Human African trypanosomiasis
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Human africanAfrican trypanosomiasis
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Human africanAfrican trypanosomiasis (HAT), also known as African sleeping sickness, is an illness caused by one of two parasitic zoonoses: trypanosomaTrypanosoma brucei gamiense or trypanosomaTrypanosoma brucei rhodesiense.
Epidemiology
HATAfrican trypanosomiasis is a disease endemic to sub-Saharan Africa. Within this region the disease is harbored mainly in rural areas 1, where access to medical imaging is often non-existentnonexistent. Trypanosoma brucei gamiensegambiense accounts for the vast majority of reported cases of HATAfrican trpanosomiasis. The incidence and prevalence of HAT hashave varied widely over the last two centuries. Under 3,000cases were reported in 2016, and the incidence is declining 2.
Clinical presentation
In the initial stage of HATAfrican trypanosomiasis, many symptoms of the disease are nonspecific, such as fever and malaise. Untreated, the disease progresses to include various neurological manifestations, causesincluding encephalitis, coma, and ultimately death.
Pathology
Trypanosoma brucei gamiensegambiense and trypanosomaTrypanosoma brucei rhodesiense are transmitted by certain species of tsetse flies, although other transmission routes are possible 3.
Radiographic features
Radiographic features of HATThere have been reported on CT and MRI. Case reportsonly small case series and case seriesreports of brain MRI of HAT patients include white matter signal changes with African trypanosomiasis at stage II (central nervous system involvement) 4,5,6.
MRI
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T2-FLAIR
- symmetric high signal intensity in the supratentorial deep white matter (all cases) 5
- high signal intensity in the basal ganglia, cerebellum, and/or brainstem (around half of cases)
- DWI: restricted diffusion may be seen in white matter tracts such as the posterior limbs of the internal capsules and splenium of the corpus callosum 5
- SWI/GRE/T2*: parenchymal microhemorrhages may be seen 5
-<p><strong>Human african trypanosomiasis</strong> (HAT), also known as <strong>African sleeping sickness</strong>, is an illness caused by one of two parasitic zoonoses: trypanosoma brucei gamiense or trypanosoma brucei rhodesiense<em>. </em></p><h4>Epidemiology</h4><p>HAT is a disease endemic to sub-Saharan Africa. Within this region the disease is harbored mainly in rural areas <sup>1 </sup>where access to medical imaging is often non-existent. Trypanosoma brucei gamiense accounts for the vast majority of reported cases of HAT. The incidence and prevalence of HAT has varied widely over the last two centuries. Under 3,000 cases were reported in 2016, and the incidence is declining <sup>2</sup>.</p><h4>Clinical presentation</h4><p>In the initial stage of HAT many symptoms of the disease are nonspecific, such as fever and malaise. Untreated the disease progresses to include various neurological manifestations, causes encephalitis, coma and ultimately death.</p><h4>Pathology</h4><p>Trypanosoma brucei gamiense and trypanosoma brucei rhodesiense are transmitted by certain species of tsetse flies, although other transmission routes are possible<sup> 3</sup>.</p><h4>Radiographic features</h4><p>Radiographic features of HAT have been reported on CT and MRI. Case reports and case series of MRI of HAT patients include white matter signal changes <sup>4,5,6</sup>.</p>- +<p><strong>Human African trypanosomiasis</strong>, also known as <strong>African sleeping sickness</strong>, is an illness caused by one of two parasitic zoonoses: <em>Trypanosoma brucei gamiense</em> or <em>Trypanosoma brucei rhodesiense. </em></p><h4>Epidemiology</h4><p>African trypanosomiasis is a disease endemic to sub-Saharan Africa. Within this region the disease is harbored mainly in rural areas <sup>1</sup>, where access to medical imaging is often nonexistent. <em>Trypanosoma brucei gambiense</em> accounts for the vast majority of reported cases of African trpanosomiasis. The incidence and prevalence have varied widely over the last two centuries. Under 3,000 cases were reported in 2016, and the incidence is declining <sup>2</sup>.</p><h4>Clinical presentation</h4><p>In the initial stage of African trypanosomiasis, many symptoms of the disease are nonspecific, such as fever and malaise. Untreated, the disease progresses to include various neurological manifestations, including encephalitis, coma, and ultimately death.</p><h4>Pathology</h4><p><em>Trypanosoma brucei gambiense</em> and <em>Trypanosoma brucei rhodesiense</em> are transmitted by certain species of tsetse flies, although other transmission routes are possible<sup> 3</sup>.</p><h4>Radiographic features</h4><p>There have been only small case series and case reports of brain MRI of patients with African trypanosomiasis at stage II (central nervous system involvement) <sup>4,5,6</sup>. </p><h5>MRI</h5><ul>
- +<li>
- +<strong>T2-FLAIR</strong><ul>
- +<li>
- +<strong></strong>symmetric high signal intensity in the supratentorial deep white matter (all cases) <sup>5</sup>
- +</li>
- +<li>high signal intensity in the basal ganglia, cerebellum, and/or brainstem (around half of cases)</li>
- +</ul>
- +</li>
- +<li>
- +<strong>DWI</strong>: restricted diffusion may be seen in white matter tracts such as the posterior limbs of the internal capsules and splenium of the corpus callosum <sup>5</sup>
- +</li>
- +<li>
- +<strong>SWI/GRE/T2<sup>*</sup></strong>: parenchymal microhemorrhages may be seen <sup>5</sup>
- +</li>
- +</ul>
References changed:
- 1. Franco J, Simarro P, Diarra A, Jannin J. Epidemiology of Human African Trypanosomiasis. Clin Epidemiol. 2014;6:257-75. <a href="https://doi.org/10.2147/CLEP.S39728">doi:10.2147/CLEP.S39728</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/25125985">Pubmed</a>
- 2. Franco J, Cecchi G, Priotto G et al. Monitoring the Elimination of Human African Trypanosomiasis: Update to 2016. PLoS Negl Trop Dis. 2018;12(12):e0006890. <a href="https://doi.org/10.1371/journal.pntd.0006890">doi:10.1371/journal.pntd.0006890</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30521525">Pubmed</a>
- 3. Rocha G, Martins A, Gama G, Brandão F, Atouguia J. Possible Cases of Sexual and Congenital Transmission of Sleeping Sickness. Lancet. 2004;363(9404):247. <a href="https://doi.org/10.1016/S0140-6736(03)15345-7">doi:10.1016/S0140-6736(03)15345-7</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/14738812">Pubmed</a>
- 4. Gill D, Chatha D, del Carpio-O'Donovan R. MR Imaging Findings in African Trypansomiasis. AJNR Am J Neuroradiol. 2003;24(7):1383-5. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973687">PMC7973687</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12917133">Pubmed</a>
- 5. Patel N, Clegg A, Brown M, Hyare H. MRI Findings of the Brain in Human African Trypanosomiasis: A Case Series and Review of the Literature. BJR Case Rep. 2018;4(4):20180039. <a href="https://doi.org/10.1259/bjrcr.20180039">doi:10.1259/bjrcr.20180039</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30931144">Pubmed</a>
- 6. Aidara C, Magne C, Kouna P et al. High Field MRI in Human African Trypanosomiasis (HAT). OJRad. 2017;07(03):190-8. <a href="https://doi.org/10.4236/ojrad.2017.73021">doi:10.4236/ojrad.2017.73021</a>
- 1. Jose R Franco, Pere P Simarro, Abdoulaye Diarra, Jean G Jannin. Epidemiology of human African trypanosomiasis. (2014) Clinical Epidemiology. 6: 257.
- 2. José R. Franco, Giuliano Cecchi, Gerardo Priotto, Massimo Paone, Abdoulaye Diarra, Lise Grout, Pere P. Simarro, Weining Zhao, Daniel Argaw. Monitoring the elimination of human African trypanosomiasis: Update to 2016. (2018) PLOS Neglected Tropical Diseases. 12 (12): e0006890.
- 3. Rocha G, Martins A, Gama G, Brandão F, Atouguia J. Possible cases of sexual and congenital transmission of sleeping sickness. Lancet 2004; 363: 247
- 4. Gill DS, Chatha DS, del Carpio-O'Donovan R. MR imaging findings in African trypansomiasis. (2003) AJNR. American journal of neuroradiology. 24 (7): 1383-5.
- 5. Nikhil K Patel, Arthur Clegg, Michael Brown, Harpreet Hyare. MRI findings of the brain in human African trypanosomiasis: a case series and review of the literature. (2018) BJR|case reports. 4 (4): 20180039.
- 6. Cherif Mohamadou Aidara, Caroline Magne, Philomene Kouna, Gaelle Ebinda Mipinda, Abdoulaye Dione Diop, Abdoulaye Ndoye Diop, Sokhna Ba. High Field MRI in Human African Trypanosomiasis (HAT). (2017) Open Journal of Radiology. 7 (3): 190.
Systems changed:
- Central Nervous System
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