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, and cerebrospinal fluid in the late stages of infection.

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 in cerebrospinal fluid.

Blood smear

Acute 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

Serology is not usually helpful in acute disease.
Detection of anti-trypanosomal IgG antibodies is helpful to detect in African trypanosomiasis infections.
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.^[1]
Detection of antibodies among infants may be difficult due to the presence of maternal antibodies early following birth. Accordingly, serologic testing for infants is only recommended at least 9 months after birth.