Approach to the Critical Patient

Immediate priorities

Recognize the life-threatening course

Airway, breathing, circulation

Concurrent tropical co-infection

Key decision points

Diagnosis confirmation before specific therapy

Staging determines drug choice

Team activation and consults

Escalation triggers

History

Travel and exposure

Travel history is paramount

High-exposure activities

Symptom timeline

Incubation and tempo

Stage 1 symptoms

Stage 2 symptoms

Key clues and negatives

Discriminating features

Past medical and exposure history

Physical Exam

Vitals and general

Stability snapshot

Classic findings

Lymphatic and skin signs

Visceral findings

Neurological and cardiac exam

Neurological assessment

Cardiac assessment

PITFALLS

Diagnostic traps

Differential Diagnosis

Life-threatening and infectious mimics

Must-not-miss infections

Chronic febrile mimics

Parasitic and neoplastic differentials

Other tropical parasites

Neoplastic and other

Differentiating clues

Distinguishing features

Laboratory Tests

Parasitological confirmation

Direct parasite detection

Aspirate microscopy

Serology and molecular

Serological screening (gambiense only)

Molecular testing

Supportive labs

Hematology and chemistry

Pre-treatment safety labs

Diagnostic Tests

Scoring Systems

Disease staging classification

Lumbar puncture decision

MRI

Brain MRI role

CT

CT head role

CT chest role

Ultrasound

Echocardiography

Abdominal point-of-care ultrasound

Disposition

Level of care

Admission indications

ICU indications

Coordination and follow-up

Consultation and drug access

Post-treatment follow-up

Treatment

Initial stabilization

Resuscitation priorities

First-line by stage gambiense

Fexinidazole oral (first-line, most cases)

Pentamidine IM for early gambiense in young children

NECT for severe second-stage gambiense

First-line by stage rhodesiense

Fexinidazole oral (first-line)

Suramin IV for early rhodesiense in young children

Melarsoprol IV for second-stage rhodesiense (last resort)

Monitoring and pearls

Fexinidazole safety monitoring

Supportive and pipeline considerations

Special Populations

Pregnancy

Pregnancy considerations

Geriatric

Older adult features

Pediatrics

Pediatric approach

Background

Epidemiology

Global burden and distribution

Outcome and elimination

Pathophysiology

Disease mechanism

Organ involvement

Therapeutic Considerations

Drug access and stewardship

Evidence base

Patient Discharge Instructions

copy discharge instructions

African sleeping sickness care plan

Warning signs to return to the ER

Follow-up schedule

Prevention for future travel

References

Guidelines and key sources

Guideline sources

Landmark evidence

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.