Rhodesiense sleeping sickness — DTM&H MCQ

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ModerateProtozoal infectionsRhodesiense sleeping sicknessDTM&H

A 31-year-old safari guide in Tanzania develops fever, severe headache and a painful chancre at the site of a fly bite. He deteriorates within 2 weeks. What is the most appropriate investigation?

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Correct answer: D — Blood film or chancre aspirate microscopy

Blood film or chancre aspirate microscopy is the single best answer because early rhodesiense disease often has high parasitaemia detectable in blood or chancre aspirate. Stool ova microscopy is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that acute progression after safari exposure needs urgent parasitological confirmation.

Reference: Manson's Tropical Diseases; WHO neglected tropical diseases guidance; CDC DPDx