Size: 98 kB
Description: A seventy-one year old white male, with a history of malaria 40 years earlier, complained of weakness of three weeks duration following a vacation trip through Botswana, South Africa in July and August of 1971. During that trip he suffered many insect bites. In September because of malaise, chills and fever, he started taking quinine. A local physician subsequently prescribed quinine and Daraprim. The chills and fever abated but weakness persisted. He became anorectic and lost weight. Physical examination in New York (Dr. Hoskins) was remarkable for lethargy, mild cnoephalopathy on HIP testing but no localizing signs, bilateral, cervical, axilary and inguinal lymphadenopathy. Laboratory examination revealed slight anemia, and motile trypanosomes in the; peripheral blood The spinal fluid was clear, opening pressure 130mm. H2O, 4RBC, 33WBC, 84% mono, 16% sugar, 58% protein. Twenty eight motile trypanosomes / mm3 were seen in the counting chamber. The patient was treated with Suramin and Mel B (Arsobal) . The parasitemia disappeared, the CSF cleared. The patient probably suffered a transient reaction to Mel B (AS1) with muscle weakness, proximal more than distal with decreasing vibratory sense and fine tremor. Positive blood smear in patient traveling independently in endemic region. Diagnosis made in N. Y.C.