Trypanosomiasis

African trypanosomiasis, also known as sleeping sickness, is a dangerous parasitic disease transmitted by tsetse fly bites. There are two main forms:

• East African trypanosomiasis: Caused by the parasite Trypanosoma brucei rhodesiense, this form progresses rapidly and is fatal if left untreated. Remember, this type of fly is only found in Africa.
• West African trypanosomiasis: Caused by Trypanosoma brucei gambiense, this form advances more slowly but is still deadly without medical attention.

How do you get it?

The disease spreads only through the bite of an infected tsetse fly. In rare cases, West African trypanosomiasis can pass from mother to child or through blood transfusion/organ transplant.

The Culprit: Tsetse Flies

The culprit behind sleeping sickness is the tsetse fly, found only in Africa. These flies live in woodlands, savannas, and near rivers and waterholes.

It’s worth noting that while around 25,000 new cases of both types of sleeping sickness are reported to the World Health Organization each year, many cases go unreported due to a lack of infrastructure. This means the actual number of cases is likely much higher. Interestingly, since 1967, there have been 36 reported cases of East African trypanosomiasis in the United States, all among individuals who had traveled to Africa.

Severity of Untreated Cases

• East African Trypanosomiasis: Without proper medical intervention, death typically occurs within several weeks to months.
• West African Trypanosomiasis: Similarly, without treatment, it’s fatal, but the timeline may vary, leading to death within several months to years.

Areas of Infection

• East African Trypanosomiasis: It’s prevalent in parts of Eastern and Central Africa, including countries like Uganda, Kenya, Tanzania, Malawi, Ethiopia, Zimbabwe, and Botswana. The distribution of infection depends on the presence of infected tsetse flies and wild animal populations.
• West African Trypanosomiasis: You can contract this type in Western and Central Africa, again, where the tsetse fly is found.

Symptoms of African trypanosomiasis

• East African Trypanosomiasis: Symptoms may include a painful bite from the tsetse fly, fever, severe headaches, irritability, extreme fatigue, swollen lymph nodes, muscle and joint pain, and sometimes a skin rash. As the disease progresses, it can lead to confusion, personality changes, slurred speech, seizures, and difficulty in walking and talking.
• West African Trypanosomiasis: Symptoms are similar, with a painful bite, followed by fever, rash, swelling around the eyes and hands, severe headaches, extreme fatigue, joint pain, and swollen lymph nodes. As the illness advances, it can cause confusion, personality changes, speech difficulties, irritability, seizures, and difficulty in movement and speech. Patients may experience excessive daytime sleepiness and insomnia.

Progression of the Disease

• Both Types: If left untreated, the infection worsens over time, leading to more severe symptoms and eventual death.

Onset of Symptoms

• East African Trypanosomiasis: Symptoms typically appear within 1 to 4 weeks after being bitten by an infected tsetse fly.
• West African Trypanosomiasis: Symptoms may take months to years to manifest after the initial bite.

Seeking Medical Help

• For East African Trypanosomiasis: If you suspect you have the infection, it’s crucial to consult your healthcare provider immediately. They will conduct various tests, including blood samples, spinal taps, and skin biopsies if there’s a chancre present.
• For West African Trypanosomiasis: Similarly, seeing a healthcare provider promptly is essential. They will order tests like blood samples and spinal taps, and may also take fluid samples from swollen lymph nodes for examination.

Treatment of African trypanosomiasis

• East African Trypanosomiasis: Treatment should commence as soon as possible upon diagnosis. Medications are available through the CDC, and hospitalization is typically required. Follow-up examinations, including spinal taps, are necessary for two years.
• West African Trypanosomiasis: Treatment also involves prompt hospitalization and is tailored based on symptoms and laboratory results. Medications are available, and like with East African trypanosomiasis, periodic follow-up exams, including spinal taps, are needed for two years.

It’s important to note that early detection and treatment significantly improve the prognosis for individuals with this sleeping sickness. Prompt medical intervention can prevent the progression of the disease and its potentially fatal outcomes. If there’s any suspicion of infection, seeking medical attention promptly is crucial for effective management.

Immunity and Re-infection

• East African Trypanosomiasis: Unfortunately, no one develops immunity to East African trypanosomiasis. Even if you’ve had the disease before, you remain susceptible to re-infection.
• West African Trypanosomiasis: Similarly, there’s no natural immunity to West African trypanosomiasis. Once infected, individuals remain at risk of contracting the disease again.

Risk Factors of African trypanosomiasis

• East African Trypanosomiasis: This type is prevalent in woodland and savannah areas away from human settlements. Those at highest risk include tourists, hunters, game wardens, and anyone working or visiting game parks in East and Central Africa.
• West African Trypanosomiasis: Tsetse flies, carriers of the parasite causing this type of trypanosomiasis, inhabit forests in Western and Central Africa, especially in areas with dense vegetation near rivers and waterholes. The risk of infection rises with the frequency of tsetse fly bites. While tourists generally face a lower risk, prolonged stays in rural regions of Western and Central Africa can increase the likelihood of contracting the disease.

Prevention of African Trypanosomiasis

Unfortunately, there’s neither a vaccine nor recommended medication to prevent East or West African trypanosomiasis. However, you can take steps to minimize your risk of exposure to tsetse flies, the carriers of the disease. Here are the preventive measures:

• Protective Clothing: Wear long-sleeved shirts and pants made of thick material to reduce the risk of tsetse fly bites.
• Clothing Color: Opt for khaki or olive-colored clothing, as tsetse flies are attracted to bright and very dark colors.
• Insect Repellent: While insect repellents may not effectively deter tsetse flies, they can help prevent bites from other insects.
• Bed Netting: Use bed nets while sleeping to create a barrier against biting insects.
• Vehicle Inspection: Before entering vehicles, inspect them for tsetse flies, especially in regions where the insects are prevalent.
• Avoiding Open Vehicles: Refrain from riding in the back of open vehicles, as tsetse flies are attracted to the dust stirred up by moving vehicles and wild animals.
• Avoid Bushes: Try to steer clear of bushes, as tsetse flies may rest there and can bite if disturbed. They are less active during the hottest parts of the day.

Additional Information

For more detailed information, you can refer to medical literature such as research articles and travel medicine guides.

Remember, this information serves as a guide and should not be used for self-diagnosis. If you suspect you have sleeping sickness or any other parasitic infection, seek medical attention promptly.

Sources

• Centers for Disease Control and Prevention (CDC)
• NIH, McGovern TW, et al. (1995). Cutaneous manifestations of African trypanosomiasis. Arch Dermatol.
• NIH, Bryan R, et al. (1989). African trypanosomiasis in American travelers: a 20-year review. Travel Medicine.