Trypanosoma brucei rhodesiense infection occurs in East and Central Africa. It is characterized by a rapidly progressive clinical course and often leads to death within months, in the third stage of the disease, without pronounced central nervous system involvement. The early course of the disease,  chancre and parasitemia, is similar to the Gambian disease. Fever and lymph node enlargement are especially prominent, often with myocarditis, weakness,  weight loss, preceding death. Myocarditis is characterized by the presence of lymphocytes and plasma cells, and is accompanied by trypanosomes in myocardial cells and by pericardial effusion.