Ashwin Lewis
African sleeping sickness, also known as human African trypanosomiasis (HAT), is a vector-borne parasitic disease caused by the species Trypanosoma brucei. The disease is transmitted to humans by bites from infected tsetse flies (glossina) and affects people in rural areas of sub-Saharan Africa. The first stage of the disease is characterised by mild, flu-like symptoms, while the second stage causes more severe symptoms affecting the brain and central nervous system, including sleep disruption, confusion, and poor coordination. Without prompt diagnosis and treatment, African sleeping sickness is almost always fatal. However, the number of new cases has decreased significantly in recent years, and efforts are underway to develop new treatments and improve access to healthcare in affected regions.
| Characteristics | Values |
|---|---|
| Other names | Human African trypanosomiasis (HAT), African trypanosomiasis |
| Cause | Parasitic infection, transmitted by the bites of tsetse flies |
| Risk factors | Living in parts of Africa where the disease is found, being bitten by tsetse flies |
| Symptoms | Sleep disruption, behaviour changes, confusion, sensory disturbances, poor coordination, lethargy, convulsions, fevers, headaches, itchiness, joint pains, numbness |
| Diagnosis | Detecting the parasite in a blood smear or lymph node fluid, lumbar puncture |
| Treatment | Pentamidine, suramin, eflornithine, nifurtimox, fexinidazole, melarsoprol, NECT |
| Prevention | Insect repellents, wearing long-sleeved clothing, avoiding tsetse-dense areas, implementing bush clearance methods, wild game culling |
| Fatality rate | Almost 100% fatality without prompt diagnosis and treatment |
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What You'll Learn
- African sleeping sickness is a parasitic disease spread by the tsetse fly
- The disease has two types, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
- Symptoms include fever, headache, itchiness, joint pain, confusion, poor coordination, numbness, and trouble sleeping
- Without treatment, sleeping sickness is usually fatal, causing death within several weeks to months
- Treatment options include fexinidazole, eflornithine, nifurtimox, and melarsoprol
African sleeping sickness is a parasitic disease spread by the tsetse fly
African sleeping sickness, also known as human African trypanosomiasis (HAT), is a parasitic disease spread by the bite of the tsetse fly. Tsetse flies are found only in rural, sub-Saharan Africa. The risk of infection from a tsetse fly bite is estimated to be less than 0.1%, but the disease is almost 100% fatal without prompt diagnosis and treatment.
The disease is caused by the parasite Trypanosoma brucei, which exists in two forms: Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. The former causes over 92% of reported cases. Both are transmitted by the bite of an infected tsetse fly and are most common in rural areas. The first stage of the disease typically causes mild, flu-like symptoms, including fever, headaches, itchiness, and joint pains. These initial symptoms begin one to three weeks after the bite.
The second stage of the disease, which can begin weeks to months later, is more severe and affects the brain and central nervous system. Symptoms include confusion, poor coordination, numbness, and trouble sleeping. This sleep disruption gives the disease its name. Without treatment, the parasite crosses the blood-brain barrier and invades the central nervous system, causing advanced-stage sleeping sickness or meningo-encephalitic stage. During this stage, people may experience neuropsychiatric symptoms such as lethargy, convulsions, and behavioural changes.
Diagnosis of African sleeping sickness is challenging, and early symptoms may not be evident or serious enough to prompt medical attention. However, early diagnosis and treatment are crucial to preventing disease progression and improving outcomes. Diagnosis typically involves detecting the parasite in blood samples or lymph node fluid. In some cases, a lumbar puncture (spinal tap) may be necessary. Treatment for sleeping sickness is available, and hospitalization is usually required.
While there is no vaccine or medicine to prevent African sleeping sickness specifically, the risk of infection can be minimized by avoiding insect bites when in affected areas. This includes wearing protective clothing, using insect repellents, and avoiding tsetse-dense areas. Systematic screening of at-risk communities in endemic regions is also an important strategy for early detection and control of the disease.
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The disease has two types, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense
African trypanosomiasis, also known as sleeping sickness, is a parasitic disease spread by the bite of a tsetse fly. The disease has two types, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. Humans are infected by these two types, transmitted by the bite of an infected tsetse fly, which are most common in rural areas.
Trypanosoma brucei gambiense causes over 92% of reported cases. It is found in 24 countries of west and central Africa. A person can be infected for months or even years without major signs or symptoms. When evident symptoms emerge, often the disease is advanced with the central nervous system already affected. The course of infection is much more gradual and slow-progressing with T. b. gambiense than T. b. rhodesiense, and both infections are almost invariably fatal without treatment.
Trypanosoma brucei rhodesiense, on the other hand, is found in 13 countries of eastern and southern Africa and accounts for 8% of reported cases. It causes an acute disease with a rapid progression, often resulting in death within weeks to months if left untreated. The disease is characterised by multi-organ invasion, including the brain.
The first stage of the disease, caused by either subspecies, typically causes mild, flu-like symptoms such as fevers, headaches, itchiness, and joint pains. The second stage, which begins weeks to months later, involves more severe symptoms affecting the brain and central nervous system, including confusion, poor coordination, numbness, and trouble sleeping.
Diagnosis of sleeping sickness involves detecting the parasite in a blood smear or lymph node fluid. However, T. b. gambiense infections may require more sensitive screening tests as parasitemia may not be as prominent. Systematic screening of at-risk communities is important because early symptoms may not be evident enough to prompt those infected to seek medical attention.
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Symptoms include fever, headache, itchiness, joint pain, confusion, poor coordination, numbness, and trouble sleeping
Human African trypanosomiasis (HAT), also known as African sleeping sickness or simply sleeping sickness, is a vector-borne parasitic disease. It is caused by the species Trypanosoma brucei. Humans are infected by two types, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. Trypanosoma brucei gambiense causes over 92% of reported cases. Both are usually transmitted by the bite of an infected tsetse fly and are most common in rural areas.
The first stage of the disease is characterised by fevers, headaches, itchiness, and joint pains, beginning one to three weeks after the bite. This stage is called the hemolymphatic or first stage, which entails bouts of fever, headache, enlarged lymph nodes, joint pains and itching.
The second stage begins weeks to months later, with confusion, poor coordination, numbness, and trouble sleeping. This is when the parasites cross the blood-brain barrier into the central nervous system, causing the meningo-encephalitic or second stage. Generally, this is when more obvious signs and symptoms of HAT appear, including behavioural changes, confusion, sensory disturbances, and sleep cycle disturbances, which give the disease its name.
Sleep-wake disturbances are a leading feature of the neurological stage. After treatment, the sleep-wake cycle can revert to normal, indicating that the parasites are responsible for circadian rhythm alteration rather than neuronal damage.
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Without treatment, sleeping sickness is usually fatal, causing death within several weeks to months
Human African trypanosomiasis (HAT), also known as African sleeping sickness or simply sleeping sickness, is a vector-borne parasitic disease. It is caused by the species Trypanosoma brucei. Humans are infected by two types, Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense.
Without treatment, sleeping sickness is almost always fatal. The first stage of the disease typically causes mild, flu-like symptoms, including fever, headaches, itchiness, and joint pains, beginning one to three weeks after the bite. The second stage, which can begin weeks to months later, invades the central nervous system and causes more severe symptoms such as confusion, poor coordination, numbness, and trouble sleeping.
The speed of disease progression varies depending on the type of parasite. For individuals infected by T. b. gambiense, which accounts for 92% of reported cases, the disease can progress slowly over months or even years without obvious symptoms. In contrast, T. b. rhodesiense, which accounts for 8% of cases, causes rapid disease progression, with severe symptoms appearing within weeks or months of infection.
Untreated T. b. gambiense infections can lead to death after several years, while untreated T. b. rhodesiense infections will typically cause death within months. In both cases, the neurological damage caused during the second stage of the disease is irreversible.
The risk of death from sleeping sickness can be significantly reduced by early diagnosis and treatment. Systematic screening of at-risk communities is important because early symptoms may not be evident or serious enough to prompt individuals to seek medical attention. Treatment for sleeping sickness can be complex and requires specific skills. Hospitalization is usually necessary, and follow-up care may involve lumbar punctures every six months or sooner if symptoms return.
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Treatment options include fexinidazole, eflornithine, nifurtimox, and melarsoprol
Human African trypanosomiasis (HAT), or African sleeping sickness, is a vector-borne parasitic disease. It is transmitted to humans by the bites of tsetse flies (glossina) which have acquired parasites from infected humans or animals. Tsetse flies inhabit sub-Saharan Africa, and only certain species transmit the disease. Without prompt diagnosis and treatment, the infection caused by these parasites is almost 100% fatal.
Treatment options for African sleeping sickness include fexinidazole, eflornithine, nifurtimox, and melarsoprol. Fexinidazole is an oral drug that has been identified as a broad-spectrum anti-infective agent. It is well-tolerated and has been shown to be effective in phase 2/3 clinical trials. In August 2024, the World Health Organization (WHO) recommended fexinidazole as the first-line treatment for sleeping sickness caused by T.b. rhodesiense, replacing melarsoprol due to its 27% failure rate.
Eflornithine is the only new molecule registered for the treatment of HAT in the last 50 years. It is mainly used as a backup for melarsoprol refractory Trypanosoma brucei gambiense cases. The dosage regimen consists of 100 mg/kg body weight at intervals of 6 hours for 14 days (150 mg/kg body weight in children) given as short infusions. Adverse drug reactions during eflornithine therapy are frequent and similar to other cytotoxic drugs for cancer treatment.
Nifurtimox is a medication used to treat sleeping sickness, often in combination with eflornithine. It is given orally and has side effects such as abdominal pain, headache, nausea, and weight loss. Nifurtimox is not recommended during pregnancy or for those with kidney or liver problems.
Melarsoprol is used to treat African trypanosomiasis with central nervous system involvement. It is administered via a complicated dosing schedule involving intravenous injections. Routine laboratory testing is required before and after initiation to evaluate both therapeutic and toxic effects. Melarsoprol is not recommended for pregnant women, and there are concerns about its potential toxicity.
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Frequently asked questions
African sleeping sickness, or human African trypanosomiasis (HAT), is a disease caused by a parasite. It is passed on by the bite of an infected tsetse fly.
The first stage of the disease is characterised by fevers, headaches, itchiness, and joint pains, beginning one to three weeks after the bite. The second stage causes more severe symptoms that affect the brain and central nervous system, including confusion, poor coordination, numbness, and trouble sleeping.
Diagnosis of African sleeping sickness involves detecting the parasite in a blood smear or lymph node fluid. A lumbar puncture, or spinal tap, is often needed to confirm the diagnosis.
Treatment for African sleeping sickness has traditionally been complex and difficult to administer. The first-line treatment was melarsoprol, a drug developed in the 1940s, but this was very toxic. In recent years, new oral treatments have been developed, including fexinidazole and acoziborole, a new single-dose oral drug.
There is currently no vaccine or medicine to prevent African sleeping sickness. The best way to avoid infection is to prevent insect bites from tsetse flies. This can be done by wearing protective clothing, using insect repellants, and avoiding tsetse-dense areas.
![Historic Framed Print, [Colonial empire: African dresser giving bare-breasted girl, who was found to be infected with sleeping sickness, an injection], 17-7/8" x 21-7/8"](https://m.media-amazon.com/images/I/41uhUafC9uL._AC_UL320_.jpg)
