Human African Trypanosomiasis (HAT) is one of the Neglected Tropical Diseases (NTDs), as classified by the World Organisation (WHO). It is transmitted by the bite of an infected tsetse fly of the genus Glossina spp. There are two forms of the disease namely, Gambiense HAT (gHAT) that is found in west, central, and parts of east Africa, and Rhodesiense HAT (rHAT), which is found in east and southern Africa.

We present a case of a patient that presented with symptoms and signs of clinical stage-I of rHAT at a rural hospital in Zambia, southern Africa. Routine laboratory investigation by examining peripheral blood from the patient revealed no trypanosomes by stained blood film light microscopy. Laboratory diagnosis of rHAT was confirmed by findings in a laboratory test for stage-II of rHAT. We give possible explanation for this observation and its relevance in the laboratory diagnosis and therefore the management of HAT in endemic area. This case underscores the relevance of cerebral spinal fluid examination for HAT diagnosis in cases where light microscopy blood film examination is negative for trypanosomes and yet clinically the patient is in stage-I of rHAT.