World Health Organization, Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management, Geneva, Switzerland.
J Travel Med. 2012 Jan-Feb;19(1):44-53. doi: 10.1111/j.1708-8305.2011.00576.x. Epub 2011 Dec 8.
Human African trypanosomiasis (HAT) can affect travelers to sub-Saharan Africa, as well as migrants from disease endemic countries (DECs), posing diagnosis challenges to travel health services in non-disease endemic countries (non-DECs).
Cases reported in journals have been collected through a bibliographic research and complemented by cases reported to the World Health Organization (WHO) during the process to obtain anti-trypanosome drugs. These drugs are distributed to DECs solely by WHO. Drugs are also provided to non-DECs when an HAT case is diagnosed. However, in non-DEC pentamidine can also be purchased in the market due to its indication to treat Pneumocystis and Leishmania infections. Any request for drugs from non-DECs should be accompanied by epidemiological and clinical data on the patient.
During the period 2000 to 2010, 94 cases of HAT were reported in 19 non-DECs. Seventy-two percent of them corresponded to the Rhodesiense form, whereas 28% corresponded to the Gambiense. Cases of Rhodesiense HAT were mainly diagnosed in tourists after short visits to DECs, usually within a few days of return. The majority of them were in first 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 second stage. Patients affected were expatriates living in DECs for extended periods and refugees or economic migrants from DECs.
The risk of HAT in travelers and migrants, albeit low, cannot be overlooked. In non-DECs, rarity, nonspecific symptoms, and lack of knowledge and awareness in health staff make diagnosis difficult. Misdiagnosis is frequent, thus leading to invasive diagnosis methods, unnecessary treatments, and increased risk of fatality. Centralized distribution of drugs for HAT by WHO enables an HAT surveillance system for non-DECs to be maintained. This system provides valuable information on disease transmission and complements data collected in DECs.
人类非洲锥虫病（HAT）可影响到前往撒哈拉以南非洲的旅行者，以及来自疾病流行国家（DEC）的移民，这给非疾病流行国家（non-DEC）的旅行健康服务带来了诊断挑战。
通过文献研究收集了期刊中报告的病例，并通过世界卫生组织（WHO）在获得抗锥虫药物过程中报告的病例进行了补充。这些药物仅由世卫组织分发给 DEC。当诊断出 HAT 病例时，也会向 non-DEC 提供药物。然而，由于其用于治疗肺孢子菌和利什曼原虫感染的适应症，非 DEC 也可以在市场上购买戊烷脒。来自 non-DEC 的任何药物请求都应附有患者的流行病学和临床数据。
在 2000 年至 2010 年期间，19 个 non-DEC 报告了 94 例 HAT 病例。其中 72%为罗得西亚形式，28%为冈比亚形式。罗得西亚 HAT 病例主要发生在短时间访问 DEC 的游客中，通常在返回后几天内。大多数病例处于第一阶段。疟疾或蜱传疾病的初始误诊很常见。冈比亚 HAT 病例通常在初次检查后数月诊断，随后进行了各种误诊。大多数处于第二阶段。受影响的患者是在 DEC 居住很长时间的侨民或来自 DEC 的难民或经济移民。
旅行者和移民患 HAT 的风险虽然较低，但不容忽视。在 non-DEC 中，疾病的罕见性、非特异性症状以及卫生人员缺乏知识和意识使得诊断变得困难。误诊很常见，因此导致了侵入性诊断方法、不必要的治疗和更高的死亡率。世卫组织对 HAT 药物的集中分发使 non-DEC 的 HAT 监测系统得以维持。该系统提供了有关疾病传播的有价值信息，并补充了在 DEC 收集的数据。
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