Refractory hypoglycaemia in a dog infected with Trypanosoma congolense

A 20 kg German shepherd dog was presented to a French veterinary teaching hospital for seizures and hyperthermia. The dog had returned 1 month previously from a six-month stay in Senegal and sub-Saharan Africa. Biochemistry and haematology showed severe hypoglycaemia (0.12 g/L), anaemia and thrombocytopenia. Despite administration of large amounts of glucose (30 mL of 30% glucose IV and 10 mL of 70% sucrose by gavage tube hourly), 26 consecutive blood glucose measurements were below 0.25 g/L (except one). Routine cytological examination of blood smears revealed numerous free extracytoplasmic protozoa consistent with Trypanosoma congolense. PCR confirmed a Trypanosoma congolense forest-type infection. Treatment consisted of six injections of pentamidine at 48-hour intervals. Trypanosomes had disappeared from the blood smears four days following the first injection. Clinical improvement was correlated with the normalization of laboratory values. The infection relapsed twice and the dog was treated again; clinical signs and parasites disappeared and the dog was considered cured; however, 6 years after this incident, serological examination by ELISA T. congolense was positive. The status of this dog (infected or non-infected) remains unclear. Hypoglycaemia was the most notable clinical feature in this case. It was spectacular in its severity and in its refractory nature; glucose administration seemed only to feed the trypanosomes, indicating that treatment of hypoglycaemia may in fact have been detrimental. Un chien Berger allemand de 20 kg a été présenté à un hôpital universitaire vétérinaire français pour convulsions et hyperthermie. Le chien était revenu un mois auparavant d’un séjour de 6 mois au Sénégal et en Afrique sub-saharienne. La biochimie et l’hématologie ont montré une hypoglycémie sévère (0.12 g/L), une anémie et une thrombocytopénie. Malgré l’administration de grandes quantités de glucose (30 mL de glucose 30 % par voie IV et 10 mL de sirop de sucre à 70 % par une sonde naso-oesophagienne, chaque heure) 26 mesures consécutives de la glycémie (sauf une) étaient inférieures à 0,25 g/L. Un examen cytologique de routine de frottis sanguins a révélé de nombreux protozoaires extracytoplasmiques libres compatibles avec Trypanosoma congolense. La PCR a confirmé une infection par Trypanosoma congolense de type forêt. Le traitement a consisté en 6 injections de pentamidine à 48 heures d’intervalles. Les trypanosomes ont disparu des frottis sanguins 4 jour