidod/dpd/parasites/trypanosomiasis/

2004_Eafrican_FS.pdf

World Health Organization African trypanosomiasis fact sheet:

http://www.who.int/mediacentre/factsheets/fs259/en/

Food and Agriculture Organization of the United Nations trypanosomiasis information:

http://www.fao.org/ag/againfo/programmes/en/paat/disease.html