Summary about Disease
Winterbottom's sign is a clinical sign characterized by the enlargement of lymph nodes, particularly those located in the posterior cervical triangle (the area at the back of the neck), due to infection with Trypanosoma brucei gambiense, the parasite that causes West African sleeping sickness (human African trypanosomiasis). It indicates a late stage of the infection, specifically stage 1 when the parasite is circulating in the blood and lymph.
Symptoms
The primary symptom is noticeably enlarged, painless, and rubbery posterior cervical lymph nodes. Other symptoms related to sleeping sickness itself will be present, including:
Fever
Headache
Fatigue
Joint pain
Itching
Swelling around the eyes
Causes
Winterbottom's sign is caused by the parasitic infection Trypanosoma brucei gambiense. This parasite is transmitted to humans through the bite of infected tsetse flies. The infection causes inflammation and enlargement of the lymph nodes.
Medicine Used
Treatment for sleeping sickness varies depending on the stage of the disease. Medications used include:
Stage 1 (Hemolymphatic phase):
Pentamidine
Suramin
Stage 2 (Meningoencephalitic phase): Drugs that can cross the blood-brain barrier are required to treat the neurological involvement.
Melarsoprol
Eflornithine
Nifurtimox-eflornithine combination therapy (NECT)
Fexinidazole Note: Melarsoprol is highly toxic and used as a last resort. Fexinidazole and NECT are preferred due to their safety and efficacy.
Is Communicable
Sleeping sickness, and therefore Winterbottom's sign, is not directly communicable from person to person through casual contact. It is transmitted by the bite of an infected tsetse fly. Transmission via blood transfusion or from mother to fetus is extremely rare but possible.
Precautions
Precautions focus on preventing tsetse fly bites:
Wear long-sleeved shirts and trousers in light colors (tsetse flies are attracted to dark colors).
Use insect repellent containing DEET or permethrin.
Avoid bushes and dense vegetation, which are common tsetse fly habitats.
Use bed nets, especially in sleeping areas.
Participate in tsetse fly control programs in affected areas (spraying, traps).
How long does an outbreak last?
Without treatment, sleeping sickness is fatal. The duration of the infection and the progression of symptoms vary, but stage 2 (when neurological symptoms develop) typically occurs weeks to months after the initial infection. Untreated, death usually occurs within a few months to a year.
How is it diagnosed?
Diagnosis involves:
Clinical examination: Assessing for Winterbottom's sign (enlarged cervical lymph nodes) and other symptoms.
Microscopic examination: Examining blood, lymph node aspirates, or cerebrospinal fluid (CSF) for the presence of Trypanosoma brucei gambiense.
Serological tests: Detecting antibodies against the parasite in the blood.
Lumbar puncture (spinal tap): To determine if the infection has spread to the central nervous system (stage 2).
Card Agglutination Test for Trypanosomiasis (CATT): A screening test performed in endemic areas.
Timeline of Symptoms
The timeline can vary, but generally:
Weeks after bite: Chancre (sore) may develop at the site of the tsetse fly bite.
Weeks to months (Stage 1): Fever, headache, fatigue, joint pain, itching, Winterbottom's sign, and swollen lymph nodes elsewhere.
Months to years (Stage 2): Confusion, behavioral changes, sleep disturbances (disrupted sleep cycle, daytime sleepiness), tremors, seizures, paralysis, coma.
Important Considerations
Early diagnosis and treatment are crucial to prevent neurological damage and death.
Sleeping sickness is a neglected tropical disease, primarily affecting rural populations in sub-Saharan Africa.
Public health efforts focus on vector control, surveillance, and providing access to diagnosis and treatment.
Neurological damage is often irreversible, even with treatment.
Follow-up is essential to monitor for relapse after treatment.