Symptoms
Possible symptoms of African trypanosomiasis (sleeping sickness) in the first stage include:
- Nodule or ulcer on the skin at the bite site (trypanosome chancre).
- Feeling sick, fatigue, weight loss.
- Fever with chills
- Headache, joint pain
- Skin rash
- Swollen lymph nodes
- Organ diseases (eg, heart, liver, spleen).
In the first stage, trypanosomes are in the blood and lymphatic system. In the second stage, the parasites can penetrate the central nervous system after weeks to years. The symptoms are then more severe:
- Disturbances of the circadian rhythm with sleep disturbances during the night and sleepiness during the day, sleep attacks.
- Personality changes, psychiatric, neurological, motor and sensory disorders.
- Visual disturbances
- Life-threatening brain and meningitis.
Untreated, the disease usually takes a fatal outcome.
Causes
The cause of the disease is infection with trypanosomes. These are protozoa that are transmitted when bitten by an infected tsetse fly. The disease occurs in various sub-Saharan African countries. It does not occur in other countries, but is observed in travelers returning from rural areas in Africa. Hosts include humans and animals. A distinction is made between:
- West African trypanosomiasis with – chronic course, about 97% of cases.
- East African trypanosomiasis with – acute, rapid course, about 3% of cases.
Diagnosis
Diagnosis is made based on patient history, clinical picture, and laboratory methods.
Drug treatment
Sleeping sickness is one of the neglected diseases. The classic drugs used to treat trypanosomiasis were developed many decades ago-the first at the beginning of the 20th century. These agents are toxic and, with the exception of nifurtimox, can only be administered parenterally. Melarsoprol is even an organic arsenic compound (!) that is particularly poorly tolerated. This is in contrast to fexinidazole, which were registered in 2018. It is available in tablet form and is better tolerated than traditional drugs. 1 stage:
- Fexinidazole
- Pentamidine
- Suramin
2nd stage:
- Eflornithine
- Fexinidazole
- Melarsoprol
- Nifurtimox
However, research is now underway on more neurally available and atoxic drugs, for example supported by the Gates Foundation.
Prevention
- Is the destination a high-risk area? Avoid affected areas if possible.
Avoid bites from tsetse flies:
- Use repellents.
- Wear protective clothing with long sleeves and neutral colors.
- Inspect cars for flies before boarding.
- Avoid bushes because the flies stay there during the day.