ARTICLE
In this case, evaluation of a peripherical blood smear confirmed the
diagnosis and showed trypanosomes. Indeed, the patient had two trypanosomal
chancres and examination of blood specimens revealed West African trypanosomiasis
due to Trypanosoma brucei. Diagnosis of West African trypanosomiasis
at the very early hemolymphatic stage was retained, and the patient received
a regimen of five doses of iv pentamidine isethionate (4 mg/kg) over 10
days. The symptoms and blood parasitic involvement improved within two
days. The immunological evaluation by immunofluorescence antibodies test
(IFAT) showed an elevated serum specific IgM and IgG antibody titer level
accounting at 1/50, 1/2500 respectively.
Our observation is remarkable as chancres to T. brucei gambiense
are rarely reported, with frequency varying from 25 to 40% in a few small
size series of European patients. Lesions have rarely been described as
unique erythematous or violaceous circumscribed indurated nodules, measuring
5-15 cm in diameter, with or without local adenopathy [1, 2].
Unlikely trypanosomal chancres occur frequently in infections due to
Trypanosoma rhodensiense suggesting a higher virulence of the parasite
and consist of rubbery inflammatory nodules, measuring 2-5 cm in diameter,
usually desquamating and resolving in 2 or 3 weeks [3].
Indeed, West African trypanosomiasis must be suspected among patients
with lymphadenopathy and fever and living in a recognized endemic area,
or even occurring in potential emergent conditions, and similarly be recognized
at the early stage of the disease when the trypanosomal chancre is present,
and a convenient and efficient therapeutic approach is possible before
the stage of CNS involvement.
Article accepted on 5/6/00
REFERENCES
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Paris: Springer-Verlag ed., 1999; 253-80.
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