A 32-year-old male traveler returns from rural Uganda, presenting with fever, severe headaches, and daytime sleepiness for the past two weeks. He reports a painful insect bite on his neck during his trip. On examination: Fever: 39°C (102.2°F) Painful, swollen lymph nodes in the posterior neck (Winterbottom’s sign) Confusion, excessive sleeping, and difficulty walking Differential Diagnosis . African trypanosomiasis (T. brucei) . Malaria . Viral encephalitis (e.g., arbovirus, herpes simplex) . Meningitis (bacterial, tuberculous) Diagnosis Blood smear/microscopy → Trypomastigotes visible in blood (early stage). Lumbar puncture → Trypomastigotes in CSF (late stage). Card agglutination test (CATT) → Rapid serologic test for T. brucei gambiense infection. Management . Early-stage (before CNS involvement) Pentamidine (T. brucei gambiense) Suramin (T. brucei rhodesiense) . Late-stage (CNS involvement present) Melarsoprol (toxic but effective). Eflornithine (T. brucei gambiense alternative). . Prevention Tsetse fly control (insect repellents, protective clothing). Avoiding infested areas during peak biting times.
