33 COTD - 20/09/18 - Jo Jarvis

Jo Jarvis 20/09/18

Both of these cases are on pubmed

East African is shit at human disease (fast presentation, quick death)

West african is great, v v good at taking a long time to clinical disease

33.1 COTD One

55 yr female - office worker

2 week safari in Zimbabwe - Mana Pools National Park

Took Malarone

Hb 9.8 CRP 65

Deteriorated

Disinhibited with a submandibular lymph node

40,000 merozoites from each sporozoite. About a 1:2 chance of infecting a cell.

About 7 days to appear in blood.

Typhoid (3 Tropical Infections where the WCC is normal, along with brucellosis)
Tick Typhus (Returning Travellers from Southern Africa - Treated with three days of doxycycline)
Encephalitis (Viral - HSV, West Nile, Rift Valley)
Dengue / Chikungunya
HIV (Seroconversion - around 3 weeks after exposure)
HAT

HAT!

No chancre - 30-50% of East African get a chancre

Winterbottoms is seen in West African. East African get others

Started on suramin for the east african stage one disease first

Then had LP day 5, showed high white cells (>5)

Given melarsoprol at that point. With prednisolone.

68 yr male pharmacist. Originally from sierra leone, lived in UK 31 years

4yr history of malaise, arthralgias, intermittent fevers, raised inflam markers

Rheumatologist treated for non-defined connective tissue disorder (all autoantibodies positive)

IMMUNOSUPPRESED

2 years later

Parkinsonian symptoms.

More autoantibody tests positive.

MORE IMMUNOSUPPRESED

Diagnsosed with atypical parkinsonism

Now pancytopaenic. ?paraneoplastic

West African Trypanasomiasis - T. b. gambiense

This is a madly long time for disease presentation

CSF Full of trypanasomes

NECT

Loads of cross reaction with auto antibodies. Due to antigen switching on parasite coat.