For exported cases of Rhodesiense HAT, infection is supposed to have been contracted in protected areas such as national parks (NP), wildlife reserves, and GR. The country exporting the majority of cases, ie, 59%, is the United Republic of Tanzania, mainly from Serengeti NP, Tarangire NP, and Mayowasi GR. Other exporting countries UK-371804 in vivo are Malawi (19%) mainly from Kasungu NP, Zambia

(12%) particularly from South Luangwa Valley NP, Zimbabwe (7%) from Mana Pools NP, and Uganda (3%) from Queen Elizabeth NP. Countries of origin for Gambiense HAT are mainly DRC and Gabon, each accounting for 23% of cases, followed by Angola (15%), Cameroon (11%), Equatorial Guinea, and Uganda (8% each), Sudan and Central African Republic (4% each), and one case (4%) in a sailor returning from West Africa. In the latter case, the country of infection could not be identified as the patient arrived to the hospital in a coma and died shortly thereafter. Rhodesiense HAT was mainly diagnosed by examination of blood smear (97% of cases) and XL184 ic50 in 3% of cases by fluid chancre examination. Chancre was present in 57% of Rhodesiense HAT cases diagnosed and it was absent in

25%. For the rest of the cases (18%), this information was not available. Trypanosomal chancre was described in one Gambiense case only.28 Foreigners were infected during short visits to DECs (usually for safaris of 1–3 wk duration) and diagnosed between 1

and 3 weeks after exposure. This means that they were usually diagnosed in the week following their return from the trip or even in some cases during the trip. In 17 cases it was referred that the diagnosis was delayed between 1 and 7 days after admission due to misdiagnosis, most notably with malaria or tick-borne diseases. Forty-six percent of the Gambiense HAT cases reported were diagnosed by examination of cerebrospinal fluid (CSF) only, including one case of brain biopsy. Blood was the body fluid where the parasite was initially found in 39% of the cases requiring concentration methods like capillary centrifugation test; in six of them blood was the sole fluid these where the parasite was found, whereas in three cases it was also observed in CSF and in one case in blood, CSF, and bone marrow (BM). In 12% of the cases, the parasite was first found in lymph. Among them, in one case the parasite was found in lymph only and in two cases the parasite was found in lymph as well as in BM. Finally, one single case (3%) was diagnosed by the clinical signs and serological test. The cases of Gambiense HAT were diagnosed after 3 to 12 months of the first examination, and following several admissions with a variety of misdiagnoses.