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African trypanosomiasis- Australia

Charles T. Faulkner ctfaulkn at utkux.utcc.utk.edu
Sat Feb 14 20:50:25 EST 1998

This was posted on the pro-med news group and forwarded to me by one of
our students. I've posted it here FYI.

A ProMED-mail post

Date: Thu, 12 Feb 1998 16:21:11 +0000
From: John Walker <johnw at cidm.wh.usyd.edu.au>

The first case of African trypanosomiasis seen in Australia for 50 years
was recently diagnosed in Sydney. A 30 year old woman from Sydney visited
several localities in Zimbabwe during late December and early January.
These included Hwange Park, Victoria Falls, rafting on the Zambezi River,
Lake Kariba and Bulawayo. She travelled via Harare and Nairobi to Serengeti
where she arrived on January 13th and stayed for a week. From there she
returned to Sydney via Nairobiand Harare, arriving on January 23rd. During
her trip she took doxycycline for malaria prophylaxis.  

She became ill with fever, rigors, headache and splenomegaly on 24th
January. Blood films were examined by a local pathology laboratory for
malaria on January 25th and 27th, with negative results.   

The patient was referred to Westmead Hospital on January 28th, and
examination of a thick film for malaria revealed numerous trypanosomes. The
patient had an erythematous lesion on her left thigh (early chancre).
Pentamidine treatment was begun until suramin was obtained by air from
South Africa two days later. The patient developed pulmonary oedema on the
Friday evening, but improved rapidly after the beginning of suramin
therapy. No trypanosomes were found in CSF specimens examined. She was
discharged from hospital on the 6th of February.  

The only other infection with African trypanosomes seen in Australia, to my
knowledge, was in a man who had been working in Nigeria and Cameroon during
WWII. He developed Loa loa infection and a single trypanosome was found on
a blood film examined in 1947. There is no information as to the outcome of
that infection.   

The recent case reflects two things: the worsening situation in Africa with
respect to trypanosomiasis and a large increase in travel to Africa by
tourists from Australia. This latter aspect is reflected in a significant
change in the proportion of malaria cases with their origin in Africa seen
in New South Wales. From 1969 to 1995 the proportion of cases with an
African origin averaged around 10 to 12%. In 1995 it jumped to 21% and in
1996 to 24%. At present in 1998 it is at 42% of cases. 

John Walker, PhD
Department of Parasitology
Centre for Infectious Diseases and Microbiology
Westmead Hospital
Westmead 2145
phone (61-2) 9845 7663
fax   (61-2) 9891 5317
email: johnw at cidm.wh.usyd.edu.au

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