A Woman with Fever and Rash after African Safari

Diagnosis: Human African trypanosomiasis due to Trypanosoma brucei subspecies rhodesiense. A diagnosis of human African trypanosomiasis was made on the basis of physical examination findings (figure 1) and the presence of T. brucei rhodesiense noted on a peripheral blood screen obtained at admission (figure 2). Our patient was given 1 dose of intravenous pentamidine and was subsequently given 1 dose of suramin procured from the Centers for Disease Control and Prevention. Because of an elevated WBC count, an elevated total protein level, and an elevated IgM level in CSF samples, CNS involvement was presumed, although the patient had no focal findings or neurologic symptoms. She was treated with intravenous melarsoprol (trivalent organic arsenic) together with prednisone to prevent post-treatment reactive encephalopathy [1, 2]. During week 1 of treatment, the patient received 108 mg of melarsoprol daily for 3 days; during week 2, she received 144 mg of melarsoprol daily for 3 days; and during week 3, she received 216 mg of melarsoprol daily for 3 days. Clinical improvement was associated with resolution of fever, a progressive decrease in the WBC count in CSF samples, and the clearance of parasitemia on serial blood smears. The patient was subsequently discharged from the hospital with resolution of her fevers and rash. Serial lumbar punctures have been performed every 6 months since discharge from the hospital to evaluate for disease recurrence; to date, results have been negative. The patient's total protein level and WBC count in CSF samples have been normal at follow-up visits.