Infectious Diseases

Symptoms and Treatment of Sleeping Sickness African Trypanosomiasis



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African trypanosomiasis, commonly known as sleeping sickness, is a serious disease that is typically fatal without treatment. A microscopic parasite within the Trypanosoma brucei  species causes the disease, which the tsetse fly spreads deep within rural Africa. According to the World Health Organization, 10,000 new cases are reported annually, however many unreported cases are thought to exist. Medication can cure it, but unfortunately many never have the opportunity to receive this lifesaving medical care in poor and disease-stricken regions.  

African trypanosomiasis has a variety of symptoms associated with it, and these are characterized by which of two types it is –T. b. rhodesiense infection (East African sleeping sickness) or T. b. gambiense infection (West African sleeping sickness). Both types have two stages, which also determine the symptoms. The symptoms will be described in detail according to the type, but the basic difference is that the parasite is only within the peripheral circulation in the first stage and within the central nervous system during the second.

The quick-moving T. b. rhodesiense infection may be first discovered in the form of a large sore where the bite of the tsetse fly occurred. Within 7-14 days, the individual is likely to develop a fever, headache, enlarged lymph nodes and muscle and joint aches. A rash is not uncommon. The disease enters the second stage after only a few weeks. Mental deterioration and neurological problems are seen. Without treatment, the disease usually takes the individual's life after only a few months.

The T. b. gambiense infection is no less serious but it is at least slower. It is also much more frequent, occurring in 95% of reported cases. Mild symptoms characterized by on and off fevers, aching muscles and joints, headaches, and malaise can occur. The patient may lose weight, experience itchiness and experience swollen lymph nodes. In this case, the disease will typically progress to the central nervous system after a year or two. Changes in personality, tiredness during the daytime hours with difficulty sleeping during the night and confusion that worsens may occur. Other symptoms include difficulty with balance or walking, partial paralysis and hormonal imbalances. Many die within three years and few survive beyond seven.

Fortunately, treatment does exist for sleeping sickness, and the stage determines the drugs utilized. Many of the drugs have very serious side effects, including death. During the first stage, the drug Pentamidine can be utilized. Most patients tolerate it relatively well, although side effects do exist. Suramin is another mediation used during the first stage of T. b. rhodesiense infection. Urinary symptoms as well as allergic reactions are possible side effects.

There are other drugs, which are used in the second stage form of the condition.  Melarsoprol is one option, however it is plagued with problems. One side effect, reactive encephalopathy, can cause death in 3-10% of the cases. Also, some have become resistant to the drug. Eflornithine is less toxic against the body, but only works against T. b. gambiense. It also is difficult to administer.

The search for effective and safe medication against sleeping sickness continues. A new drug emerged in 2009 utilizing a combination of nifurtimox and eflornithine to fight against T. b. gambiense.  Although it is recommended for a different form of the disease, its success has prompted its use in the African form.

Sleeping sickness is a serious disease ravaging people in 36 sub-Saharan African countries. Hopefully, those inflicted will receive medical care at increasing rates to stave off unnecessary fatalities.  

Resources:

http://www.cdc.gov/parasites/sleepingsickness/

http://www.who.int/mediacentre/factsheets/fs259/en/

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