Progressive meningoencephalitis in a Sudanese immigrant

Adam P Liu, Shaun Chou, Lavier Gomes, Thomas Ng, Elizabeth L Salisbury, Grant L Walker and Donald R Packham
Med J Aust 2010; 192 (7): 413-416.

A 24-year-old woman presented to hospital in May 2009 after two generalised seizures with focal motor onset involving the right arm and leg. She had a 2-month history of intermittent frontal headaches and twitching of the right hand that did not interfere with usual activities. Her family had noticed she had lost weight. The patient was originally from the Eastern Equatoria province in southern Sudan and spent 12 years in a Ugandan refugee camp before migrating to Australia in 2007 with her family. Her only significant past medical history was malaria. Her family were in good health.

Please login with your free MJA account to view this article in full

  • Adam P Liu1
  • Shaun Chou1
  • Lavier Gomes1,2
  • Thomas Ng1,3,0
  • Elizabeth L Salisbury3
  • Grant L Walker1
  • Donald R Packham1

  • 1 Westmead Hospital, Sydney, NSW.
  • 2 Sydney Medical School, University of Sydney, Sydney, NSW.
  • 3 Department of Pathology, University of Western Sydney, Sydney, NSW.


We thank Dr Pere P Simarro (Innovative and Intensified Disease Management Program, Control of Neglected Tropical Diseases Unit of the World Health Organization, Geneva, Switzerland) for providing eflornithine. Both eflornithine and nifurtimox can now be obtained from the WHO. We also thank the patient for permission to report her story.

Competing interests:

None identified.

  • 1. World Health Organization. African trypanosomiasis fact sheet. Geneva: WHO, 2006.
  • 2. Picozzi K, Fevre EM, Odiit M, et al. Sleeping sickness in Uganda: a thin line between two fatal diseases. BMJ 2005; 331: 1238-1241.
  • 3. Kirchhoff LV. Trypanosomiasis. In: Kaspar DL, Braunwald E, Fauci AS, et al, editors. Harrison’s principles of internal medicine. Sydney: McGraw-Hill, 2005: 1238-1242.
  • 4. Kennedy PG. Human African trypanosomiasis of the CNS: current issues and challenges. J Clin Invest 2004; 113: 496-504.
  • 5. Miezan TW, Meda HA, Doua F, et al. Assessment of central nervous system involvement in gambiense trypanosomiasis: value of the cerebro-spinal white cell count. Trop Med Int Health 1998; 3: 571-575.
  • 6. Chappuis F, Loutan L, Simarro P, et al. Options for field diagnosis of human African trypanosomiasis. Clin Microbiol Rev 2005; 18: 133-146.
  • 7. Kager PA, Schipper HG, Stam J, Majoie CBLM. Case report: magnetic resonance imaging findings in human African trypanosomiasis: a four-year follow-up study in a patient and review of the literature. Am J Trop Med Hyg 2009; 80: 947-952.
  • 8. Kennedy PGE. Human African trypanosomiasis: In and out of Africa. Neurology 2006; 66: 962-963.
  • 9. Sahlas DJ, MacLean JD, Janevski J, Detsky AS. Clinical problem-solving. Out of Africa. N Engl J Med 2002; 347: 749-753.
  • 10. Lejon V, Buscher P. Cerebrospinal fluid in human African trypanosomiasis: a key to diagnosis, therapeutic decision and post-treatment follow-up. Trop Med Int Health 2005; 10: 395-403.
  • 11. World Health Organization: Human African trypanosomiasis. (accessed Jan 2010).
  • 12. Priotto G, Kasparian S, Mutombo W, et al. Nifurtimox–eflornithine combination therapy for second-stage African Trypanosoma brucei gambiense trypanosomiasis: a multicentre, randomised phase III, non-inferiority trial. Lancet 2009; 374: 7-9.
  • 13. Cherian P, Junckerstorff R, Rosen D, et al. Late-stage human African trypanosomiasis in a Sudanese refugee. Med J Aust 2010; 192: 417-419. <MJA full text>
  • 14. Maddocks S, O’Brien R. African trypanosomiasis in Australia. N Engl J Med 2000; 342: 1254.
  • 15. Darby JD, Huber MGP, Sieling WL, Spelman DW. African trypanosomiasis in two short-term Australian travelers to Malawi. J Travel Med 2008; 15: 375-377.
  • 16. Beaman MH, Wesselingh SL. Acute community-acquired meningitis and encephalitis. Med J Aust 2002; 176: 389-396. <MJA full text>


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.