A 16-year-old boy from South Sudan referred to Sudan National Centre for Neurological Sciences, Khartoum, Sudan suffering from non-convulsive status epilepticus, mental deterioration and behavioral changes for the last nine months. He was not malnourished and there was no fever, weight loss or lymphadenopathy. This disease affected the health status of the boy, and he became unable to communicate with his family and inattentive to his surroundings. This boy suffered from a decrease in school performance ended by leaving school. There were no motor or sensory symptoms, and no symptoms related to other systems were observed.

Past medical history is only significant to African trypanosomiasis three years ago which had been treated by combination therapy (full course of nifurtimox and eflornithine) for trypanosomiasis. His previous symptoms were fever, weight loss and excessive sleeping. Unfortunately, we lost his previous follow up after giving him the previous treatment. No family history of similar condition or neurological diseases were identified during taking clinical history.

Physical exam

During physical examination, the patient was found conscious but disorientated to time, place and persons. Also, there was no lymphadenopathy or hepatomegaly but there was slight splenomegaly.

The boy scored zero in the abbreviated mental test score (a 10-point test, and score ≤ 8 indicate cognitive impairment). There were no signs of meningeal irritation. intact cranial nerves, normal fundal examination. Normal upper and lower limbs motor examinations. Sensations were intact. Vital signs were found stable and examinations for other systems were unremarkable.

Work up

In the routine laboratory investigations for the boy, hemoglobin concentration was low (8.9 gdl), mean corpuscular volume (MCV) was 65.5 fl and serum random blood glucose was 110 mg/dl. An elevated estimation sedimentation rate (ESR) was found during laboratory investigation (61 mm/hour). Other renal and liver function tests were normal. During blood film microscopy, no trypanosome were seen in buffy coat preparation, wet preparation, and thin blood film. Trypomastigotes were seen in the CSF and card agglutination test for trypanosomiasis was found positive in this patient.

CSF Fluid analysis

We took CSF for analysis, and we found trypomastigotes and less than five white blood cells per milliliter. Level of glucose was: 8.7 mg/dl, and lactate dehydrogenase (LDH) was 27 u/l. CSF protein level was normal (29.3 mg/dl). No CSF centrifugation and microscopy was done for trypomastigotes in CSF.

Radiological investigations

A normal magnetic resonance imaging (MRI) of Brain was found in this patient. Regarding ultrasound (US) for the abdomen, enlarged spleen with normal texture was observed.

Electro-encephalogram (EEG) suggested an on-going generalized seizure activity. (Fig. 1 and 2).

Fig. 1
figure 1

EEG finding of the patients shows generalized seizure activity

Fig. 2
figure 2

Printed EEG report of the patients by neurologist

Management

The boy was managed with a loading dose of intravenous phenytoin followed by a maintenance dose. Oral Carbamazepine 400 mg was given twice/day, tonics (ferrous sulphate 200 mg three times a day and folic acid 5 mg once daily) to improve his health status because we thought that his cognitive impairment had jeopardized his oral feeding, and combination therapy (Nifurtimox-Eflornithine) for African trypanosomiasis.

Hospital course

This patient was admitted and managed for two months and he completed his combination therapy (Nifurtimox-Eflornithine) for African trypanosomiasis. After two weeks of treatment in hospital, he showed a remarkable improvement in his cognitive function and started to communicate with his family. After that, he was referred back to his country with a combination therapy (Nifurtimox-Eflornithine) for African trypanosomiasis if he encounters a relapse of the disease; because this treatment is not available in his home country (South Sudan) after separation from the republic of Sudan.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Disclaimer:

This article is autogenerated using RSS feeds and has not been created or edited by OA JF.

Click here for Source link (https://www.biomedcentral.com/)