Ira Shah, Uma S. Ali, Parmanand Andankar & Rajesh R. Joshi

Directory of Open Access Journals

J Vector Borne Dis 48, June 2011, pp. 122–123Trypanosomiasis in an infant from IndiaIra Shah, Uma S. Ali, Parmanand Andankar & Rajesh R. JoshiDepartment of Pediatrics, B.J.Wadia Hospital for Children, Parel, Mumbai, IndiaKey words  India; Maharashtra; Trypanosoma brucei rhodesiense; TrypanosomiasisHuman trypanosomiasis is endemic in Africa andSouth America. Human African Trypanosomiasis (HAT)also known as sleeping sickness is caused by Trypano-soma brucei rhodesiense (in East and South Africa) orTrypanosoma brucei gambiense (in West and CentralAfrica)1. Disease due to T.b. rhodesiense progresses rap-idly over weeks while disease due to T.b. gambiense tendsto be chronic. In both the cases, infection leads to CNSinvolvement and if untreated even death. American trypa-nosomiasis known as Chagas disease is caused by T. cruzi2.HAT is transmitted by tsetse fly while the American vari-ety is transmitted by reduviid bugs. Human trypanosomeinfections like the ones seen in Africa and South Americaare unknown in India3. There have been only three docu-mented cases of Trypanosomiasis reported from India. Twocases of self-limiting febrile illness due to Trypanosomalewisi were reported in 19744 of an adult couple who livedin a rat-infested village and symptoms resolved withoutspecific treatment after two to three days. Repeat bloodfilms taken eight weeks later were found negative. An-other unusual case of Trypanosoma evansi was reportedfrom rural parts of Chandrapur district in Maharashtra inan adult male farmhand with recurrent febrile episodesand he responded to suramin2.Human infection by animal species of Trypanosomais not seen due to presence of trypanolytic factor in hu-man serum2. A one and a half month old girl staying in arat infested house in Mumbai presented with fever,hepatosplenomegaly, thrombocytopenia and blood filmsteeming with multiple trypanosomes morphologically simi-lar to Trypanosoma lewisi.Case report: A one and a half month old girl born of non-consanguineous marriage presented with fever since 5 dayson 1 September 2006. There was no cough, diarrhea, vom-iting, refusal of feeds or lethargy. She was a full-term nor-mal delivery with no antenatal or postnatal complications.She was on breast feeds and had received boiled cow’smilk once. She had received only one dose of oral poliovaccine. She was a resident of Andheri, Mumbai and stayedin a flat that was infested by rodents. The parents werewell. On examination, she was well-nourished and her vi-tal parameters were normal. She was febrile and hadhepatosplenomegaly. Other systemic examination wasnormal. Investigations showed hemoglobin of 8.5 g% withWBC count of 8800/mm3 (38% polymorphs, 60% lym-phocytes and 2% eosinophils). Platelet count was reduced(77,000/mm3). Peripheral smear showed presence of try-panosomes which were suggestive of the T. lewisi speciesin view of large size of kinetoblast, pointed posterior ofcell and lack of undulating membrane (Fig. 1). Serum as-partate transminase (SGPT) was 171 IU/L and total pro-teins were 6.8 g/dl with serum albumin of 3.3 g/dl. Totalbilirubin was 0.7 mg/dl and both prothrombin time (PT)and partial thromboplastin time (PTT) were prolonged(16 & 47 sec respectively). Renal function tests and se-rum electrolytes were normal. In view of symptomatic try-panosomiasis, an HIV ELISA test was done to rule outimmunocompromised state which was negative. After hos-pitalization, the child continued to have fever for 4 dayswhich then subsided on its own. Repeat investigations af-ter 12 days of presentation showed normal platelet count(3,78,000/mm3) and SGPT decreased to 73 IU/L with al-bumin increasing to 3.5 g/dl and normalization of PT (15sec) and PTT (33 sec). Repeated peripheral smear exami-nation over a period of 15 days showed no trypanosomesFig. 1: Trypanosomes on peripheral blood film. 123 Shah  et al: Trypanosomiasis in an infant from Indiaand child continued to remain asymptomatic and had re-gression of liver and spleen enlargement. The child wasdischarged and continues to do well on follow up.Trypanosomiasis is confined to animals in India andT. lewisi, T. evansi have been found in camels, dogs androdents in India5-7. Trypanosoma lewisi is a trypanosomeof the sub-genus Herpetosoma and is a parasite of rats(Rattus rattus and Rattus norvegicus) tramsmitted by fleas.Trypanosoma lewisi has stringent species-specificity andcannot grow in other rodents such as mice. Rats are in-fected principally by oral route, through contaminationby flea faeces or ingestion of fleas8. All trypanosomes ofthe sub-genus Herpetosoma are non-pathogenic to theirvertebrate host8. There are only 4 cases of human T. lewisiaround the world; 2 adults from India4, one from Malay-sia9 and a child from The Gambia1. The Gambian infanthad CNS infection also and responded to malarsoprolwhereas the child from Malaysia who was also four monthold responded without any specific treatment. In our pa-tient also, the parasitemia resolved on its own without anyspecific treatment.Humans are naturally resistant to infection by animaltrypanosomes possibly because of a trypanolytic factor inthe serum10. Also recent research suggests that for T. bruceian apolipoprotein leads to resistance to infection in hu-man serum11. Whether similar factors are important incontrolling infections with T. lewisi is unknown. In ourpatient, we tested the child for a possible infection withHIV which was negative.The usual duration of the incubation period of T.b.gambiense is months whereas Herpetosoma infections de-velop detectable parasitemia typically within 7 to 14 daysof inoculation in rodents1. This suggests that in our pa-tient, transmission probably occurred due to exposure tothe excreta of infected fleas in the environment in whichthe child was living. For early stage HAT, pentamidine isthe drug of choice12 whereas suramin is the drug of choicein T.b. rhodesiense. For CNS involvement, eflornithineor malarsoprol have been used13.Thus, to conclude, animal trypanosomiasis can infecthumans given the right combination of environmental, host-related and organism-related factors and these patientsshould be managed diligently. Also, it will be necessary todetermine whether other people in Mumbai also harbortrypanosoma infections.ACKNOWLEDGEMENTSDr Wendi Bailey at Hospital for Tropical Diseases,London, United Kingdom and Dr Gareth Tudor Willams(St. Mary’s Hospital, London, U.K.), contributed adviceregarding the investigation of this case.REFERENCES1. Howie S, Guy M, Fleming L, Bailey W, Noyes H, Faye JA, etal. A Gambian infant with fever and unexpected blood film.PLoS Med 2006; Sep 3; e355.2. Joshi PP, Shegokar VR, Powar RM, Herder S, Katti R, SalkarHR et al. Human trypanosomiasis caused by Trypanosoma evansiin India: The first case report. Am J Trop Med Hyg 2005; 73:491–5.3. Powar RM, Shegokar VS, Joshi PP, Dani VS, Tankhiwale NS,Truc P, et al. A rare case of human trypanosomiasis caused byTrypanosoma evansi. Indian J Med Microbiol 2006; 24: 72–4.4. Shrivastva K, Shrivastva G. Two cases of trypanosoma(Herpetastoma) species infection of man in India. Trans R SocTrop Med Hyg 1974; 68:143.5. Pathak KM, Arora JK, Kapoor M. Camel trypanosomiasis inRajasthan, India. Vet Parasitol 1993; 49: 319–23.6. Singh B, Kalra IS, Gupta MP, Nauriyal DC. Trypanosoma evansiinfection in dogs: seasonal prevalence and chemotherapy. VetParasitol 1993; 50:137–41.7. Saxena VK, Miyata A. An unusual morphological type of Try-panosoma (Herpetosoma) lewisi detected in the blood of Rattusnorvegicus in India. J Commun Dis 1993; 25: 15–7.8. Desquesnes M, Ravel S, Cuny G. PCR identification of Trypa-nosoma lewisi, a common parasite of laboratory rats.Kinetoplastid Biol Dis 2002; 1: 2. Available from: http://www.kinetoplastids.com/content/1/1/2 [accessed on October 15,2006].9. Johnson P. A case of infection by Trypanosoma lewisi in a child.Trans R Soc Trop Med Hyg 1933; 26: 467.10. Howking F. The resistance of Trypanosoma congolense, T. vivaxand T. evansi to human plasma. Trans R Soc Trop Med Hyg1978; 72: 405–7.11. Vanhamme L, Paturiaux-Hanocq F, Poelvoorde P, Nolan DP,Lins L, Van Den Abbeele J, et al. Apolipoprotein L-1 is thetrypanosome lytic factor of human serum. Nature 2003; 422:83.12. Control and surveillance of African trypanosomiasis. Geneva:World Health Organization 1998: p.119.13. Burri C, Nkunku S, Merolle A, Smith T, Blum J, Brun R, et al.Efficacy of new, concise schedule for melarsoprol in treatmentof sleeping sickness caused by Trypanosoma brucei gambiense:a randomised trial. Lancet 2000; 355: 1419.Correspondence to: Dr Ira Shah, 240 D, Walkeshwar Road, Malabar Hill, Mumbai-400 006, India.E-mail: irashah@pediatriconcall.comReceived: 12 November 2010 Accepted: 12 May 2011

Trypanosomiasis in an infant from India

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals