Rare drug rushed from UK to save patient's life

Woman contracted often-fatal sleeping sickness, spread by tsetse fly, during trip to Tanzania.

tanzania nature reserve flamingoes 248 (photo credit: )
tanzania nature reserve flamingoes 248
(photo credit: )
Doctors at Sheba Medical Center at Tel Hashomer saved the life this week of a woman in her 30s who traveled to Tanzania with her husband to tour sub-Saharan Africa and contracted a serious case of sleeping sickness, which is spread by the tsetse fly and is usually fatal. It was reportedly the first such case of an Israeli bringing the disease back home after becoming infected abroad. The woman was bitten by the fly during her trip and returned home a few days ago. She suddenly developed a fever, severe headaches and a rash surrounding the bite. Initially attributing her condition to a simple infection, her doctor prescribed antibiotics to bring down the fever. But when her temperature rose again doctors suspected she had a much more serious problem. Sheba's microbiology lab managed to identify the rare protozoa that cause African trypanosomiasis, which is not transmitted among humans but only when a tsetse fly carrier bites an infected victim (animal or human) and passes it on; in mother-to-fetus infection via the placenta; or by accidental infections in laboratories due to pricks from contaminated needles. At first the parasites remain in the bloodstream, but when the protozoa eventually pass through the blood-brain barrier, they can cause brain damage and death, therefore the disease requires immediate treatment. The leading drug for sleeping sickness is called Suramin, but it is not registered for use in Israel and is not kept by the Health Ministry in its emergency storage facilities. To obtain the medication Prof. Eli Schwartz, head of Sheba's center for medical tourism, contacted his counterparts in tropical medicine units in the US and Europe. Within a few hours a London colleague told him of a UK hospital that had a small supply of Suramin. Schwartz contacted Orit Shani, head of the Foreign Ministry's situation room in Jerusalem, who connected him with the Israeli consul in London, Liora Givon. When the hospital agreed to provide the medication Givon personally delivered it to the El Al terminal at the airport, which dispatched it to Israel and on to Tel Hashomer. The woman is in stable condition and is fully conscious, but has a lingering fever, the hospital reported. Schwartz said that with the growing number of Israelis traveling to Africa and the risk they may bring tropical diseases home with them, it is important for doctors and the Health Ministry to be ready for such emergencies. Asked by The Jerusalem Post to comment, the ministry spokeswoman's office said that since the disease is very rare in the West and Suramin is not even licensed for use here, no supply was available in its warehouse. But the panel of experts that decides which medications are required to be in the warehouse will be informed of the case to allow it to reconsider whether to require the purchase of Suramin. An epidemic of sleeping sickness in 1920 led the World Health Organization to send mobile teams to screen millions of Africans at risk. By the mid-1960s the disease had almost disappeared and surveillance was relaxed, but it reappeared in several areas over the past three decades, the WHO reports. Only certain species of tsetse flies, mainly those found in vegetation by rivers and lakes, in forests and in wooded savannahs, transmit the disease. It now threatens millions of people in 36 sub-Saharan countries. One decade ago nearly 40,000 cases were reported, but the WHO believes between 300,000 and 500,000 more cases remained undiagnosed and therefore untreated. Suramin was discovered in 1921 and is effective for treatment in the first stage of sleeping sickness, but it can cause allergic reactions and certain undesirable effects in the urinary tract. Pentamidine was discovered 20 years later, and despite a few undesirable effects, it is well tolerated by patients, according to the WHO. There are two other drugs used to treat African trypanosomiasis in its second stage, but they have undesirable side effects and have met with increased resistance or involve a strict treatment regimen.