African trypanosomiasis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

The hemo-lymphatic stage of African trypanosomiasis presents with a rash, fever, and anemia and must be differentiated from other diseases such as brucellosis, typhoid fever, malaria, tuberculosis, lymphoma, dengue, and leptospirosis. The most prominent symptoms in the neurological stage of African trypanosomiasis are mental status changes and sleep disturbances; accordingly, differential diagnoses include CNS tuberculosis, meningitis, and HIV-related opportunistic infections, including cryptococcal meningitis.

Differentiating African trypanosomiasis from other diseases

The table below summarizes the findings that differentiate African trypanosomiasis from other conditions that cause fever, rash and altered mental status

Differential diagnosis of African trypanosomiasis Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis
Brucellosis + + - + + + + + Relative lymphocytosis

Night sweats, often with characteristic smell, likened to wet hay

Typhoid fever + + - + - - + + Decreased hemoglobin Incremental increase in temperature initially and then sustained fever as high as 40°C (104°F)
Malaria + - + + - - + + Microcytosis,

elevated LDH

"Tertian" fever: paroxysms occur every second day
Tuberculosis + + - + + + - + Mild normocytic anemia, hyponatremia, and

hypercalcemia

Night sweats, constant fatigue
Lymphoma + - - + + - + - Increase ESR, increased LDH Night sweats, constant fatigue
Mumps + - - - - + - - Relative lymphocytosis, serum amylase elevated Parotid swelling/tenderness
HIV - - - + + + - + Constant fatigue

References

  1. Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  2. Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017
  3. Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
  4. Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016

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