Summary about Disease
West African sleeping sickness, also known as West African trypanosomiasis or Trypanosoma brucei gambiense trypanosomiasis, is a parasitic disease caused by the protozoan parasite *Trypanosoma brucei gambiense*. It is transmitted to humans through the bite of infected tsetse flies. The disease progresses in two stages: an early hemolymphatic stage and a late neurological stage. Without treatment, it is fatal.
Symptoms
Early Stage (Hemolymphatic): Fever, headaches, itching, joint pain, swollen lymph nodes (especially in the back of the neck – Winterbottom's sign), fatigue.
Late Stage (Neurological): Confusion, sensory disturbances, poor coordination, sleep disturbances (daytime sleepiness and nighttime insomnia), personality changes, seizures, coma.
Causes
West African sleeping sickness is caused by the parasite Trypanosoma brucei gambiense. The parasite is transmitted to humans and animals through the bite of the tsetse fly (*Glossina* genus) that has previously fed on an infected host (human or animal).
Medicine Used
The medications used to treat West African sleeping sickness vary depending on the stage of the disease:
Early Stage: Pentamidine or Suramin
Late Stage:
Nifurtimox-eflornithine combination therapy (NECT)
Fexinidazole (for T. b. gambiense infections only)
Is Communicable
? West African sleeping sickness is not directly communicable from person to person through casual contact. It is transmitted solely through the bite of an infected tsetse fly. Transmission can also rarely occur through other routes like mother to child.
Precautions
Avoid Tsetse Fly Bites:
Wear long-sleeved shirts and trousers in neutral colors (tsetse flies are attracted to bright and dark colors).
Use insect repellent containing DEET on exposed skin.
Avoid bushes and areas known to be infested with tsetse flies.
Inspect vehicles for tsetse flies before entering.
Use bed nets (especially in rural areas).
Vector Control: Efforts to control tsetse fly populations through trapping and insecticide spraying are crucial.
Surveillance and Screening: Active screening of at-risk populations is essential for early detection and treatment.
How long does an outbreak last?
The duration of an outbreak of West African sleeping sickness is variable and depends on multiple factors including: the effectiveness of control measures (vector control, screening, and treatment), the geographic area affected, and the resources available. Outbreaks can last for months to years if not effectively controlled.
How is it diagnosed?
Diagnosis involves several steps:
Clinical Suspicion: Based on symptoms and travel history to endemic areas.
Screening Tests: Card Agglutination Test for Trypanosomiasis (CATT) is a common screening test.
Confirmatory Tests: Microscopic examination of lymph node aspirate, blood, or cerebrospinal fluid (CSF) to identify the parasite.
Staging: Lumbar puncture (spinal tap) to analyze the CSF for parasite presence and white blood cell count to determine if the disease has progressed to the neurological stage.
Timeline of Symptoms
The timeline of symptoms can vary, but generally follows this pattern:
Days to Weeks After Bite: Chancre (sore) may develop at the site of the tsetse fly bite, but is more common in rhodesiense (East African) sleeping sickness.
Weeks to Months (Early Stage): Fever, headache, fatigue, itching, swollen lymph nodes. These symptoms can be mild and intermittent.
Months to Years (Late Stage): Neurological symptoms gradually develop, including confusion, sleep disturbances, personality changes, and ultimately coma if untreated.
Important Considerations
Early Diagnosis is Key: Treatment is much more effective in the early stage before the parasite invades the central nervous system.
Treatment Complexity: Medications used to treat sleeping sickness can have significant side effects, requiring careful monitoring.
Drug Resistance: Monitoring for and addressing drug resistance is important for treatment success.
Public Health Measures: Control of the disease requires a comprehensive approach including vector control, screening, diagnosis, treatment, and surveillance.
Co-infections: Consider and test for other possible co-infections in affected individuals.