12 Exercises

1. Central African Republic. A patient is given a rapid IV injection of pentamidine. He suddenly falls down. Is this probably the consequence of an allergic reaction to the product?
2. In an epidemic of sleeping sickness in Congo it is proposed that all pigs in the region should be slaughtered. What do you think?
3. Belgium. A technician receives a blood smear in the laboratory. She has no clinical information. After a few minutes she notices an elongated blood parasite. Her answer is: "Trypanosoma rhodesiense". What do you think?
4. Congo. Why do a lumbar puncture in trypanosomiasis?
5. Congo. In any screening programme for trypanosomiasis a lumbar puncture should be done in every investigated person. Do you agree?
6. Congo. A man has had fever for 10 weeks. He is emaciated. You notice swollen lymph nodes in the neck. Do you think of malaria, trypanosomiasis, tuberculosis or HIV (human immunodeficiency virus) infection? Give arguments for your opinion.
7. Does using a mosquito net offer good protection against African trypanosomiasis?
8. Your lady friend visited a wildlife reserve in Tanzania 11 days ago. She now has a painful ulcer on her right arm, and also has high fever. What do you think and what do you do?
9. Because of increasing international air travel there is the possibility that sleeping sickness could be brought into Europe and in time could give rise to local epidemics. What do you think about this statement?
10. A mission sister in Zambia has high fever. She has constantly taken malaria prophylaxis. Should one think first of sleeping sickness?
11. Congo. An Italian businessman visits the Equator region for the first time. He stays there for 6 weeks and gets fever. He is treated for suspected P. falciparum malaria. The spleen is swollen to 17 cm. There are no swollen cervical lymph nodes. When examining him you notice 2 structures on a thick smear that morphologically resemble trypanosomes. What do you do? Should you give melarsoprol?
12. In earlier times numerous slaves from trypanosomiasis areas were transported to America. Why did T. b. gambiense not become endemic there?
13. Trypanosomiasis is currently spreading in areas with civil unrest. Any connection?
14. Madagascar. A colleague reports on a blood smear from a local patient with fever: "gametocytes of T. brucei brucei". What is your interpretation of this information?
15. Congo. A 30-year-old woman is diagnosed as having late stage trypanosomiasis. The cerebrospinal fluid contains 50 white blood cells per mm³. One week after the start of the treatment a new lumbar puncture is carried out. The fluid now contains 100 leukocytes per mm³. Is this to be interpreted as failure of the therapy? Why was a lumbar puncture carried out?
16. Congo. Patients A and B both have trypanosomiasis. You are told that the cerebrospinal fluid of patient A contains 20 WBC (white blood cells)/mm³ and that of patient B 2000 leukocytes/ml. What do you think?
17. How would you outline the management of the clinical problem of "confused patient", based on information about blood pressure, body temperature, history of acute infections or chronic problems, relevant medication, neurological evaluation including eye movement, glycaemia, thick smear test, blood examination, sickle cell test, CATT, HIV-status, lumbar puncture, VDRL results and cranial X-ray?