Sleeping sickness
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Web Resources for Sleeping sickness
ICD 10 code: B56
Relevant Clinical Literature
UK Guidance
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Medpedia on Sleeping sickness (Less technical, good quality control)
Wikipedia on Sleeping sickness (Less technical, ? quality control)
Limited to the distribution in sub-Saharan of the Tsetse fly which is the intermediate host of the protozoa Trypanosoma brucei.
- West African sleeping sickness (Gambiense trypanosomiasis) due to Trypanosoma brucei gambiense
- Typical cause untreated 3 years
- East African sleeping sickness (Rhodesiense trypanosomiasis) due to Trypanosoma brucei rhodesiense
- Typical course untreated months
- Tyyranosomal chancre in about 20%
- Nagana in animals caused by Trypanosoma brucei brucei
Contents |
Infection
- Some mammals can harbour asymptomatic infection of the human Trypanosoma subspecies (so can some humans !)
- Is related to contact time with the Tsetse fly. Thus tourists are far less likely to get the disease (but if they do get it tend to an acute presentation with high fever, chancre, rash)
- Long incubation so many first manifest many years after exposure
- Normal protection in man offered by trypansosome lytic factor, which has subunit components of apolipoprotein L1 and haptoglobin-related protein[1].
Clinical
- Haemolymphatic stage
- Chronic intermittent fever
- Headache
- Puritis
- Lymphadenopathy
- Sometimes hepatosplenomegaly
- Occasional myopericarditis (esp rhodesiense)
- Occasional endocrine dysfuction (esp rhodesiense)
- Meningoencephalitic
- Sleep disturbance
- Dysregulation of circadian rhythm
- Fragmentation of sleep
- Other neuropsychiatric manifestations
- Tremor
- Palsies
- Dyskinesias
- Psychosis
- Fever rare
- Sleep disturbance
Diagnosis
 | CSF examination is essential to differentiate between first and second stage |
- Card agglutination test (CATT) the usual practice in endemic regions[2]
- Immunofluorescense
- Blood/lymph node aspirate fresh films
- PCR being developed[3]
Prevention
- Surveillance and vector control
- Almost eradicated disease in colonial era
Treatment
- Haemolymphatic stage
- Pentamidine in West African sleeping sickness parentally once a week
- Suramin in East African sleeping sickness (Take advice on regime as these vary)
- Meningoencephalitic
- Melarsoprol
- Eflornithine is now first choice in West African sleeping sickness. It may yet be found to have a wider role in combination with nifurtimox
Possible treatments
Parfuramidine is too nephrotoxic to use. Fexinidazole is in phase 1 studies.
External link
References
- ↑ Thomson R, Molina-Portela P, Mott H, Carrington M, Raper J. Hydrodynamic gene delivery of baboon trypanosome lytic factor eliminates both animal and human-infective African trypanosomes. Proceedings of the National Academy of Sciences of the United States of America. 2009 Nov 17; 106(46):19509-14.(Link to article – subscription may be required.)
- ↑ Hasker E, Mitashi P, Baelmans R, Lutumba P, Jacquet D, Lejon V, Kande V, Declercq J, Van der Veken W, Boelaert M. A new format of the CATT test for the detection of Human African Trypanosomiasis, designed for use in peripheral health facilities. Tropical medicine & international health : TM & IH. 2009 Dec 9.(Epub ahead of print) (Link to article – subscription may be required.)
- ↑ de Clare Bronsvoort BM, von Wissmann B, Fèvre EM, Handel IG, Picozzi K, Welburn SC. No Gold Standard Estimation of the Sensitivity and Specificity of Two Molecular Diagnostic Protocols for Trypanosoma brucei spp. in Western Kenya. PloS one. 2010; 5(1):e8628.(Epub) (Link to article – subscription may be required.)
