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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