A Wandering Missionary's Burden: Persistent Fever and Progressive Somnolence in a Returning Traveler

Kruti J Yagnik; Alonso Pezo-Salazar; David Rosenbaum; Jesse Manuel Jaso; Dominick Cavuoti; Benjamin Nelson; Rebecca J Chancey; Megan L McKenna; Laila M Castellino

doi:10.1093/ofid/ofab377

A Wandering Missionary's Burden: Persistent Fever and Progressive Somnolence in a Returning Traveler

Open Forum Infect Dis. 2021 Jul 15;8(8):ofab377. doi: 10.1093/ofid/ofab377. eCollection 2021 Aug.

Authors

Affiliations

¹ Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
² Parkland Health and Hospital System, Dallas, Texas, USA.
³ Division of Pathology, UT Southwestern Medical Center, Dallas, Texas, USA.
⁴ Division of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
⁵ Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Abstract

Human African trypanosomiasis incidence has declined, but diagnosis remains difficult, especially in nonendemic areas. Our patient presented with fever, progressive lethargy, and weight loss for 5 months and had previously traveled to Ghana and Cameroon but had not been to areas with recently reported African trypanosomiasis. Extensive workup was negative, except for lymphocytic pleocytosis in cerebrospinal fluid; ultimately, a bone marrow aspiration revealed necrotizing granulomatous inflammation with 2 trypanosomes discovered on the aspirate smear, consistent with Trypanosoma brucei. The patient was treated with combination nifurtimox and eflornithine with full recovery.

Keywords: African sleeping sickness; Trypanosoma brucei; fever in a returning traveler; human African trypanosomiasis.

Publication types

Case Reports