Question 1 of 10

    African Trypanosomiasis (Sleeping Sickness)

    Trypanosoma sp. PHIL 613 lores[1]

    African trypanosomiasisis an illness endemic to sub-Saharan, also called African Sleeping Sickness.

    The disorder is related to the following process: infectious.

    Presentation

    With T. b. rhodesiense, symptoms are seen within 1-3 weeks of the infective bite and the symptoms include high fever, chancre at the site of penetration, skin rash, headache, thrombocytopenia, myalgia and on rare occasions, splenomegaly, cardiac dysfunction and renal failure may be seen [9].

    T.b gambiense does not have a specific presentation but weight loss, lymphadenopathy, pruritus, facial edema, myalgia, malaise, headache and fever may be recorded. The CNS gets involved after months to years of infection and this is characterized by severe headaches, somnolence, range of neurologic manifestations, mood disorders, behavior change, focal deficits, endocrine disorders etc. The clinical course of disease caused by T. b gambiense is less severe than T. b rhodesiense but if left untreated, they can be very fatal.

    Liver, Gall & Pancreas
    Hepatomegaly
    • Hepatomegaly and particularly splenomegaly may be observed, and generalized lymphadenopathy may also be present.[uptodate.com]
    • Skin invasion for enhanced transmission is likely a powerful evolutionary force driving extravasation, suggesting that the generalised tissue penetration underlying pathogenesis (i.e. splenomegaly, hepatomegaly, CNS invasion) is a secondary epiphenomenon[elifesciences.org]
    Hepatosplenomegaly
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  • Entire body system
    Anemia
    • Inflammatory changes lead to a demyelinating meningoencephalitis; there is cerebral edema, hemorrhages, pericarditis, and anemia.[dna.kdna.ucla.edu]
    • These macrophages release harmful chemicals such as TNF's, cause organ lesions, anemia, and cachexia.[austincc.edu]
    • If left untreated, the parasitic infection causes anemia, heart, kidney, and endocrine failure, and neurologic damage.[icd10data.com]
    • Other, nonspecific laboratory findings include anemia, monocytosis, and markedly elevated serum levels of polyclonal IgM.[merckmanuals.com]
    • Other hematologic findings may include anemia , granulocytopenia and thrombocytopenia.[histopathology-india.net]
    Fatigue
    • Blood 2016 127:167; doi: A 49-year-old Spanish woman presented immediately on return to Spain from a 2-week visit to Tanzania with malaise, fatigue, arthralgia, and high fever (39 C).[bloodjournal.org]
    • These include fever, rash , swelling around the eye and hands, severe headaches , extreme fatigue , aching muscles and joints.[webmd.com]
    • However, after 1-2 years the parasite enters the CNS and causes the patient to go through neurological symptoms such as personality changes, insomnia, fatigue, partial paralysis, trouble walking, and hormone imbalances.[austincc.edu]
    • Weight loss and general fatigue are also common symptoms associated with infection by this subspecies.[microbewiki.kenyon.edu]
    • Profound fatigue during the day gives way to extreme agitation at night.[the-scientist.com]
    Fever
    • African pig disease see African swine fever (below).[medical-dictionary.thefreedictionary.com]
    • Typhoid fever and other enteric fevers.[patient.info]
    • People who have had tsetse fly bites or become ill with high fever or other manifestations of African trypanosomiasis are advised to seek early medical attention.[medicinenet.com]
    • Blood 2016 127:167; doi: A 49-year-old Spanish woman presented immediately on return to Spain from a 2-week visit to Tanzania with malaise, fatigue, arthralgia, and high fever (39 C).[bloodjournal.org]
    • BLOOD STAGE The earliest sign of a generalized infection is fever; there may also be malaise, headache and pains in the joints.[dna.kdna.ucla.edu]
    High Fever
    • People who have had tsetse fly bites or become ill with high fever or other manifestations of African trypanosomiasis are advised to seek early medical attention.[medicinenet.com]
    • Blood 2016 127:167; doi: A 49-year-old Spanish woman presented immediately on return to Spain from a 2-week visit to Tanzania with malaise, fatigue, arthralgia, and high fever (39 C).[bloodjournal.org]
    • Clinically there is high fever, severe depression, purple skin discoloration, incoordination and posterior paresis.[medical-dictionary.thefreedictionary.com]
    Hypersomnia
    • The primary symptom of the disease is hypersomnia or excessive sleep, although the disease can also cause insomnia .[house.wikia.com]
    • In contrast to other infections, there is no hypersomnia, but the sleep pattern is fragmented.[physiologyonline.physiology.org]
    Malaise
    • Blood 2016 127:167; doi: A 49-year-old Spanish woman presented immediately on return to Spain from a 2-week visit to Tanzania with malaise, fatigue, arthralgia, and high fever (39 C).[bloodjournal.org]
    • BLOOD STAGE The earliest sign of a generalized infection is fever; there may also be malaise, headache and pains in the joints.[dna.kdna.ucla.edu]
    • Early infection (stage I) — Early symptoms of HAT infection include intermittent headache, fevers, malaise, and arthralgias.[uptodate.com]
    • Symptoms tend to be nonspecific, including: General malaise.[patient.info]
    • Progression is very slow with only mild symptoms intialy appearing such as intermittent head,muscle, and joint aches, malaise, and itching of the skin can occur.[austincc.edu]
    Weight Loss
    • The illness progresses after a few weeks to weight loss, as well as personality changes, slurred speech, seizures, difficulty balancing and walking resulting from central nervous system failure.[iamat.org]
    • Other nonspecific symptoms may be present including pruritus, rash, weight loss, and facial swelling.[uptodate.com]
    • Anorexia, wasting and weight loss.[patient.info]
    • As the illness gets worse, symptoms may include: Severe headache Personality change Weight loss Irritability Loss of concentration Progressive confusion Slurred speech Seizures Difficulty walking and talking Sleeping for long periods of the day Insomnia[hopkinsmedicine.org]
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  • Face, Head & Neck
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  • neurologic
    Ataxia
    • CNS involvement causes persistent headache, inability to concentrate, personality changes (eg, progressive lassitude and indifference), daytime somnolence, tremor, ataxia, and terminal coma.[merckmanuals.com]
    • Irritability, tremors, and increased muscle tone are usual signs; sometimes ataxia or hemiparesis occurs, but rarely meningism.[patient.info]
    Headache
    • Symptoms include characteristic skin lesions, intermittent fever, headache, rigors, transient edema, generalized lymphadenopathy, and often fatal meningoencephalitis.[merckmanuals.com]
    • In the first stage, infected persons typically experience fever , headache , muscle and joint pain , and inflammation of the lymph nodes .[britannica.com]
    • If a person contracts T. b. rhodesiense , symptoms usually appear 1 to 2 weeks after the infection and include a red sore (chancre) at the site of the bite, severe headache, lack of appetite, insomnia, enlarged lymph nodes, muscle and joint pain, and[iamat.org]
    • This is followed within two to three weeks by rash, fever, headaches, lethargy, confusion, and severe illness.[thirdworldtraveler.com]
    • Chronic and intermittent fever, headache, and lymphadenopathy are the leading signs and symptoms of the first stage of human African trypanosomiasis [ Infect Dis Clin North Am . 2012;26(2):261-273] and may pose diagnostic challenges to health professionals[bloodjournal.org]
    Insomnia
    • If a person contracts T. b. rhodesiense , symptoms usually appear 1 to 2 weeks after the infection and include a red sore (chancre) at the site of the bite, severe headache, lack of appetite, insomnia, enlarged lymph nodes, muscle and joint pain, and[iamat.org]
    • The primary symptom of the disease is hypersomnia or excessive sleep, although the disease can also cause insomnia .[house.wikia.com]
    • Early findings include insomnia, loss of appetite, behavioural changes, mood disorders, apathy, and headaches.[dermnetnz.org]
    • In the Gambian form the disease progresses in a more insidious fashion with personality changes, insomnia or irritability signaling invasion of the CNS.[dna.kdna.ucla.edu]
    • However, after 1-2 years the parasite enters the CNS and causes the patient to go through neurological symptoms such as personality changes, insomnia, fatigue, partial paralysis, trouble walking, and hormone imbalances.[austincc.edu]
    Irritability
    • Fever, severe headaches , irritability, extreme fatigue , swollen lymph nodes , and aching muscles and joints are common symptoms of sleeping sickness.[webmd.com]
    • In the Gambian form the disease progresses in a more insidious fashion with personality changes, insomnia or irritability signaling invasion of the CNS.[dna.kdna.ucla.edu]
    • As the illness gets worse, symptoms may include: Severe headache Personality change Weight loss Irritability Loss of concentration Progressive confusion Slurred speech Seizures Difficulty walking and talking Sleeping for long periods of the day Insomnia[hopkinsmedicine.org]
    • Either way, the sickness begins with fever, headache, joint pain, itching, and lethargy, then, as the parasites cross the blood-brain barrier, irritability, confusion, slurred speech, poor coordination, and sensory disturbances ensue.[the-scientist.com]
    Mental Deterioration
    • Subsequently patients develop confusion, disruption of the sleep cycle, and mental deterioration.[icd10data.com]
    • Symptoms include headache, stiff neck, sleep disturbance, and depression, followed by progressive mental deterioration, focal seizures, tremors, and palsies.[web.stanford.edu]
    • Without treatment, the disease is invariably fatal, with progressive mental deterioration leading to coma, systemic organ failure, and death.[en.wikipedia.org]
    Personality Change
    • The illness progresses after a few weeks to weight loss, as well as personality changes, slurred speech, seizures, difficulty balancing and walking resulting from central nervous system failure.[iamat.org]
    • Progressive confusion, personality changes, slurred speech, seizures , and difficulty in walking and talking occur when infection has invaded the central nervous system .[webmd.com]
    • In the Gambian form the disease progresses in a more insidious fashion with personality changes, insomnia or irritability signaling invasion of the CNS.[dna.kdna.ucla.edu]
    • The second stage, which develops within several weeks ( T. brucei rhodesiense ) or within one to two years ( T. brucei gambiense ), is marked by involvement of the brain and spinal cord , accompanied by personality changes, sleep disturbances, and profound[britannica.com]
    • However, after 1-2 years the parasite enters the CNS and causes the patient to go through neurological symptoms such as personality changes, insomnia, fatigue, partial paralysis, trouble walking, and hormone imbalances.[austincc.edu]
    Seizure
    • The illness progresses after a few weeks to weight loss, as well as personality changes, slurred speech, seizures, difficulty balancing and walking resulting from central nervous system failure.[iamat.org]
    • Progressive confusion, personality changes, slurred speech, seizures , and difficulty in walking and talking occur when infection has invaded the central nervous system .[webmd.com]
    • Congenital African trypanosomiasis occurs in children, causing psychomotor retardation and seizure disorders.[emedicine.medscape.com]
    • W W W … Sign In 01:19 … Monsters Inside Me W … The Acanthamoeba Parasite i … While swimming with a friend a man has a seizure and collapses.[animalplanet.com]
    Somnolence
    • The encephalopathy leads to apathy, somnolence and coma.[dna.kdna.ucla.edu]
    • Somnolence is the classic symptom of the disease; however it is preceded by a period of nighttime insomnia and daytime somnolence.[dermnetnz.org]
    • Sleeping sickness refers to the somnolence that occurs during the day and the restlessness and insomnia that occur at night.[ajnr.org]
    • CNS involvement causes persistent headache, inability to concentrate, personality changes (eg, progressive lassitude and indifference), daytime somnolence, tremor, ataxia, and terminal coma.[merckmanuals.com]
    • Daytime somnolence then nocturnal insomnia with upset of the circadian rhythm. [ 7 ] Behavioural changes with mood swings and sometimes depression.[patient.info]
    Stupor
    Tremor
    • The resulting neurological symptoms include severe headache, mental dullness and apathy , a weary shuffling gait, tremors, spastic or flaccid paralysis , chorea, and a profound sleepiness that develops during a meal or when the patient is standing or[britannica.com]
    • Once infected, people have anywhere from weeks to years before the parasite crashes into the brain, causing headaches, tremors, confusion, and paralysis.[sciencemag.org]
    • CNS involvement causes persistent headache, inability to concentrate, personality changes (eg, progressive lassitude and indifference), daytime somnolence, tremor, ataxia, and terminal coma.[merckmanuals.com]
    • A variety of muscle disorders may follow, including tremors and disturbances of speech, gait, and reflexes.[dermnetnz.org]
    • Irritability, tremors, and increased muscle tone are usual signs; sometimes ataxia or hemiparesis occurs, but rarely meningism.[patient.info]
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  • Immune System
    Generalized Lymphadenopathy
    • Generalized lymphadenopathy often occurs.[merckmanuals.com]
    • Hepatomegaly and particularly splenomegaly may be observed, and generalized lymphadenopathy may also be present.[uptodate.com]
    Splenomegaly
    • Hepatomegaly and particularly splenomegaly may be observed, and generalized lymphadenopathy may also be present.[uptodate.com]
    • The disease progresses through two phases: Stage 1 is marked by fever, lymphadenopathy, splenomegaly, and myocarditis.[medical-dictionary.thefreedictionary.com]
    • Skin invasion for enhanced transmission is likely a powerful evolutionary force driving extravasation, suggesting that the generalised tissue penetration underlying pathogenesis (i.e. splenomegaly, hepatomegaly, CNS invasion) is a secondary epiphenomenon[elifesciences.org]
    • However the pathological symptoms observed in experimental trypanosomiasis are mainly loss of body weight, fever, reduced locomotory activity, splenomegaly, and liver damages.[hindawi.com]
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  • Skin
    Chancre
    • A trypanosomal chancre may appear around 48 hours after the tsetse bite.[dermnetnz.org]
    • The chancre precedes parasitemia.[histopathology-india.net]
    • ., M.D. [1] ; Associate Editor(s)-In-Chief: Pilar Almonacid, Jesus Rosario Hernandez, M.D. [2] Overview The diagnosis of African trypanosomiasis rests on demonstrating trypanosomes by microscopic examination of chancre fluid, lymph node aspirates , blood[wikidoc.org]
    • The same parasites were seen in the material obtained from the trypanosomal chancre.[bloodjournal.org]
    • It’s called a chancre.[hopkinsmedicine.org]
    Eruptions
    • Frequently there are transient skin eruptions characterized by erythema or edema.[histopathology-india.net]
    • In 1901, a devastating epidemic erupted in Uganda, killing more than 250,000 people, including about two-thirds of the population in the affected lakeshore areas.[en.wikipedia.org]
    • Other severe adverse reactions reported are polyneuropathies (up to 10%), exfoliative dermatitis, fever, headache, diarrhea, maculopapular eruptions, pruritus, and abdominal and chest pain [ 274 , 275 ].[hindawi.com]
    • T. equiperdum : fever, swellings and local oedema of the genital organs and mammary glands, oedematous eruptions of the skin, anaemia, emaciation, ocular lesions, lack of coordination in the limbs, facial paralysis and continuing appetite.[discontools.eu]
    Insect Bite
    • Permethrin-impregnated clothing and insect repellent have not been proved to be particularly effective against tsetse flies, but they will prevent other insect bites that can cause illness.[cdc.gov]
    • Awareness of risk and insect bite avoidance is therefore the only method of preventing infection.[unhs.co.uk]
    • Trypanosomiasis refers to three types of infections caused by protozoa * and spread to humans through insect bites.[humanillnesses.com]
    • The only way to prevent the disease is to avoid insect bites.[hopkinsmedicine.org]
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  • gastrointestinal
    Loss of Appetite
    • Early findings include insomnia, loss of appetite, behavioural changes, mood disorders, apathy, and headaches.[dermnetnz.org]
    • People who experience symptoms may have fevers, rashes, extreme tiredness, vomiting, loss of appetite, or swollen lymph nodes.[humanillnesses.com]
    • […] of appetite and weight, leading to early death in acute forms or to digestive and/or nervous signs with emaciation and eventually death in chronic forms.[discontools.eu]
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  • musculoskeletal
    Arthralgia
    • Blood 2016 127:167; doi: A 49-year-old Spanish woman presented immediately on return to Spain from a 2-week visit to Tanzania with malaise, fatigue, arthralgia, and high fever (39 C).[bloodjournal.org]
    • Early infection (stage I) — Early symptoms of HAT infection include intermittent headache, fevers, malaise, and arthralgias.[uptodate.com]
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  • Workup

    Although general laboratory studies may be helpful in the diagnosis of African trypanosomiasis (sleeping sickness), a definitive diagnosis of T brucei infection requires actual detection of trypanosomes in blood, lymph nodes, cerebrospinal fluid (CSF), skin chancre aspirates, or bone marrow. In areas where diagnostic studies are not readily available, however, symptomatic improvement after empiric treatment is the usual confirmatory test. Buffy-coat preparations concentrate the parasite [9].

    Pathology

    Cytology
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  • Laboratory

    Serum
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  • Cerebrospinal Fluid
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  • Treatment

    Prehospital care of African trypanosomiasis (sleeping sickness) centers on management of the acute symptoms of fever and malaise in conjunction with close monitoring of the patient’s neurologic status. In the emergency department, if central nervous system (CNS) symptoms are severe, airway management to prevent aspiration becomes important, along with an immediate blood smear, complete blood count (CBC), and lumbar puncture for trypanosome detection [10].

    Prognosis

    Patients of stage 1 trypanosomiasis recover fully after treatment. In stage 2 trypanosomiasis however, the manifestations in the CNS ultimately become fatal if left untreated. With drugs that work inside the CNS like melasorprol, the cure rate is more than 95% [8].

    Complications

    African Trypanosomiasis
    Coma
    Depression
    • Clinical findings Acute febrile syndrome, chills, headache, vomiting, pain in extremities, lymphadenopathy, anaemia, depression, fatigue, coma rapidly progressing to death; chronic disease with CNS depression.[medical-dictionary.thefreedictionary.com]
    • Daytime somnolence then nocturnal insomnia with upset of the circadian rhythm. [ 7 ] Behavioural changes with mood swings and sometimes depression.[patient.info]
    • This man’s medical history was also remarkable for psychiatric problems, such as “hearing voices” and depression.[ajnr.org]
    • Symptoms include headache, stiff neck, sleep disturbance, and depression, followed by progressive mental deterioration, focal seizures, tremors, and palsies.[web.stanford.edu]
    Edema
    • The signs and symptoms of the infection are initially nonspecific (high fever , rash , edema , or swollen glands) but the disease progresses to encephalitis and meningitis .[medicinenet.com]
    • Frequently there are transient skin eruptions characterized by erythema or edema.[histopathology-india.net]
    • Inflammatory changes lead to a demyelinating meningoencephalitis; there is cerebral edema, hemorrhages, pericarditis, and anemia.[dna.kdna.ucla.edu]
    • Symptoms include characteristic skin lesions, intermittent fever, headache, rigors, transient edema, generalized lymphadenopathy, and often fatal meningoencephalitis.[merckmanuals.com]
    • The clinical picture includes an acute pulmonary form manifested by dyspnea, cough and profuse nasal discharge, and a subacute, cardiac form in which the principal signs are edema of the head and internally, oral petechiation and esophageal paralysis.[medical-dictionary.thefreedictionary.com]
    Hallucinations
    Meningoencephalitis
    • Inflammatory changes lead to a demyelinating meningoencephalitis; there is cerebral edema, hemorrhages, pericarditis, and anemia.[dna.kdna.ucla.edu]
    • After many weeks, the infection may become meningoencephalitis.[hopkinsmedicine.org]
    • Symptoms include characteristic skin lesions, intermittent fever, headache, rigors, transient edema, generalized lymphadenopathy, and often fatal meningoencephalitis.[merckmanuals.com]
    • Microscopically, the picture is that of a diffuse meningoencephalitis.[histopathology-india.net]
    Thrombocytopenia
    • Blood analysis showed leukopenia (2.3 10 9 /L) and thrombocytopenia (55 10 9 /L), low prothrombin index expressed as a percentage (66%), increased lactate dehydrogenase (622 IU/L; normal, 250-450 IU/L), and hepatic transaminase values (aspartate aminotransferase[bloodjournal.org]
    • Other hematologic findings may include anemia , granulocytopenia and thrombocytopenia.[histopathology-india.net]
    • Investigations Blood tests may show: Anaemia and thrombocytopenia.[patient.info]
    • Laboratory testing showed normocytic anemia and thrombocytopenia.[ajnr.org]
    • He had renal failure, thrombocytopenia, raised liver enzymes, and evidence of possible cardiac involvement with a bradycardia and features suggestive of Wenkebach-type [atrioventricular] heart block.[medicalecology.org]
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  • Etiology

    In humans, there are two subspecies that are responsible for the initiation of the disease. In west and central Africa, the disease is caused by Trypanosoma brucei gambiense [5]. Trypanosoma brucei rhodesiense has a limited geographical range and it is responsible for causing the disease in east and southern Africa. Additionally, Trypanosoma brucei brucei is responsible affecting animals bit it doesn’t affect humans.

    Epidemiology

    In the United States, all cases of African trypanosomiasis is imported from Africa by travellers who go to areas that have been designated as endemic. Infections amongst travellers however, is around 1 case per year, with some years not getting any records. Most of the infections are of T brucei rhodesiense and these are acquired in game parks in Eastern Africa.

    Internationally, this disease is confined to tropical Africa covering the north of South Africa to south of Algeria, Libya and Egypt. Outside this area, the prevalence of African Trypanosomiasis varies by country and region [4]. Major outbreaks occurred in Angola, DR Congo and Sudan in 2005. African trypanosomiasis remains a challenge in the Central African Republic, Chad, Congo, Cote d’Ivoire, Tanzania, Uganda, Malawi and Guinea.

    In Zimbabwe, Zambia, Rwanda, Nigeria, Mozambique, Kenya, Gabon, Equatorial Guinea, Cameroon and Burkina Faso, less than 50 cases are reported each year. The transmission of T.Brucei seems to have stopped in Togo, Swaziland, Sierra Leone, Senegal, Niger, Namibia, Mali, Liberia, Guinea Bissau, Ghana, Gambia, Ethiopia, Burundi, Bostwana and Benin as no new case has been reported for decades now.

    The African Trypanosomiasis condition is a threat to millions of people in 36 countries in sub Saharan Africa. The situation is difficult to assess presently because of the lack of diagnostic expertise and surveillance in these locations.

    Sex distribution
    Age distribution

    Pathophysiology

    The parasites, trypanosomes are parasites known for a 2-host life cycle namely mammalian and arthropod. The life cycle begins when the trypanosome is ingested during the course of a blood meal from either an animal reservoir (East African trypanosomiasis) or a human reservoir (West African trypanosomiasis). The parasites multiply over a 2-3 week period in the mid gut of the fly from where they move to its salivary gland, developing into an epimastigote [6].

    Humans get infected with T brucei following the bite of a fly. Occasionally this causes a skin chancre at the site of penetration. The injected parasites mature further and divide in the blood and lymphatic system causing malaise, intermittent fever, rash and wasting. Over time, the parasites spread into the Central Nervous System where behavioral and neurologic changes like encephalitis and coma. In extreme cases, death may occur.

    The parasites escape the initial host defense mechanisms through extensive antigenic variation of parasite surface glycoproteins (major variant surface glycoprotein [VSG]). This evasion of humoral immune responses contributes to virulence. During the parasitemia, most pathologic changes occur in the hematologic, lymphatic, cardiac, and central nervous systems. This may be the result of immune-mediated reactions against antigens on red blood cells, cardiac tissue, and brain tissue, resulting in hemolysis, anemia, pancarditis, and meningoencephalitis [7].

    Skin problems like persistent urticaria, puritus and facial edema are caused by hypersensitivity reaction. Infested lymph nodes and increased lymphocyte levels in the spleen lead to fibrosis but it rarely every gets to splenomegaly. When the monocytes, macrophages and plasma cells get into the blood vessels increased vascular permeability and endarteritis occur.

    Prevention

    No vaccine is available for African trypanosomiasis. Chemoprophylaxis is unavailable.

    Avoidance of travel to areas heavily infested with tsetse flies is recommended. Tsetse flies are attracted to moving vehicles and dark contrasting colors. They are not affected by insect repellants and can bite through lightweight clothing. At-risk travelers are advised to wear wrist- and ankle- length clothing that is made of medium-weight fabric in neutral colors.

    Summary

    More commonly known as sleeping sickness, African Trypanosomiasis is an ailment that is endemic in sub-Saharan Africa [1]. It is caused by Trypanosoma brucei, a flagellate protozoan that exists in two morphologically identical subspecies namely: T brucei gambiense (West African or Gambian African trypanosomiasis) and T brucei rhodesiense (East African or Rhodesian African trypanosomiasis).

    Both parasites are passed on to human hosts via the bite of already infected tsetse flies. Glossina palpalis transmits T brucei gambiense and Glossina Morsitans transmits T brucei rhodesiense. Both are only found in Africa.

    For West African trypanosomiasis, humans are the exclusive reservoir of infection. With East African trypanosomiasis on the other hand, there is a zoonotic infection with animal vectors. African trypanosomiasis must not be confused with American trypanosomiasis. The latter is caused by Trypanosoma Cruzi and has different vectors, clinical manifestations as well as therapies.
    The main factor that is epidemiologic in African trypanosomiasis is the contact between humans and tsetse flies [2].

    The interaction is further influenced by increase in tse tse fly density, feeding habits that have continued to change, continued expansion into tsetse fly infested by humans, and increasing number of immunologically naïve individuals in areas that were formally endemic. The major outbreak between 1920 and 1950 brought about extensive treatment and immunity for 50 years. Infection is now recurring though meaning that the same populatison are losing their immunity [3].

    Patient Information

    Following recovery from stage-2 disease, a lumbar puncture is required every 3 months for the first year in patients with East African disease and every 6 months for 2 years in patients with West African disease.

    Relapse has occurred if symptoms return, CSF pleocytosis appears, or if trypanosomes are still present in blood or CSF. A persistently elevated CSF white cell count can be found in recovering patients, so a change in white cell count is more helpful as an indicator of relapse.

    If relapse occurs, treatment with melarsoprol or eflornithine should be repeated.

    Self-assessment

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    References

    1. Truc P, Lando A, Penchenier L, Vatunga G, Josenando T. Human African trypanosomiasis in Angola: clinical observations, treatment, and use of PCR for stage determination of early stage of the disease. Trans R Soc Trop Med Hyg. Jan 2012;106(1):10-4.
    2. Simarro PP, Cecchi G, Franco JR, Paone M, Fèvre EM, Diarra A, et al. Risk for human african trypanosomiasis, central Africa, 2000-2009. Emerg Infect Dis. Dec 2011;17(12):2322-4.
    3. Kohagne TL, M'eyi MP, Kamkuimo RG, Kaba D, Louis JF, Mimpfoundi R. Transmission of human African trypanosomiasis in the Komo-Mondah focus, Gabon. Pan Afr Med J. 2011;8:36.
    4. Abramowicz M. Drugs For Parasitic Infections. In: Abramowicz M, ed. The Medical Letter on Drugs and Therapeutics. New Rochelle, NY: The Medical Letter, Inc; 2000:1-12.
    5. Bisser S, N'Siesi FX, Lejon V, Preux PM, Van Nieuwenhove S, Miaka Mia Bilenge C, et al. Equivalence trial of melarsoprol and nifurtimox monotherapy and combination therapy for the treatment of second-stage Trypanosoma brucei gambiense sleeping sickness. J Infect Dis. Feb 1 2007;195(3):322-9.
    6. Kennedy PG. Human African trypanosomiasis of the CNS: current issues and challenges. J Clin Invest 2004; 113:496.
    7. Barrett MP, Burchmore RJ, Stich A, et al. The trypanosomiases. Lancet 2003; 362:1469.
    8. Jamonneau V, Ilboudo H, Kaboré J, et al. Untreated human infections by Trypanosoma brucei gambiense are not 100% fatal. PLoS Negl Trop Dis 2012; 6:e1691.
    9. Urech K, Neumayr A, Blum J. Sleeping sickness in travelers - do they really sleep? PLoS Negl Trop Dis 2011; 5:e1358.
    10. Pépin J, Méda HA. The epidemiology and control of human African trypanosomiasis. Adv Parasitol 2001; 49:71.

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