African trypanosomiasis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Pilar Almonacid; Jesus Rosario Hernandez, M.D. [2]

Overview

The diagnosis of African trypanosomiasis rests upon demonstrating trypanosomes by microscopic examination of chancre fluid, lymph node aspirates,blood, bone marrow, or, in the late stages of infection, cerebrospinal fluid.

Laboratory Findings

The diagnosis of African trypanosomiasis rests upon demonstrating trypanosomes by microscopic examination of chancre fluid, lymph node aspirates,blood, bone marrow, or, in the late stages of infection, cerebrospinal fluid.

Blood smear

• Acute Chagas disease is often diagnosed by visual detection of the T.b. rhodesiense parasite on peripheral blood smear.
• Peripheral blood smears are usually stained with Giemsa stain for adequate visualization of the parasite.

	Microscopy	Findings
	African trypanosomiasis	Thin blood smear stained with Giemsa. Typical trypomastigote stages (the only stages found in patients), with a posterior kinetoplast, a centrally located nucleus, an undulating membrane, and an anterior flagellum.   The two T. brucei species that cause human trypanosomiasis, T. b. gambiense and T. b. rhodesiense, are indistinguishable morphologically.   The trypanosomes length range is 14 to 33 µm.
	African trypanosomiasis 5	Dividing parasite is seen at the right.

Electrolyte and Biomarker Studies

• Three serological tests are available for detection of the parasite; the micro-CATT, wb-CATT, and wb-LATEX. The first uses dried blood while the other two use whole blood samples.
• wb-CATT is to be the most efficient for diagnosis, while the wb-LATEX is a better exam for situations where greater sensitivity is required.

African trypanosomiasis	A, B: Two areas from a blood smear from a patient with African trypanosomiasis. Thin blood smear stained with Giemsa. Typical trypomastigote stages (the only stages found in patients), with a posterior kinetoplast, a centrally located nucleus, an undulating membrane, and an anterior flagellum. The two T. brucei species that cause human trypanosomiasis, T. b. gambiense and T. b. rhodesiense, are indistinguishable morphologically. The trypanosomes length range is 14 to 33 µm.
African trypanosomiasis 2 and 3	C, D: Blood smear from a patient with T. b. rhodesiense, Giemsa stain. D shows the same field as C, with the addition of differential interference contrast (DIC) which better visualizes the flagella (DIC is not necessary for diagnosis!). 41-year-old man who had returned from a trip to Tanzania. Specimen contributed by Dr. Phil Smith, Omaha, Nebraska.
African trypanosomiasis 5	E: Blood smear from a patient (a U.S. traveler) with T. b. rhodesiense. A dividing parasite is seen at the right. Dividing forms are seen in African trypanosomiasis, but not in American trypanosomiasis (Chagas disease).
African trypanosomiasis 6	F: Blood smear from a patient with T. b. gambiense. Image contributed by Prof. J. Le Bras, Hôpital Bichat - Claude Bernard, Paris, France.

Gallery

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).

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  African trypanosomiasis. Adapted from Public Health Image Library (PHIL).