ALSO KNOWN AS
Sleeping sickness
DESCRIPTION
* This disease is caused by the parasites Trypanosoma brucei rhodesiense or Trypanosma brucei gambeinse. They are transmitted to humans by the bites of tsetse flies, found in the moist climate regions in Africa.
SYMPTOMS
* Stage 1: The area of the bite causes an itching pain and swollen glands that lasts 2-4 weeks.
* Stage 2: Occurs 3-10 days after stage 1. The infection goes into the bloodstream and lymph system. Symptoms include high fever, severe headache, joint pains, lack of energy, and rashes. Weight loss may also occur. Symptoms may temporarily disappear for two weeks at a time, only to return for a second go around.
* Stage 3: "Sleeping Sickness Stage" occurs from 6 months to years after the original infection. Symptoms may include Insomnia (instead of sleepiness), loss of appetite, personality changes, lack of energy, and headaches. Severe sleepiness occurs late. This is followed by severe weight loss and coma. Death occurs from infections from other diseases.
HOW THE DIAGNOSIS IS MADE
* Stage 1: Examination may show inflammation of the bite site and swollen lymph glands nearby.
* Stage 2: Examination may show mild enlargement of the liver and spleen, lower extremity edema, Ascites (fluid in the abdomen), pleural effusions (fluid in the lungs) and enlarged rubbery lymph nodes. Cardiac involvement (myocarditis) may occur.
* Stage 3: Examination may reveal tremors, Speech Problems, gait disturbances, and abnormal reflexes.
* Laboratory:
1. Wet films after Giemsa staining from bite lesion, lymph node aspirates, bone marrow, or CSF
2. Blood specimens need to be examined daily for 15 days because the number of trypanosomes in the blood can vary.
3. Cerebrospinal fluid shows increased lymphocytes and protein. A centrifuge of CSF may be needed to find the parasites.
4. Serologic (blood) testing for IgM and IgG antibodies may be performed
5. Other findings may include increased sedimentation rates, anemia, decreased platelets, decreased total serum protein, and increased serum globulin.
TREATMENT
* Suramin for both parasites (rhodesiense and gambiense)
* Eflornithine (DMFO) is a drug of choice for gambiense. An alternative is Pentamidine.
* A third choice for both parasites is Melarsoprol, but it has a severe amount of toxicity.
* Late stage diseases with Central Nervous System Involvement: Melarsoprol for both parasites or Eflornithine for gambeinse, are the leading drugs of choice. Alternative drugs for gambiense are Eflornithine or Tryparsamide plus Suramin.
IF YOU SUSPECT THIS CONDITION
* Seek treatment as soon as possible. This disease is often fatal if untreated.
PREVENTION
* Wear long sleeves and trousers and avoid dark clothing.
* Use mosquito nets while sleeping because repellents have no effect.
* Pentamidine may be used for gambiense type.
SIMILIAR CONDITIONS
* Malaria
* Pneumonia
* Influenza
* Mononucleosis
* Lymphoma
* Leukemia
* Viral Encephalitis
* Cerebral Tumor
* Psychiatric Diseases
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