Priapism as an Additional Clinical Presentation of Rhodesiense Human African Trypanosomiasis in Stage-1 of the Disease: A Case Report from Zambia

Human African Trypanosomiasis (HAT) is listed among diseases referred to as Neglected Tropical Diseases (NTD) by the World Health Organisation (WHO) [1]. This disease is caused by an invasive parasite, which a hemoflagellate, that belongs to the species Trypanosoma brucei. There are two subspecies of Trypanosoma brucei that are pathogenic to humans. These are Trypanosoma brucei rhodesiense (Tbr) that causes Rhodesiense Human African Trypanosomiasis (rHAT) or East African sleeping sickness and Trypanosoma brucei gambiense (Tbg) that causes Gambiense Human African Trypanosomiasis (gHAT) or West African sleeping sickness. The parasite is transmitted to humans mainly by the bite of an infected tsetse fly belonging to the genus Glossina spp. The two diseases caused by Tbr and Tbg are basically the same, the difference being in the duration of the illness [2]. The acute, rapidly progressive form of the disease is rHAT while gHAT is a chronic disease and progresses at a more indolent pace. The two diseases occur in two stages namely, Stage-1, also called the Hemo-lymphatic stage, and Stage-2, also called the Meningo-encephalitic stage. In Stage-1, the parasites are confined to the blood circulation and the lymphatics. For rHAT the patient presents usually with fever and headache [3, 4, 5]. Other presentations include thyroid dysfunction, adrenal insufficiency, hypogonadism, and liver involvement [6, 7]. In stage -2, the parasite has invaded the Central nervous System. Here the patient presents with signs and symptoms of progressive mental deterioration. 

Priapism is an erectile dysfunction characterized by a persistent, usually painful, erection of the penis that lasts for more than four hours and is unrelated to sexual stimulation [8]. There are many causes of this condition, even though in many instances the cause is unknown. Priapism has not been reported in literature before to be a clinical presentation of rHAT. We report a case where a patient presented with priapism in addition to the typical clinical presentations of Stage-1 of rHAT.