The 3 stages:
(1) primary (initial chancre at site of tsetse fly bite and inoculation)
(2) secondary (hemolymphatic spread)
(3) tertiary (central nervous system manifestations
Features of the primary stage:
(1) chancre
(2) trypanosomes in an aspirate or biopsy taken from the chancre
Features of the secondary stage:
(1) trypanids (transient erythematous, urticarial, and/or macular rash, which may be accentuated by cold, heat or sweating)
(2) lymphadenopathy
(3) localized edema, especially of the face
(4) petechiae and/or purpura
(5) pruritis
(6) erythema nodosum
(7) ichthyosis
(8) jaundice
(9) acroparesthesias
(10) arthralgias
(11) dizziness
(12) headache
(13) hepatosplenomegaly
(14) malaise
(15) spiking fevers
(16) trypanosomes in peripheral blood, lymph node aspirate or skin lesions aspirates/biopsies
Features of the tertiary stage:
(1) meningoencephalitis
(2) daytime somnolence and/or insomnia at night
(3) Parkinsonian behavior
(4) psychiatric manifestations including psychosis
(5) Kerandel’s deep hyperesthesia (delayed, bilateral pain following a blow or squeeze to soft tissue that is out of proportion to the stimulus)
(6) trypanosomes in the CSF
Variations may arise:
(1) if there is pre-existing partial immunity
(2) dependinig on skin color
(3) if the clinical findings are misinterpreted
