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African Sleeping Sickness

(African Trypanosomiasis; Human African Trypanosomiasis; HAT)

By

Chelsea Marie

, PhD, University of Virginia;


William A. Petri, Jr

, MD, PhD, University of Virginia School of Medicine

Reviewed/Revised Mar 2023
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Topic Resources

Human African sleeping sickness is an infection caused by the protozoa Trypanosoma brucei gambiense or Trypanosoma brucei rhodesiense. It is transmitted by the bite of a tsetse fly.

  • Sleeping sickness occurs only in equatorial Africa.

  • A painful bump or sore may form at the site of the fly's bite, followed by fevers, chills, headache, swollen lymph nodes, sometimes a rash, and eventually drowsiness, problems with walking, and, if untreated, coma and death.

  • Doctors usually confirm the diagnosis by identifying the protozoa (single-cell infectious organisms) in a sample of blood, fluid taken from a lymph node, or cerebrospinal fluid.

  • All infected people should be treated with one of several medications effective against Trypanosoma.

Sleeping sickness occurs only in parts of equatorial Africa where tsetse flies live. There are two forms of sleeping sickness. Each is caused by a different species of Trypanosoma. One form (caused by Trypanosoma brucei gambiense) occurs in West and Central Africa. The other form (caused by Trypanosoma brucei rhodesiense) occurs in East Africa. Both occur in Uganda.

The World Health Organization (WHO) is trying to eradicate African trypanosomiasis, and, as a result of control efforts, there has been a dramatic decrease in cases of this infection over the past 20 years (> 95%, with approximately 800 cases in 2021). On average one case is diagnosed in the United States each year, always in travelers or immigrants from endemic regions (areas of the world where the disease is common).

Transmission

Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense are usually transmitted to people when an infected tsetse fly bites them and injects the protozoa into the skin. The protozoa move to the lymphatic system Overview of the Lymphatic System The lymphatic system is a vital part of the immune system. It includes organs such as the thymus, bone marrow, spleen, tonsils, appendix, and Peyer patches in the small intestine that produce... read more and bloodstream, where they multiply. They then travel to organs and tissues throughout the body and eventually reach the brain. The infection is spread when a fly bites an infected person or animal, then bites another person.

An infected mother can transmit the protozoa to her baby during pregnancy or delivery. Rarely, people are infected through blood transfusions. Theoretically, the infection could be transmitted through an organ transplant from an infected donor.

Symptoms of African Sleeping Sickness

In African sleeping sickness, different parts of the body are affected in the following order:

  • Skin

  • Blood and lymph nodes

  • Brain and cerebrospinal fluid (the fluid that surrounds the brain and spinal cord)

How quickly the infection progresses and which symptoms it causes depend on which species is the cause.

Skin

A bump may develop at the site of the tsetse fly bite within a few days to 2 weeks. It turns dusky red and may become a painful and swollen sore.

Blood and lymph nodes

The infection spreads to the blood and lymph over a period of weeks or months. Then people have fevers that come and go, chills, headaches, and muscle and joint pain. The face may swell temporarily. In some people, a rash develops, and lymph nodes along the back of the neck enlarge. Anemia Overview of Anemia Anemia is a condition in which the number of red blood cells is low. Red blood cells contain hemoglobin, a protein that enables them to carry oxygen from the lungs and deliver it to all parts... read more may develop.

Brain and cerebrospinal fluid

When the brain and cerebrospinal fluid are affected, headaches become persistent. People become drowsy, lose their concentration, and have problems with balance and walking. Drowsiness worsens, and people may fall asleep in the middle of activities.

Without treatment, damage to the brain progresses, leading to coma and death. Death occurs within months or within 2 or 3 years after symptoms develop, depending on the species causing it. Death sometimes results from undernutrition or other infections.

Diagnosis of African Sleeping Sickness

  • Examination of a sample of blood or fluid from a lymph node

  • Spinal tap and analysis of cerebrospinal fluid

Doctors diagnose African sleeping sickness by examining a sample of blood or fluid from a lymph node and identifying the protozoa in it. Sometimes doctors check for the protozoa by examining a sample of bone marrow or fluid from the sore.

Doctors do a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Imaging tests commonly used to diagnose nervous system (neurologic) disorders... read more Spinal Tap (lumbar puncture) using a needle inserted along the person's lower spine to obtain a sample of cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) to determine whether the infection involves the cerebrospinal fluid and brain. Doctors check the fluid sample for the protozoa and for other signs of the infection. Such signs include increases in the fluid's pressure and in the number of white blood cells in the fluid.

Treatment of African Sleeping Sickness

  • Medications that are effective against these protozoa

Treatment of African sleeping sickness is guided by species and stage of disease.

Sleeping sickness should be treated as soon as possible with medications that are effective against these infections. However, some of the medications can have serious side effects.

The medication used depends on which species (gambiense or rhodesiense) is causing the infection and whether the infection has spread to the brain and cerebrospinal fluid.

If the infection has not spread to the brain and cerebrospinal fluid, effective medications include

  • For rhodesiense, suramin

  • For gambiense, fexinidazole or, alternatively, pentamidine

Fexinidazole is an oral medication that is the first choice for gambiense infection that is not severe, with or without brain and cerebrospinal fluid involvement.

If the infection has spread to the brain and cerebrospinal fluid, effective medications include

  • For nonsevere gambiense, fexinidazole

  • For severe gambiense, eflornithine, alone or in combination with nifurtimox, or melarsoprol (if eflornithine is not available)

  • For rhodesiense, melarsoprol

Melarsoprol can have serious, sometimes life-threatening side effects, but in many African countries, it is often the only medication available for sleeping sickness that affects the brain and cerebrospinal fluid. Corticosteroids may be given to reduce the risk of some of these side effects.

There is no test available to confirm that a person has been cured. Therefore, after treatment, doctors monitor people for 24 months, and, if symptoms recur, they obtain a sample of cerebrospinal fluid to check for parasites.

Prevention of African Sleeping Sickness

People can reduce their chances of being bitten by a tsetse fly by doing the following:

  • Avoiding areas that are heavily infested with tsetse flies: Travelers to parts of Africa where tsetse flies live can ask local residents about places to avoid.

  • Wearing heavy long-sleeve tops and long pants: Tsetse flies can bite through thin clothes.

  • Wearing neutral-colored clothing that blends in with the environment: Tsetse flies are attracted to bright or dark colors.

  • Using insect repellents as needed, although they may not be effective against tsetse flies.

More Information

The following English-language resource may be useful. Please note that The Manual is not responsible for the content of this resource.

Drugs Mentioned In This Article

Generic Name Select Brand Names
No brand name available
NebuPent, Pentam
Iwilfin, Vaniqa
Lampit
NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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