Sleeping Sickness in Travelers - Do They Really Sleep 英文参考文献.docVIP

SleepingSicknessinTravelers-DoTheyReallySleep? KarinUrech1,2*,AndreasNeumayr1,JohannesBlum1 1SwissTropicalandPublicHeathInstitute,Basel,Switzerland,2MedicalFaculty,UniversityofBasel,Basel,Switzerland Abstract ThenumberofimportedHumanAfricanTrypanosomiasis(HAT)casesinnon-endemiccountrieshasincreasedoverthelast years. The objective of this analysis is to describe the clinical presentation of HAT in Caucasian travelers. Literature was screened(MEDLINE,Pubmed)usingtheterms‘‘HumanAfricanTrypanosomiasis’’,‘‘travelers’’and‘‘expatriates’’;allEuropean languagesexceptSlaviconeswereincluded.Publicationswithoutclinicaldescriptionofpatientswereonlyincludedinthe epidemiologicalanalysis.Forty-fivereportsonCaucasianswithT.b.rhodesienseand15withT.b.gambienseinfectionswere includedintheanalysisoftheclinicalparameters.Bothspecieshavepresentedwithfever(T.b.rhodesiense97.8%andT.b. gambiense93.3%),headache(50%each)andatrypanosomalchancre(T.b.rhodesiense84.4%,T.b.gambiense46.7%).While sleeping disorders dominate the clinical presentation of HAT in endemic regions, there have been only rare reports in travelers:insomnia(T.b.rhodesiense7.1%,T.b.gambiense21.4%),diurnalsomnolence(T.b.rhodesiense4.8%,T.b.gambiense none). Surprisingly, jaundice has been seen in 24.2% of the Caucasian T.b. rhodesiense patients, but has never been describedinHATpatientsinendemicregions.TheseresultscontrasttotheclinicalpresentationofT.b.gambienseandT.b. rhodesienseHATinAfricansinendemicregions,wherethepresentationofchronicT.b.gambienseandacuteT.b.rhodesiense HATisdifferent.Theanalysisof14reportsonT.b.gambienseHATinAfricanslivinginanon-endemiccountryshowsthat neurological symptoms such as somnolence (46.2%), motor deficit (64.3%) and reflex anomalies (14.3%) as well as psychiatric symptoms such as hallucinations (21.4%) or depression (21.4%) may dominate the clinical picture. Often, the diagnosis has been missed initially: some patients have even been hospitalized in psychiatric clinics. In travelers T.b. rhodes