Bisoffi, Z.

Bonazzi, L.

Bronner, U.

de Frey, A.

Gundersen, S.G.

Jelinek, T.

McWhinney, P.

Ripamonti, D.

van Thiel, P.P.A.M.

English

International Migration, Integration and Social Cohesion online publications

UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl)UvA-DARE (Digital Academic Repository)Cluster of African trypanosomiasis in travelers to Tanzanian national parksJelinek, T.; Bisoffi, Z.; Bonazzi, L.; van Thiel, P.P.A.M.; Bronner, U.; de Frey, A.; Gundersen,S.G.; McWhinney, P.; Ripamonti, D.Publication date2002Published inEmerging Infectious DiseasesLink to publicationCitation for published version (APA):Jelinek, T., Bisoffi, Z., Bonazzi, L., van Thiel, P. P. A. M., Bronner, U., de Frey, A.,Gundersen, S. G., McWhinney, P., & Ripamonti, D. (2002). Cluster of African trypanosomiasisin travelers to Tanzanian national parks. Emerging Infectious Diseases, 8(6), 634-635.General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s)and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an opencontent license (like Creative Commons).Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, pleaselet the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the materialinaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letterto: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. Youwill be contacted as soon as possible.Download date:09 Mar 2023DISPATCHES634 Emerging Infectious Diseases  •  Vol. 8, No. 6, June 2002Cluster of AfricanTrypanosomiasisin Travelersto TanzanianNational ParksTomas Jelinek,* Zeno Bisoffi,† Lucio Bonazzi,‡ Pieter van Thiel,§ Ulf Bronner,¶ Albie de Frey,# Svein Gunnar Gundersen,** Paul McWhinney,†† and Diego Ripamonti,‡‡ for European Network on Imported Infectious Disease SurveillanceGame parks in Tanzania have long been considered to be atlow risk for African trypanosomiasis; however, nine cases of thedisease associated with these parks were recently reported.The outbreak was detected through TropNetEurop, a sentinelsurveillance network of clinical sites throughout Europe.frican trypanosomiasis (sleeping sickness), a seriousinfection caused by a protozoan (Trypanosoma brucei), isusually spread to humans by the tsetse fly via infected animalsand humans. Although the World Health Organization hasreported a dramatic increase in incidence in Africa, the diseasehas remained a rare but well-documented cause of fever intravelers returning from endemic areas. In recent years, infec-tion in returning travelers has been more likely to be due to theEast African form (caused by T. brucei rhodesiense), ratherthan the West African form (which is due to T. brucei gambi-ense); the latter form causes a fulminant illness for which rapiddiagnosis is necessary (1,2). We report details of nine recentcases caused by the West African form of this disease, onefatal; all of the cases occurred in travelers to Tanzaniannational parks.Case ReportsGame parks in Tanzania have long been considered to below-risk areas for African trypanosomiasis (3). However, inFebruary 2001, two index patients and seven additional Euro-pean and South African patients were seen with trypanosomia-sis acquired in the Tarangire and Serengeti National Parks,Tanzania (4). The patients were identified and reported inTropNetEurop, a sentinel surveillance network of clinical sitesthroughout Europe for monitoring imported infectious dis-eases.All of the South African patients but one were Europeannationals (Table). To our knowledge, all patients had traveledto the Tarangire and Serengeti National Parks, in addition to anumber of other destinations. This area in East Africa has beenimplicated as being endemic for African trypanosomiasis.However, the case incidence in Tanzanian and foreign nation-als has been very low in recent decades.During their journey or briefly after their return, thepatients, all febrile, were seen by general practitioners oremergency departments. Most patients were seen during theprimary stage of disease (patients 1, 3, 4, 6, 7, 8; Table); how-ever, several showed signs of the secondary stage, includingcerebral manifestations. Most patients also showed a typicalskin lesion, the trypanosome chancre. Diagnosis was estab-lished by thin and thick blood film. Although three patientshad multiorgan failure, and specific medication was difficult toobtain, drug treatment proved successful in all but one patient,who died. Drugs for treatment were not chosen for the clinicalstage the patients exhibited but rather for availability. Thus,patients with complications and a manifest secondary stage ofdisease received pentamidine only.ConclusionsThe temporal clustering of imported cases suggests achange in the local epidemiology of this disease and may her-ald further cases in tourists during the current travel season.For 1998, the World Tourism Organization recorded 450,000visitors to Tanzania (5), for a potential annual incidence of try-panosomiasis in tourists to Tanzania of at least 9/450,000. Thisis an increase from near zero during recent years to 2/100,000.The risk for those visiting the Tarangire and SerengetiNational Parks is obviously higher. Reaction of the Tanzanianauthorities involved strengthening installation of insecticide-impregnated locations in Serengeti to include roads, lodges,staff quarters, and campsites. This initial program resulted in adramatic decline of tsetse flies in Serengeti during the secondhalf of 2001. This effort will have to be sustained by manda-tory killing of flies at some keys areas including Serengeti,Tarangire, and Lake Manyara National Parks. The NationalMedical Research Program has been directed to screen morepeople for the disease around these foci.For many of the patients, drugs for treatment wereextremely difficult to obtain. For some European patients,treatment with suramin was possible only after informal helpfrom member sites of the network. Drugs for treatment(suramin, melasoprol, and eflornithin) have now beenobtained. Surveillance in cattle to establish their role in theepidemiology of the disease will also be conducted (TanzaniaChief Veterinary Officer, pers. comm.).This report highlights the effectiveness and importance ofsentinel surveillance methods for monitoring imported infec-tious diseases in Europe. TropNetEurop, the network that iden-tified and reported the index cases, is known for its speed ofreporting, often within days of diagnosis. The network’s use ofmember sites as regional referral centers is based on an*Ludwig-Maximilians-University, Munich, Germany; †S. Cuore Hospital,Negrar, Verona, Italy; ‡Reggio Emilia Hospital, Reggio, Italy; §Univer-sity of Amsterdam, Amsterdam, the Netherlands; ¶Karolinska Hospital,Stockholm, Sweden; #Worldwide Travel Medical Consultants, Northcliff,South Africa; **Ullevaal Hospital, Oslo, Norway; ††Bradford Royal Infir-mary, Bradford, United Kingdom; and ‡‡General Hospital, Bergamo,ItalyAEmerging Infectious Diseases  •  Vol. 8, No. 6, June 2002 635DISPATCHESanonymous reporting system at sentinel clinics. Discussion ofthe index patients by member sites triggered increased aware-ness within the network and led to the rapid recording of addi-tional patients and a pattern that might have otherwise goneundetected.Dr. Jelinek is consultant for infectious diseases and tropical med-icine at the Department of Infectious Diseases and Tropical Medicine,University of Munich. He also coordinates the European Network onSurveillance of Imported Infectious Diseases (TropNetEurop).References1. Sinha A, Grace C, Alston W, Westenfeld F, Maguire J. African trypanoso-miasis in two travelers from the United States. Clin Infect Dis1999;29:840–4.2. Sanner B, Doberauer C, Tepel M, Zidek W. Fulminant disease simulatingbacterial sepsis with disseminated intravascular coagulation after a trip toEast Africa. Intensive Care Med 2000;26:646–7.3. Ponce de Leon S, Lisker-Melman M, Kato-Maeda M, Gamboa-Dominguez A, Ontiveros C, Behrens R, et al. Trypanosoma brucei rhode-siense infection imported to Mexico from a tourist in Kenya. Clin InfectDis 1996;23:847–8.4. Ripamonti D, Massari M, Arici C, Gabbi E, Farina C, Brini M, et al. Afri-can sleeping sickness in tourists returning from Tanzania: the first 2 Ital-ian cases from a small outbreak among European travelers. Clin InfectDis 2002;34:e18–22.5. Yearbook of tourism statistics. Barcelona: World Tourism Organization;2000. p. 2.Address for correspondence: Tomas Jelinek, University of Munich, Depart-ment of Infectious Diseases and Tropical Medicine, Leopoldstr. 5, 80802Munich, Germany; fax: 49 89 336112; e-mail: jelinek@lrz.uni-muenchen.deTable. Patients with African trypanosomiasis, Tanzania No. Sex Age NationalityMo/yr ofdiagnosis Clinical details and treatment Travel historya1 M 33 Italian 02/01 Skin lesion (back), fever, nausea/vomiting; no major complications; treatment with suraminTourist: Kenya; Lake Manyara, Serengeti, and Ngorongoro NPs 2 M 32 Italian 02/01 Skin lesion left leg; fever; multiorgan fail-ure; anuria; treatment with pentamidineTourist: East Tsavo, Ngorongoro, and Serengeti NPs 3 F 44 British 02/01 Skin lesion left leg; fever; no major compli-cations; treatment with suraminTourist: Nairobi, Amboseli, Lake Manyara, Ngorongoro, and Serengeti NPs4 M 41 Swedish 03/01 Skin lesion right foot; fever; treatment with suraminTourist: Lake Manyara, Ngorongoro, Tarangire, and Serengeti NPs5 M 68 South African 03/01 Fever; renal failure; acidosis; jaundice; DIC; treatment with melasoprolTourist: Serengeti NP6 F 27 Norwegian 03/01 Skin lesion left side of face; fever; no com-plications; treatment with suraminResearch project on zebras: Ngorongoro and Serengeti NPs7 M 60 Dutch 03/01 Fever; treatment with suramin Tarangire NP8 F 55 Dutch 04/01 Skin lesion left ankle; fever; headache; treat-ment with suraminTarangire NP9 F 53 Dutch 06/01 Skin lesion right leg; fever; headache; intrac-erebral manifestation; coma; death; treat-ment with suramin and melasoprolLake Manyara, Ngorongo, and Serengeti NPsaEast Tsavo NP and Amboseli NP are in Kenya; all other NPs mentioned are in Tanzania. NP, national park; DIC, disseminated intravascular coagulopathy.Dispatches. Articles should be 1,000 to 1,500 wordsand need not be divided into sections. If subheadings areused, they should be general, e.g., “The Study” and Con-clusions.” Provide a brief abstract (50 words); refer-ences, (not to exceed 10), figures or illustrations, not toexceed two; and a brief biographical sketch of firstauthor—both authors if only two. Dispatches are updates on infectious disease trendsand research. The articles include descriptions of newmethods for detecting, characterizing, or subtyping newor reemerging pathogens. Developments in antimicro-bial drugs, vaccines, or infectious disease prevention orelimination programs are appropriate. Case reports arealso welcome. Guidelines for Letters. 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Cluster of African trypanosomiasis in travelers to Tanzanian national parks

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Cluster of African trypanosomiasis in travelers to Tanzanian national parks

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