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. 

References:

Kennedy, P. Human African trypanosomiasis of the CNS: current issues and challenges. J Clin Invest. 2004; 113(4): 496-504. 

Kuepfer, I. et al. Clinical presentation fo T.b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda. PLoS Negl Trop Dis. 2011. 5(3):e968. 

Stich, A., Abel, P. and Krishna, S. Human African trypanosomiasis. BMJ. 2002; 325(7357): 203-206.