- Also called:
- African trypanosomiasis
sleeping sickness
-
What is sleeping sickness?
Sleeping sickness, or trypanosomiasis, is a disease caused by infection with the protozoan Trypanosoma brucei gambiense or the closely related subspecies T. brucei rhodesiense. Tsetse flies transmit it through their bite.
Sleeping sickness has two stages. The first stage brings fever, headache, and joint pain. The second involves the brain and spinal cord, leading to personality changes, sleep disturbances, and lethargy. The East African form (T. brucei rhodesiense) can cause death within months, while the West African form (T. brucei gambiense) takes one or more years to invade the brain and spinal cord.
Diagnosis involves microscopic examination of blood, lymph, and cerebrospinal fluid. Treatment varies based on the stage and type of sleeping sickness.
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What causes sleeping sickness?
Sleeping sickness, or African trypanosomiasis, is caused by infection with the protozoan Trypanosoma brucei gambiense or the subspecies T. brucei rhodesiense. Tsetse flies transmit these parasites when they feed on human blood.
The parasites multiply in the fly's gut and migrate to its salivary glands. When an infected fly bites a human, the trypanosomes are injected via saliva into the bloodstream. The infection progresses in two stages: The first stage brings fever, headache, and joint pain. The second stage involves the brain and spinal cord, leading to personality changes, sleep disturbances, and, without treatment, death.
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How is sleeping sickness spread?
Sleeping sickness, or African trypanosomiasis, is caused by the parasite Trypanosoma brucei, transmitted through the bite of the tsetse fly. The tsetse fly becomes infected by feeding on the blood of infected humans or other mammals.
There are two subspecies of T. brucei that cause sleeping sickness: T. b. gambiense and T. b. rhodesiense. T. brucei gambiense is transmitted by the tsetse fly Glossina palpalis, while T. brucei rhodesiense is transmitted by G. morsitans. Once the parasite enters the human body, it multiplies and spreads, leading to the first and second stages of the illness.
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What are the symptoms of sleeping sickness?
Sleeping sickness, or African trypanosomiasis, arises from infection by Trypanosoma brucei gambiense or T. brucei rhodesiense, transmitted via tsetse flies.
The disease manifests in two stages. The first stage includes fever, headache, muscle and joint pain, and inflamed lymph nodes. A key sign is Winterbottom’s sign, marked enlargement of lymph nodes at the back of the neck. The second stage involves the brain and spinal cord, leading to personality changes, sleep disturbances, severe headache, mental dullness, tremors, and a shuffling gait. Profound lethargy, increasing emaciation, coma, and ultimately death may occur if left untreated. The Rhodesian form can result in death within months, while the Gambian type may take years.
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Where is sleeping sickness most common?
Sleeping sickness, or trypanosomiasis, is most common in Africa, where the tsetse fly transmits the disease. The majority of cases, about 70 percent, occurred in the Democratic Republic of the Congo (DRC) in the early 21st century. Infections of T. brucei gambiense are found from the west coast of Africa eastward to the East African lakes and southward to the Congo River basin. T. brucei rhodesiense is limited to the highlands of central eastern and southern Africa.
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How can sleeping sickness be prevented or treated?
Sleeping sickness, or human African trypanosomiasis, is caused by Trypanosoma brucei parasites transmitted via tsetse fly bites. Prevention includes minimizing tsetse fly bites through the use of insect repellent and wearing long sleeves and pants, as well as maintaining clearings around villages to reduce fly habitats.
Diagnosis involves microscopic examination of blood, lymph, and cerebrospinal fluid. Treatment varies by disease stage. Early stages of East African sleeping sickness are treated with suramin, while eflornithine is used for early stages of the West African type, with pentamidine as an alternative. Later stages of the West African form are treated with eflornithine. Melarsoprol may be used as a second-line agent against the East African form. Intensive control efforts and regular screening have significantly decreased cases.
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sleeping sickness, disease caused by infection with the flagellate protozoan Trypanosoma brucei gambiense or the closely related subspecies T. brucei rhodesiense, transmitted by the tsetse fly (genus Glossina). Sleeping sickness is characterized by two stages of illness. In the first stage, infected persons typically experience fever, headache, muscle and joint pain, and inflammation of the lymph nodes. 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 lethargy, frequently ending in death when left untreated.
Infections with T. brucei gambiense occur in an area extending from the west coast of Africa eastward to the East African lakes and southward to the Congo River basin. Cases caused by T. brucei rhodesiense are limited to the highlands of central eastern and southern Africa. Several major epidemics of sleeping sickness occurred in the 20th century, but since then the number of new cases reported annually has declined significantly. In 2012 the World Health Organization published a plan targeting the elimination of sleeping sickness as a public health problem by 2020.
Nagana, a form of sleeping sickness that primarily affects cattle and horses, continues to be a major factor preventing the development of cattle farming in parts of tropical Africa where tsetse flies are endemic.
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Infection and disease course
The vast majority of human cases result from the transfer of T. brucei trypanosomes by tsetse flies as they suck human blood. The flies become infected while feeding on the blood of infected people or other infected mammals. Usually 12 to 15 days elapse before flies that have picked up the parasites become infective toward humans. During this time the trypanosomes multiply by binary division in the midgut of the fly, then migrate to the salivary glands, and pass out of the fly’s proboscis in droplets of saliva during the fly’s bloodsucking.
After an incubation period in humans lasting one to two weeks, the trypanosomes are found in significant numbers in the circulating blood. Next the lymph nodes and spleen are invaded, becoming swollen, soft, and tender. The marked enlargement of the lymph nodes at the back of the neck (known as Winterbottom’s sign) is a common sign of the disease. Irregular fever and delayed sensation to pain are also characteristic symptoms at this stage. In the more severe East African (or Rhodesian) form of sleeping sickness, T. brucei rhodesiense infection, toxemia becomes so profound that the patient dies within months. In the West African (or Gambian) type, T. brucei gambiense infection, there is a delay of one or more years before the trypanosomes proceed to invade the brain and spinal cord. 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 walking. These symptoms are followed by increasing emaciation, coma, and death. The West African form of sleeping sickness usually causes death in two or three years; in some cases, the patient develops a tolerance to the infection and may continue to live for many years as a carrier of the parasites.
Diagnosis and treatment
The earlier that sleeping sickness is diagnosed and treated, the greater the chances for recovery. Diagnosis is made by microscopic examination of blood and lymph for the presence of trypanosomes and of cerebrospinal fluid for increased levels of white blood cells. Information obtained from these tests is then used to determine the stage of disease and course of treatment.
Suramin is effective for early stages of East African sleeping sickness. Eflornithine is used for the early stages of the West African type, with pentamidine used as an alternative. For later stages involving the central nervous system, the West African form is treated with eflornithine. The highly toxic organoarsenic agent melarsoprol may used as a second-line agent against the East African form. All treatment of T. brucei rhodesiense infection is useless once the fulminating toxemic stage has developed. Researchers have been investigating eflornithine-based combination therapies for West African sleeping sickness. The most effective combination has been eflornithine used in conjunction with nifurtimox, an agent used to treat Chagas disease.
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Prevention
In the early 21st century the majority of sleeping sickness cases—about 70 percent—occurred in the Democratic Republic of the Congo (DRC), which reported about 1,000 new cases each year. By 2015, with the exception of the DRC, most other African countries had reported fewer than 100 cases annually, and many others had not reported a case in more than a decade. Just 663 cases were reported worldwide in 2020—the fewest since systematic data collection began in the mid-20th century.
The dramatic decline in sleeping sickness cases was attributed to intensive control efforts, which included the isolation and proper treatment of all infected persons (including large numbers of asymptomatic chronic carriers) and the protection of humans from bites of tsetse flies by using insecticides and by maintaining extensive clearings around villages and residence compounds. Regular screening of communities in areas where tsetse flies are endemic and the culling of wild animal reservoirs, as well as personal approaches such as the use of insect repellent and the wearing of long-sleeved shirts and pants, have also helped reduce the number of cases of sleeping sickness.
Historically, epidemics of West African sleeping sickness were controlled in part through the administration of prophylactic doses of pentamidine to village populations. The destruction of wild animals that served as host reservoirs for the parasites was also carried out, particularly in East Africa; the approach helped reduce tsetse fly populations, though neither the flies nor the disease were successfully exterminated.