Case Study 3

1
Case Study 3

• Presented by
• Lisa, Jennifer and Esmeralda

2
Case Background

• Simon, a student, presents with ulcerated, raised
  
• lesions on his neck, calves, and feet. These
  lesions
• have drained, ulcerated, healed and then broken
• open again. He traveled to the Middle East last
  
• summer (4 months ago) and spent June and July in
• Israel followed by several weeks in Egypt .
  During
• this time he remembers being bitten by numerous
• small black flies. While in Egypt, he noticed
  the
• first neck lesions.

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Etiologies and Differential Diagnosis

• Differential diagnosis
• African Sleeping Sickness
• HIV with Cryptococcosis
• Leishmania Infection
• Malaria
• Melanoma

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Etiologies and Differential Diagnosis

• Etiological agents
• Trypanosoma brucei
• Human Immunodeficiency Virus with Cryptococcus
  neoforman
• Leishmania
• Plasmoduim sp.
• UV light

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Acquired Patient History

• Are you sexually active
• Have you had a blood transfusion
• Do you or anyone in your family have diabetes,
  high blood pressure, cancer, or heart condition
• Have you put any ointment on the rash
• Do you have any allergies
• Do you use needles
• Do you do drugs
• Have you come in contact with anyone that has a
  similar rash
• Are you sleepy most of the time
• Do you feel tired

6
Lab Tests

• ? CBC
• ?Blood Smear- a wet smear of unstained blood
• ?Culture of lesion and placed on wet mount
• ?CT or MRI

?
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Lab Test Findings

• Normal WBC count
• Lesion revealed hemoflagellate protozoan

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Etiological Agent

• East African Trypanosomiasis
• Trypanosoma brucei rhodesiense

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Diagnosis

• African Sleeping Sickness

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Signs and Symptoms

• Stage 1 ( early or hemolymphatic stage )
• ? Painless skin lesions that appear 5- 15 days
  after the bite
• ? Skin lesions in light skinned people
• ?Lymphadenopathy
• ?Fever, tachycardia, rash, edema and weight loss

?
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Signs and Symptoms

• Stage 2 ( late or CNS stage )
• ? Irritability, tremors, muscle rigidity
• ? Mood swings, depression, seizures
• ?Stupor and Coma (Hence the name sleeping
  sickness)

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Mode of Transmission

• Tsetse Fly

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Why are infections typically seen on the head and
neck ?

• Portal of Entry

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Treatment Plan

• Anthelmintic drugsInhibits biochemical
• pathways of parasites.
• Hospital care for acute symptoms of fever and
• malaise and continual monitoring of
• neurological conditions.
• Regular blood smears to monitor patasitemia

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Recommended Medications
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Recommended Medications

• Drug Name Suramin
• Antiparasitic agent used IV in early-stage
  African
• trypanosomiasis and onchocerciasis. Suramin is
• trypanocidal and works by inhibiting parasitic
• enzymes and growth factors. Highly bound to serum
  
• proteins and, thus, crosses the blood-brain
  barrier
• poorly. Serum levels are approximately 100
• mcg/mL. Suramin is effective and less toxic than
• pentamidine. Excreted in the urine at a slow
  rate.

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Recommended Medications

• Drug Name Melarsoprol

Trivalent arsenical used in the late or CNS stage
of African trypanosomiasis. Trypanocidal,
inhibiting parasitic glycolysis. Water insoluble
and has a half-life of 35 h. Serum levels range
from 2-5 mcg/mL, but CSF levels are 50-fold
lower. The drug is primarily excreted by the
kidneys. Clinical improvement is usually observed
within 4 d after starting the drug. Therapy is as
high as 90-95 successful in clearing the
parasitemia. However, it can be toxic and even
fatal in 4-6 of cases.
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Patient Prognosis

• Since Simon was diagnosed in Stage 1, we
• feel that his prognosis is good.
• Early treatment usually results in the
• resolution of symptoms and clearance of the
• parasite.

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• The End