African trypanosomiasis

Definition

Sleeping sickness is an infectious disease caused by certain flies, which results in swelling of the brain.

Alternative Names

Causes

Sleeping sickness is caused by two organisms, T. brucei rhodesiense and T. brucei gambiense. The more severe form of the illness is caused by rhodesiense. Flies called tsetse flies carry the infection. If an infected fly bites you, painful, red swelling occurs at the site of the bite. The swelling is similar to that seen in Chagas disease.

Once the fly bites you, the infection spreads through the blood, causing episodes of fever, headache, sweating, and swelling of the lymph nodes. When the infection spreads to the central nervous system, it causes the symptoms typical of sleeping sickness. When it reaches the brain, behavioral changes such as fear and mood swings occur, followed by headache, fever, and weakness. Myocarditis may develop.

Risk factors include living in parts of Africa where the disease is found and being bitten by tsetse flies. The disease is extremely low in the United States, and is only found in travelers who have visited or lived in those African areas.

Symptoms

Gambiense-infections lead to drowsiness during the day, but insomnia at night. Sleep becomes uncontrollable as the disease gets worse, and eventually leads to coma.

General symptoms include:

• Swollen, red, painful nodule at site of fly bite
• Swollen lymph nodes all over the body
• Headache
• Fever
• Sweating
• Anxiety
• Increased sleepiness
• Insomnia at night
• Mood changes
• Drowsiness
• Uncontrollable urge to sleep

Exams and Tests

A physical examination may show signs of meningoencephalitis (inflammation of the brain and meninges).

Tests include the following:

• Blood smear
• Lymph node aspiration
• CSF test
• Red blood cell count
• Globulin levels
• Albumin levels
• ESR

Antibody and antigen test are not very helpful

Treatment

Medications used to treat this disorder include:

• Suramin (Antrypol)
• Melarsoprol
• Pentamidine

Outlook (Prognosis)

Without treatment, death may occur within 6 months from cardiac failure

Possible Complications

Complications include injury related to falling asleep while driving or performing other activities, and progressive damage to the nervous system.

When to Contact a Medical Professional

Call your health care provider if symptoms of this disorder develop. It is important to begin treatment as soon as possible.

Prevention

Pentamidine injections protect against gambiense, but have not yet been demonstrated as effective against rhodesiense. Insect control measures can help prevent the spread of sleeping sickness in areas where the disease is endemic.