National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; Wits Research Institute for Malaria, University of the Witwatersrand, Johannesburg, South Africa.
Netcare Pretoria East Hospital, Pretoria, South Africa.
Int J Infect Dis. 2018 Oct;75:101-108. doi: 10.1016/j.ijid.2018.08.012. Epub 2018 Aug 25.
East African trypanosomiasis is an uncommon, potentially lethal disease if not diagnosed and treated in a timely manner. South Africa, as a centre for emergency medical evacuations from much of sub-Saharan Africa, receives a high proportion of these patients, mostly tourists and expatriate residents.
The cases of East African trypanosomiasis patients evacuated to South Africa, for whom diagnostic and clinical management advice was provided over the years 2004-2018, were reviewed, using the authors' own records and those of collaborating clinicians.
Twenty-one cases were identified. These originated in Zambia, Malawi, Zimbabwe, Tanzania, and Uganda. Nineteen cases (90%) had stage 1 (haemolymphatic) disease; one of these patients had fatal myocarditis. Of the two patients with stage 2 (meningoencephalitic) disease, one died of melarsoprol encephalopathy. Common problems were delayed diagnosis, erroneous assessment of severity, and limited access to treatment.
The key to early diagnosis is recognition of the triad of geographic exposure, tsetse fly bites, and trypanosomal chancre, plus good microscopy. Elements for successful management are rapid access to specific drug treatment, skilled intensive care, and good laboratory facilities. Clinical experience and the local stock of antitrypanosomal drugs from the World Health Organization have improved the chance of a successful outcome in the management of East African trypanosomiasis in South Africa; the survival rate over the period was 90.5%.
东非锥虫病如果不能及时诊断和治疗，是一种罕见的、潜在致命的疾病。南非作为撒哈拉以南非洲大部分地区的紧急医疗后送中心，接收了大量此类患者，其中大多数是游客和外籍居民。
回顾了 2004 年至 2018 年间，为在南非接受东非锥虫病患者的诊断和临床管理建议的病例，使用作者自己的记录和合作临床医生的记录。
确定了 21 例病例。这些病例源自赞比亚、马拉维、津巴布韦、坦桑尼亚和乌干达。19 例（90%）为 1 期（血液淋巴）疾病；其中 1 例患者患有致命心肌炎。在 2 例脑膜脑炎（meningoencephalitic）疾病患者中，1 例死于梅拉索尔普罗 encephalopathy。常见的问题是诊断延迟、严重程度评估错误和治疗途径有限。
早期诊断的关键是识别地理暴露、采采蝇叮咬和锥虫溃疡三联征，加上良好的显微镜检查。成功管理的要素包括快速获得特定药物治疗、熟练的重症监护和良好的实验室设施。临床经验和世界卫生组织的抗锥虫药物库存提高了南非东非锥虫病管理成功的机会；在此期间的存活率为 90.5%。
