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Sleeping sickness
(Human African Trypanosomiasis)
By Rachel Kaplan
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Trypanosomiasis affects thousands in central Africa
• Only found in 36 sub-saharan African countries where tsetse fly is found
• ~50 million people in at-risk areas
• In 1993 there were 55,000 deaths
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Most African nations gained independence from colonial powers in the 1960’s.
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After independence, the incidence of sleeping sickness rose dramatically.
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It is now being brought back under control.
1998 2005 20090
50,000
100,000
150,000
200,000
250,000
300,000
350,000
Reported CasesEstimated Actual Cases
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The trypanosome is the causative agent.
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It’s transmitted by the tsetse fly
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How Transmission Works
Reservoir
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How Transmission Works
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There are 4 forms of trypanosomiasis.
• Chagas disease- American Trypanosomiasis, found in Latin America
• Nagana- “to be depressed,” animal form• Trypanosoma brucei rhodesiense- East Africa,
acute• Trypanosoma brucei gambiense- West Africa,
chronic, 95% of cases
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Trypanosomes are multiplying in subcutaneous tissues (inner layer of 3 layers of skin), blood, and lymph
Symptoms: fever, headaches, joint pains, itching
Stage 1
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Stage 2- Trypanosomes cross the blood/brain barrier
Symptoms: behavior/personality changes, confusion, disturbance of sleep cycle
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T. Rhodesiense has similar symptoms to T. Gambiense, but it is faster.
Stage T. Rhodesiense (acute)
T. Gambiense (chronic)
Stage 1 Weeks to months after infection
Months to years after infection
Stage 2 Several months after infection
Up to several years after infection
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You can mount an immune response, but the trypanosome fights back.
• VSG- variant surface glycoprotein• Chromosome repair moves new gene to
surface• New surface structure evades immune
response
Time
Para
sites
in b
ody
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Because symptoms can remain hidden for so long, testing is vital.
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There are effective treatments available.
Happily, the main 4 drugs for Human African Trypanosomiasis are supplied to endemic
countries free of charge.
But…
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TreatmentDrug What it can
treatHow it is
administeredSide effects
Pentamidine 1st stage t.b. gambiense
7-10 intramuscular
injections a day or alternate
days
Minimal but significant
Suramin 1st stage both forms
5 intravenous injections every
5-7 days
Urinary tract problems,
allergic reactions
Eflornithine 1st and 2nd stage t.b. gambiense
Intravenous injection every 6 hours for 14
days
Some, but less toxic than
melarsoprol
Melarsoprol 1st and 2nd stage both forms
3-4 series of intravenous injections
separated by 1 weeks
Many undesirable side effects,
including death in 1-5% of patients
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There are massive impediments to diagnosis and treatment.
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Vector control has been found to be effective.
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We’re making dramatic progress.
1998 2005 20090
50,000
100,000
150,000
200,000
250,000
300,000
350,000
Reported CasesEstimated Actual Cases
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Photos• http://www.doctorswithoutborders.org/news/issue.cfm?id=2401• http://findmeacure.com/2010/04/09/sleeping-sickness-african-trypanos
omiasis/• http://www.wrongdiagnosis.com/phil/html/african-sleeping-sickness/61
3.html• http://www.iaea.org/NewsCenter/Features/Tsetse/index.shtml• http://blog.africaimports.com/wordpress/?p=2246• http://dna.kdna.ucla.edu/parasite_course-old/african%20tryps%20new_
files/subchapters/Epidemiology.htm• http://www.bmj.com/content/325/7357/203.1.full• http://thomashawk.com/2004/08/thomas-hawks-digital-photoblog-augu
st.html• http://www.petsfoto.com/top-10-deadliest-insects/• http://www.worldproutassembly.org/archives/2007/09/livestock_breed.
html• http://www.parasitemuseum.com/trypanosome/• http://www.yoursolarlink.com/blog/solar-pebbles-for-rural-africa/• http://exploringafrica.matrix.msu.edu/students/curriculum/m14/pics4.p
hp• http://etc.usf.edu/clipart/18900/18909/net_18909.htm• http://www.earlham.edu/~martilu/trypanosomiasispathology.htm
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Sources• http://www.who.int/mediacentre/factsheets/fs259/en/• http://www.cdc.gov/parasites/sleepingsickness/• Documentary: Survival- The Deadliest Disease
http://www.rockhopper.tv/programmes/150/• http://bmb.oxfordjournals.org/content/41/2/169.full.pd
f+html• http://www.humpath.com/african-trypanosomiasis• http://apps.who.int/tdr/svc/diseases/african-trypanoso
miasis• http://www.sciencedirect.com/science?_ob=ArticleURL
&_udi=B6T1R-47GJC1J-2&_user=130907&_coverDate=09%2F30%2F1993&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000004198&_version=1&_urlVersion=0&_userid=130907&md5=bcd6671a39e122bb349b4215d9bb95f2&searchtype=a
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2120053/pdf/jc12551147.pdf
• http://www.cdc.gov/parasites/sleepingsickness/health_professionals/index.html
• Man against Tsetse: Struggle for Africa by John J. McKelvey