Sleeping sickness = African trypanosomiasis

Sleeping sickness, AKA African trypanosomiasis, is a tropical illness spread by the tsetse fly. 

It is caused by 
  • trypanosoma brucei gambiense 
    • West and central Africa 
    • Slow progression, 1 year to reach 2nd stage disease
    • If untreated, death in 3 years 
  • trypanosoma brucei rhodesiense 
    • east and south Africa
    • fast progression, 3 weeks to reach 2nd stage disease 
    • If untreated, death in 6 to 12 months 

First stage - blood
  • Fever, headache, loss of appetite 
  • Lymphadenopathy, splenomegaly, hepatomegaly 
  • Possibly a chancre at site of bite in t.rhodesiense 
  • Treatment
    • t. gambiense – eflornithine 
    • t. rhodesiense – suramin 

Second stage - CNS
  • Sleeping during the day 
  • Headache 
  • Neuro-psychiatric signs and symptoms
  • Motor signs 
  • Treatment 
    • Melarsoprol for both 

Diagnosis is by microscopy of blood or CSF. 

Small print gem: In sleeping sickness, lympadenopathy in the posterior triangle of the neck is known as Winterbottom’s sign. 

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