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African sleeping sickness
Signs and symptoms
Symptoms of stage 1 (early or hemolymphatic stage) disease may include the following:
Painless skin chancre
Intermittent fever (refractory to antimalarials), general malaise, myalgia, arthralgias, and headache
Generalized or regional lymphadenopathy
Facial edema
Transient urticarial, erythematous, or macular rashes 6-8 weeks after onset
Skin lesions (trypanids)
Symptoms of stage 2 (late or neurologic stage) disease may include the following:
Persistent headaches (refractory to analgesics)
Daytime somnolence followed by nighttime insomnia
Behavioral changes, mood swings, or depression
Loss of appetite, wasting syndrome, and weight loss
Seizures (more common in children)
Physical findings in stage 1 (early or hemolymphatic stage) disease may include the following:
Indurated chancre at bite site
Trypanids in light-skinned patients
Lymphadenopathy
Fevers, tachycardia, irregular rash, edema, and weight loss
Organomegaly, particularly splenomegaly
Physical findings in stage 2 (late or neurologic stage) disease may include the following:
CNS manifestations (irritability, tremors, increased muscle rigidity and tonicity, ataxia, hemiparesis)
Kerandel sign
Behavioral changes consistent with mania or psychosis, speech disorders, and seizures
Stupor and coma
Psychosis
Sensory disorders
Diagnosis
Although general laboratory studies may be helpful, a definitive diagnosis of African trypanosomiasis requires actual detection of trypanosomes.
Significant laboratory abnormalities include the following:
Anemia
Hypergammaglobulinemia
Low complement levels
Elevated erythrocyte sedimentation rate (ESR)
Thrombocytopenia
Hypoalbuminemia
Primary amebic meningoencephalopathy
Amebic meningoencephalitis, an extremely rare and sporadic central nervous system (CNS) infection, is caused by free-living amoebae; specifically, Naegleria fowleri and Balamuthia mandrillari s ,as well as species of Acanthamoeba and Sappinia.
Typically, N fowleri produces primary amebic meningoencephalitis (PAM), which is clinically indistinguishable from acute bacterial meningitis. The other amoebae cause granulomatous amebic encephalitis (GAE), which is a more subacute or chronic infection. The presentation of GAE can mimic a brain abscess, aseptic or chronic meningitis, or CNS malignancy.
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