Transcript Case Study 3 - Bakersfield College

Case Study 3
Presented by:
Lisa, Jennifer and Esmeralda
Case Background
Simon, a student, presents with ulcerated, raised
lesions on his neck, calves, and feet. These lesions
have drained, ulcerated, healed and then broken
open again. He traveled to the Middle East last
summer (4 months ago) and spent June and July in
Israel followed by several weeks in Egypt . During
this time he remembers being bitten by numerous
“small black flies.” While in Egypt, he noticed the
first neck lesions.
Etiologies and Differential Diagnosis
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Differential diagnosis:
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African Sleeping Sickness
HIV with Cryptococcosis
Leishmania Infection
Malaria
Melanoma
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Etiologies and Differential Diagnosis
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Etiological agents:
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Trypanosoma brucei
Human Immunodeficiency Virus with
Cryptococcus neoforman
Leishmania
Plasmoduim sp.
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UV light
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Acquired Patient History
 Are you sexually active
 Have you had a blood transfusion
 Do you or anyone in your family have diabetes,
high blood pressure, cancer, or heart condition
 Have you put any ointment on the rash
 Do you have any allergies
 Do you use needles
 Do you do drugs
 Have you come in contact with anyone that has
a similar rash
 Are you sleepy most of the time
 Do you feel tired
Lab Tests
● CBC
●Blood Smear- a wet smear of unstained
blood
●
●Culture of lesion and placed on wet mount
●CT or MRI
Lab Test Findings
Normal WBC count
Lesion revealed hemoflagellate
protozoan
Etiological Agent
East African Trypanosomiasis
Trypanosoma brucei rhodesiense
Diagnosis
African Sleeping
Sickness
Signs and Symptoms
Stage 1 ( early or hemolymphatic stage )
● Painless skin lesions that appear 5- 15 days
●
after the bite
● Skin lesions in light skinned people
●Lymphadenopathy
●Fever, tachycardia, rash, edema and weight
loss
Signs and Symptoms
Stage 2 ( late or CNS stage )
● Irritability, tremors, muscle rigidity
● Mood swings, depression, seizures
●Stupor and Coma (Hence the name sleeping
sickness)
Mode of Transmission
Tsetse Fly
Why are infections typically seen on
the head and neck ?
Portal of Entry
Treatment Plan
Anthelmintic drugs—Inhibits biochemical
pathways of parasites.
Hospital care for acute symptoms of fever and
malaise and continual monitoring of
neurological conditions.
Regular blood smears to monitor patasitemia
Recommended Medications
Trypanosomiasis Medications
Stage 1
Tryoanosoma
Suramin 100brucei
200 mg IV test
rhodesiense
dose, then 1 g
IV on days 1, 3,
7, 14, 21
Medications
Stage 2
Melarsoprol 23.6 mg/kg/d IV
for 3 d; after 1
wk, 3.6 mg/kg/d
for 3 days; after
10-21 d, repeat
the cycle
Recommended Medications
Drug Name: Suramin
Antiparasitic agent used IV in early-stage African
trypanosomiasis and onchocerciasis. Suramin is
trypanocidal and works by inhibiting parasitic
enzymes and growth factors. Highly bound to serum
proteins and, thus, crosses the blood-brain barrier
poorly. Serum levels are approximately 100
mcg/mL. Suramin is effective and less toxic than
pentamidine. Excreted in the urine at a slow rate.
Recommended Medications
Drug Name: Melarsoprol
Trivalent arsenical used in the late or CNS stage of
African trypanosomiasis. Trypanocidal, inhibiting
parasitic glycolysis. Water insoluble and has a half-life of
35 h. Serum levels range from 2-5 mcg/mL, but CSF
levels are 50-fold lower. The drug is primarily excreted
by the kidneys. Clinical improvement is usually observed
within 4 d after starting the drug. Therapy is as high as
90-95% successful in clearing the parasitemia. However,
it can be toxic and even fatal in 4-6% of cases.
Patient Prognosis
Since Simon was diagnosed in Stage 1, we
feel that his prognosis is good.
Early treatment usually results in the
resolution of symptoms and clearance of the
parasite.
The End