African Sleeping Sickness

Trypansoma brucei sp. in a thin blood smear, dividingA recent post looked at the need for an improvement in the treatment of African Trypanosomiasis, also known as sleeping sickness.   

Basics:

Also known as “African Sleeping Sickness”. This is a protozoal disease from the famous Tsetse fly’s (Glossina species) bite. Two main species exist, Trypanosoma Brucei Gambiense (West Africa) and T. B. Rhodesiense (East Africa). T.B. Gambiense can be an indolent disease for several years. T.B Rhodesiense is fatal in weeks to a month. Both are fatal, unless treated.  This disease affects 300,000 to 500,000 people, as of 2006. Symptoms include fever, a painful blister/chancre at bite site, lymphadenopathy (lymph node swelling) are common. As the illness progresses and the trypanosomes cross the blood-brain barrier, sleep disturbances and mental status changes are seen.

 Location:

Trypanosoma Brucei Gambiense is found is Western Africa, in areas where Glossinia (tsetse) species live. T.B. Rhodsiense is found in scattered spots of Eastern Africa and more associate with sylvatic cycles involving wild deer and range animals.

Transmission/ Incubation:

Acquired from the bite of an infected tsetse fly. T. Rhodesiense can become symptomatic is a few days to weeks, while T. Gambiense can take months to years before presentation.

Prevention:

Avoidance of bites from infected Glossina fly species, reduction of species

Diagnosis:

Demonstration of trypanosomes in blood, lymph or CSF (the fluid around the brain and spine) is gold standard. Centrifugation is generally needed for proper identification. A rapid reagent card agglutination test for T.B. Gambiense exists (CATT). ELISA can also be used to diagnose. Diagnosis cannot be based on symptoms alone.

Treatment:

Based on which species causes the infection. Early treatment has a high cure rate. Pentamadine, melarsoprol, eflornithine, suramin and nifurtimox are the main drugs used to treat this. Pentamiadine is used for early stage T. B. Gambiense and Suramin for early stage T.B. Rhodesiense. Late stages of both diseases (including neurological forms) can be treated with melarsoprol or eflornithine. Caution giving these last two drugs as the side effect of encephalopathy can be fatal.

New Reports of Sleeping Sickness in Uganda

Poor Uganda seems to be in the news a lot, recently.  First, the Ebola Fever outbreak continues to cause concern and now there are reports of African Trypanosomiasis.  This illness, also known as “African Sleeping Sickness” is spread through the bite of a Tse Tse Fly (Glossina Species).

The illness has 2 main types: African and American.  The American form is also known as Chagas Disease, but is very different from the African version.

There are 2 main types of African Trypanosomiasis: Trypanosome Brucei Gambiense and Trypanosome Brucei Rhodesiense. T. Gambiense or Western Africa Sleeping Sickness generally has a longer/slower onset of symptoms, over months to years. T. Rhodesiense has an acute or rapid onset of symptoms and is considered much more severe, with a higher fatality rate. Fortunately, the East African form (T. Rhodesiense) is much less common. Both are fatal if not treated. See more about these parasitic diseases at Adventure Doc Trypanosome Page

The Ugandan Region of Mayuge has reported 12 cases for the month of November. Local health officials stated that locals living in the area are at risk due to farming in known Tse Tse fly areas.

The Original article by New Vision can be viewed here: http://www.newvision.co.ug/D/8/17/600571

Adventure Doc

Fatal Trypanosomiasis in Serengeti

The ISTM/Geo Sentinel has a news release about a fatal case of African Trypanosomiasis in a tourist traveling through the Serengeti. The victim was dead 6 days after being bitten by the notorious Tse Tse Fly, carrier of “African Sleeping Sickness”.

Apparently, she was initially diagnosed, by blood smear, as a case of malaria. This delay in correct diagnosis cost valuable time and the patient died in an Intensive Care Unit in a Niarobi hospital. This is the first case of African Trypanosomiasis, in a Serengeti Tourist, since 2001.

She was reported to acquire the infection while traveling through Tanzania.

The causative agent in Sleeping Sickness is Trypanosoma Brucei Gambiense, found is Western Africa, in areas where Glossinia (tsetse) species live. T.B. Rhodsiense is found in scattered spots of Eastern Africa and more associate with sylvatic cycles involving wild deer and range animals.

Nicknamed “Sleeping Sickness”, mental status changes are common. The acute nature of the disease suggest the East African form, T.B. Rhodiense.

Adventure Doc

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