Herbie Murray
Sleeping sickness, or Human African Trypanosomiasis (HAT), is an insect-borne parasitic infection caused by the bite of an infected tsetse fly. The disease is found in sub-Saharan Africa, with about 60 million people living in endemic areas. The parasites invade the lymph nodes and spleen, causing swelling, and can eventually invade the brain and spinal cord, leading to neurological symptoms. The disease is often characterised by sleep and wakefulness disturbances, with patients experiencing episodes of nocturnal insomnia and daytime sleep. If left untreated, sleeping sickness is usually fatal, with death occurring within months to a few years.
| Characteristics | Values |
|---|---|
| Cause | Infection with the protozoan parasite Trypanosoma brucei |
| Transmission | Bite of an infected tsetse fly |
| Geographical Occurrence | 250 foci in 36 sub-Saharan countries |
| Risk Factors | Living in parts of Africa where the disease is found and being bitten by tsetse flies |
| Symptoms | Fever, headache, itchiness, joint pains, confusion, poor coordination, numbness, trouble sleeping, enlarged lymph nodes, swelling of the spleen, sleep-wake disturbances, lethargy, convulsions, severe headache, mental dullness, apathy, tremors, paralysis, coma |
| Diagnosis | Microscopic examination of blood and lymph for the presence of trypanosomes, lumbar puncture, blood tests |
| Treatment | Suramin, eflornithine, pentamidine, melarsoprol, nifurtimox, fexinidazole, acoziborole |
| Prevention | Insect control measures, vector control, animal reservoir management |
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What You'll Learn
- Sleeping sickness is caused by the parasite Trypanosoma brucei, transmitted by tsetse flies
- Symptoms include fever, headache, swollen lymph nodes, and sleep-wake cycle disturbances
- The disease has two forms: West African (slow progression) and East African (rapid progression)
- Diagnosis is made through blood tests, lumbar punctures, and microscopic examination of body fluids
- Treatment options include eflornithine, pentamidine, melarsoprol, and the newer fexinidazole
Sleeping sickness is caused by the parasite Trypanosoma brucei, transmitted by tsetse flies
Sleeping sickness, or Human African Trypanosomiasis (HAT), is a vector-borne parasitic disease caused by the parasite Trypanosoma brucei. The parasite is transmitted to humans by the bite of an infected tsetse fly (genus Glossina). Tsetse flies are found in sub-Saharan Africa, and the disease is endemic to rural areas in this region. The flies acquire the parasites from infected humans or animals, and transmit them to humans when they bite.
There are two clinically distinguishable forms of HAT, depending on the subspecies of the infecting parasite: Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. T. b. gambiense accounts for 92% of reported cases, and causes a chronic illness that progresses slowly over months or years. It is found in 24 countries in West and Central Africa. T. b. rhodesiense causes an acute illness with rapid progression, leading to death within a few months. It is found in 13 countries in East and Southern Africa and accounts for 8% of reported cases.
The parasites multiply in the blood and tissue fluids of their human host, causing a range of symptoms. The first stage of the disease typically involves mild, flu-like symptoms, including fever, headache, enlarged lymph nodes, joint pains, and inflammation of the lymph nodes. The second stage involves more severe symptoms affecting the brain and central nervous system, such as confusion, poor coordination, numbness, sleep disturbances, and behavioural changes. Without treatment, HAT is generally fatal.
The treatment for sleeping sickness depends on the stage of the disease. The first stage is treated with fexinidazole by mouth or pentamidine by injection. The second stage requires a drug that can pass the blood-brain barrier. While there is no vaccine or drug to prevent sleeping sickness, prevention of tsetse fly bites through protective clothing, insect repellent, and avoiding bushes can help reduce the risk of infection.
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Symptoms include fever, headache, swollen lymph nodes, and sleep-wake cycle disturbances
Sleeping sickness, or Human African Trypanosomiasis (HAT), is a vector-borne parasitic disease caused by infection with the protozoan parasite Trypanosoma brucei. It is transmitted by the tsetse fly, which is endemic to rural parts of sub-Saharan Africa. Sleeping sickness is characterized by two stages of illness, with the first stage being marked by symptoms such as fever, headache, swollen lymph nodes, and sleep-wake cycle disturbances.
In the first stage, infected persons typically experience fever, headache, muscle and joint pain, and swollen lymph nodes. The lymph nodes in the neck, armpits, groin, or inner and upper arms may be affected. This stage also includes other symptoms such as itchy, irritated skin, weakness, fatigue, and weight loss. The fever is intermittent, with attacks lasting from a day to a week, followed by intervals of a few days to a month or longer.
The lymph nodes become swollen, soft, and tender, and their marked enlargement at the back of the neck is known as Winterbottom's sign, which is a common sign of the disease. The parasite invades the circulatory and lymphatic systems, causing severe swelling of the lymph nodes. This invasion is associated with other symptoms such as skin rash, anaemia, abnormal liver function, and cardiac involvement.
The sleep-wake cycle disturbances in the first stage include insomnia and daytime sleepiness. Patients may experience fragmented sleep patterns and even sleep less than usual, which contrasts with the typical increase in sleep seen during infections. This disturbance is caused by the parasite targeting circumventricular organs in the brain, leading to inflammatory responses in hypothalamic structures that affect the circadian-timing and sleep-regulatory systems. The parasite disrupts the host's circadian clock with its own intrinsic clock, impacting the host's sleep and wakefulness.
If left untreated, the infection progresses to the second stage, which affects the brain and central nervous system, resulting in more severe symptoms. This stage includes behavioural changes, confusion, sensory disturbances, poor coordination, and more pronounced sleep-wake cycle reversal, with individuals becoming sleepy during the day and awake at night.
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The disease has two forms: West African (slow progression) and East African (rapid progression)
Human African trypanosomiasis (HAT), or sleeping sickness, is a vector-borne disease caused by infection with the parasite Trypanosoma brucei. The disease is transmitted by the tsetse fly (genus Glossina) and is prevalent in sub-Saharan Africa.
Sleeping sickness is characterised by two clinically distinguishable forms, depending on the parasite subspecies and geographical location. The two forms of the disease exhibit different rates of progression and vary in intensity.
The West African form, also known as the Gambian type, is caused by the parasite subspecies Trypanosoma brucei gambiense. This form of the disease is characterised by a slow progression, with the infection lasting for months or even years. The parasite is found in 24 countries in West and Central Africa, including the area extending from the west coast of Africa eastward to the East African lakes and southward to the Congo River basin. The slow progression of the disease allows it to remain in a passive phase for an extended period, delaying the onset of evident symptoms. In some cases, individuals may be infected without exhibiting any major signs or symptoms for months or years. This long asymptomatic period makes early diagnosis challenging and increases the risk of disease progression.
The East African form, also known as the Rhodesian type, is caused by the parasite subspecies Trypanosoma brucei rhodesiense. This form of the disease is characterised by rapid progression, with symptoms appearing within weeks or months of infection. The parasite is found in 13 countries in East and Southern Africa, primarily in the highlands of central eastern and southern Africa. The rapid progression of the disease leads to multi-organ invasion, including the brain, causing severe neurological symptoms and a high risk of death within a short period.
The differences in the rates of progression and disease intensity between the two forms of sleeping sickness are primarily due to the different parasite subspecies and their varying geographical distributions. Early diagnosis and treatment are crucial for improving the chances of recovery from sleeping sickness, regardless of the form.
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Diagnosis is made through blood tests, lumbar punctures, and microscopic examination of body fluids
Sleeping sickness, or Human African Trypanosomiasis (HAT), is a vector-borne disease caused by infection with the parasite Trypanosoma brucei. The parasite is transmitted by the bite of a tsetse fly and is most common in rural parts of sub-Saharan Africa.
Diagnosis of sleeping sickness involves blood tests, lumbar punctures, and microscopic examination of body fluids. Blood tests are used to detect the presence of the parasite in the blood. This typically involves examining a blood smear or lymph node fluid under a microscope to confirm the diagnosis. Lumbar punctures, also known as spinal taps, are needed to collect cerebrospinal fluid (CSF) and determine the stage of the disease. The CSF is analysed to detect the presence of trypanosome parasites, which indicates that the infection has progressed to the neurological phase. This assessment is crucial as treatment protocols differ depending on whether the central nervous system has been affected.
The information obtained from these diagnostic tests is used to determine the stage of the disease and the appropriate course of treatment. Early detection and treatment of sleeping sickness are essential for increasing the chances of recovery.
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Treatment options include eflornithine, pentamidine, melarsoprol, and the newer fexinidazole
Human African trypanosomiasis (HAT), or sleeping sickness, is a vector-borne disease caused by infection with the protozoan parasite Trypanosoma brucei. It is transmitted by the tsetse fly, which is found in sub-Saharan Africa. The parasites multiply in the blood and tissue fluids of their human host. The disease is characterised by two stages of illness. The first stage includes symptoms such as fever, headache, muscle and joint pain, and inflammation of the lymph nodes. In the second stage, the parasites invade the brain and spinal cord, causing neurological symptoms such as severe headaches, mental dullness, tremors, and a profound sleepiness.
Due to the complex epidemiology and clinical presentation of HAT, it is a challenging and deadly disease with potentially high death rates if left untreated. Treatment for HAT depends on the type and stage of infection. Early detection and treatment are crucial for increasing the chances of recovery. Treatment options include eflornithine, pentamidine, melarsoprol, and the newer fexinidazole.
Eflornithine is used for the early stages of the West African type of sleeping sickness, with pentamidine as an alternative. In the later stages involving the central nervous system, eflornithine is also used. Pentamidine is generally well-tolerated but may cause adverse reactions such as hypotension, hypoglycaemia, injection site pain, diarrhoea, nausea, and vomiting.
Melarsoprol is used to treat late-stage Rhodesian sleeping sickness, although it can cause severe and life-threatening adverse reactions, including encephalopathic reactions with a high case-fatality rate. To reduce the risk of encephalopathy, prednisone or prednisolone is often given alongside melarsoprol. Other adverse reactions to melarsoprol include gastrointestinal and skin reactions, pyrexia, and peripheral neuropathy. Intravenous injections of melarsoprol are painful and can cause phlebitis.
Fexinidazole is a newer oral drug that has been approved for the treatment of late-stage Gambian sleeping sickness. It is also available for the treatment of first-stage T. b. gambiense infection in patients who are at least six years old and weigh at least 20 kg. While fexinidazole is generally well-tolerated, adverse reactions such as vomiting, nausea, decreased appetite, general weakness, headache, dizziness, insomnia, hallucinations, agitation, anxiety, and psychotic disorder have been reported. There is also a risk of QT interval prolongation with fexinidazole.
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Frequently asked questions
Sleeping sickness, or African trypanosomiasis, is an insect-borne parasitic infection caused by the species Trypanosoma brucei. It is transmitted by the bite of a tsetse fly.
Sleeping sickness disrupts the sleep-wake cycle, causing sleep and wakefulness disturbances. It is characterised by two stages of illness. The first stage includes symptoms such as fever, headache, muscle and joint pain, and inflammation of the lymph nodes. In the second stage, the parasite crosses the blood-brain barrier and invades the central nervous system, causing neuropsychiatric symptoms such as confusion, lethargy, and convulsions.
Treatment for sleeping sickness involves active and passive case-finding for early detection, followed by treatment with drugs such as suramin, eflornithine, or pentamidine. New methods of diagnosis and treatment, as well as transmission control, are needed to achieve the goal of global elimination of the disease.
