Case history
Case history #1
A 30-year-old man, who was previously living in a rural area of the Democratic Republic of the Congo, presents with a history of fever, headache, and malaise lasting several months. He shows enlarged cervical nodes and splenomegaly. He has received treatment against malaria several times with little improvement.
Case history #2
A 20-year-old Sudanese woman living in the south of her country as a refugee in a displaced camp describes a chronic disease that started more than 10 months ago. She presents with variable fever, headache, dermatitis, and a significant loss in weight. She reports amenorrhoea in the last 4 months and changes in character with aggressiveness and tremors in the last few weeks. She does not sleep well, with periods of insomnia during the night, but falls asleep easily during the daytime.
Other presentations
Acute cases have been described in tourists after visiting game parks in Africa, sometimes showing a chancre after being bitten by a tsetse fly. Congenital cases are possible after vertical transmission from infected mothers. Occasionally, cases have been reported after professional infection in the laboratory or, very rarely, after sexual transmission. The presence of enlarged cervical nodes (Winterbottom's sign) is characteristic in gambiense human African trypanosomiasis (HAT). The presence of a chancre at the infective bite site is very frequent in rhodesiense HAT. In endemic areas, HAT is a frequent cause of miscarriage in pregnant women.
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