Sleeping Sickness: a congenital case after a possible parents sexual transmission

Abstract

The authors identify a rare case of congenital infection by Trypanosoma brucei gambiense on a 21-year-old Afro-Brazilian boy, born in the USA, who was diagnosed at 16 months of age after returning to Portugal. At that moment, neither the patient nor his mother had ever been to Africa. He was admitted in our Paediatric Department under symptoms of a wasting syndrome, lymphadenopathies and intermittent fever. During the initial evaluation, he was diagnosed with anaemia, hypergammaglobulinemia and a positive serology for cytomegalovirus infection. A month later, the wasting syndrome had gotten worse and he was identified with daytime somnolence. At this point, his mother was diagnosed with HAT, which motivated specific diagnostic procedures in the child. A blood test revealed Trypanosomes, the CATT (Card Agglutination Test for Trypanosomes) was positive and a lumbar puncture was performed, which clearly established the diagnosis of late-stage HAT. Consequently, Electroencephalogram and brain MRI showed extensive brain damage and a Fundoscopic examination revealed spots of an atypical chorioretinitis, probably associated with the combined trypanosomal and cytomegalovirus infection. Treatment was established with intravenous eflornithine (DFMO). The patient tolerated the drug, which led to a gradual clinical improvement, including the complete regression of brain and retinal injuries. Two years after this treatment, parasitological cure was confirmed according to established criteria. At the moment, the patient remains well, and shows a normal psychomotor development. Diagnostic difficulties in pediatric sleeping sickness, including the elusive characteristics of the patient and his parents’ epidemiological history are highlighted.