Late-stage human African trypanosomiasis in a Sudanese refugee

Paul Cherian, Ralph K Junckerstorff, David Rosen, Prasad Kumarasinghe, Alan Morling, Philip Tuch, Sonja Raven, Ronan J Murray and Christopher H Heath
Med J Aust 2010; 192 (7): . || doi: 10.5694/j.1326-5377.2010.tb03569.x
Published online: 5 April 2010

A 19-year-old Sudanese woman, who had lived for about a decade in Ugandan refugee camps, was referred for investigation of a 12-month history of a generalised rash. Two months later, her condition had deteriorated to include cachexia and drowsiness. Despite initial negative findings on investigation, human African trypanosomiasis (HAT) was suspected, and parasites were found in a double-centrifuged sample of cerebrospinal fluid. Eflornithine, the appropriate drug for treatment of late-stage disease, was obtained through the World Health Organization. This case highlights the diagnostic and therapeutic difficulties in managing late-stage HAT in a non-endemic country.

In January 2008, a 19-year-old Sudanese woman was referred from the community to a tertiary hospital for investigation of a 12-month history of generalised pruritus. There were no obvious precipitants or triggers for the itch. She was born in southern Sudan, but had lived in refugee camps in north-western Uganda for about a decade before migrating to Australia in November 2006. Her past medical history was non-contributory. Initial examination showed generalised hyperpigmented papules and nodules with excoriations. Prurigo was diagnosed, and treatment with topical corticosteroids was trialled.

  • Paul Cherian1
  • Ralph K Junckerstorff1
  • David Rosen1
  • Prasad Kumarasinghe1
  • Alan Morling1
  • Philip Tuch1
  • Sonja Raven1
  • Ronan J Murray1,2
  • Christopher H Heath1,2

  • 1 Royal Perth Hospital, Perth, WA.
  • 2 University of Western Australia, Perth, WA.



We thank Aesen Thambiran (Migrant Health Unit, Perth WA) for providing information about the patient prior to her arrival in Australia. We also thank Dr Pere P Simarro (Innovative and Intensified Disease Management Program, Control of Neglected Tropical Diseases Unit of the World Health Organization, Geneva, Switzerland), and Nyree Marr and Naomi Lillywhite (Pharmacy Department, Royal Perth Hospital, Perth, WA) for coordinating prompt access to eflornithine through the WHO. We also thank J Blum and C Hatz (FMH Innere Medizin und Tropen- und Reisemedizin, Schweizerisches Tropeninstitut, Basel, Switzerland); Marjan Van Esbroeck and P Büscher (Institute of Tropical Medicine, Antwerp, Belgium); Henk Schallig (Royal Tropical Institute, Amsterdam, the Netherlands) for assistance in the diagnosis and subspeciation of this parasite. We thank RC Thompson and Zablon Njiru from the WHO Collaborating Centre for the Molecular Epidemiology of Parasitic Infections, School of Veterinary and Biomedical Sciences, Murdoch University, Perth, WA for performing the rapid detection of the sub-genus Trypanozoon by loop-mediated isothermal amplification of parasite DNA from our patient.

Competing interests:

None identified.


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