African trypanosomiasis differential diagnosis

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 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 neurological stage of African trypanosomiasis are mental status changes and sleep disturbances. Differential diagnoses includes CNS tuberculsosis, meningitis, and HIV-related opportunistic infections, including cryptococcal meningitis.

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