Trypanosoma brucei-gambiense (African sleeping sickness)

Introduction

Etiologic agent of west African trypanosomiasis (classic African sleeping sickness).

Epidemiology

• West Africa
• transmitted by the bite of the tsetse fly (genus Glossina)
• humans are primary reservoir
• accounts for virtually all reported cases of Trypanosoma brucei (African sleeping sickness)

Clinical manifestations

• chronic course
• intermittent fevers, night sweats, malaise
• lymphadenopathy, especially of cervical nodes (Winterbottom's sign)
• CNS involvement occurs with time
  • somnolence, confusion, fatigue
  • psychotic changes
  • uncontrollable urge to sleep
  • chorea & athetosis
  • progression to stupor, coma & death

Management

• suramin (stage I, normal CSF)
  • 100-200 mg IV test dose to detect hypersensitivity
  • adults: 1 g IV on days 1,3,7,14 & 21
  • children: 20 mg/kg/day (max 1 g) IV on days 1,3,7,14 & 21
  • slow IV infusion of freshly prepared 10% aqueous solution
• eflornithine (stage I normal CSF or stage II, abnormal CSF)
  • highly effective for stage I or stage II
  • 90% cure rate for stage II disease
  • 400 mg/kg/day IV in 4 divided QID for 2 weeks
  • followed by 300 mg/kg/day PO for 3-4 weeks
• pentamidine
  • alternative agent for stage I
  • 4 mg/kg/day IV or IM for 10 days
• no vaccine available

More general terms

• Trypanosoma brucei (African trypanosomiasis)

Additional terms

• fly/gnat-borne infection