Fatal without treatment. All of the recommended drugs are available free of charge from the World Health Organization.
Definite diagnosis is based on microscopic evidence of the trypanosome in body fluids. Disease staging is based on cerebrospinal fluid exam.
Aim of treatment is to cure the disease. The approach depends on parasite subspecies and disease stage, but all drugs have severe side effects and are complex to use.
The card agglutination test is used for population screening in endemic regions.
A fatal disease caused by extracellular parasites (genus Trypanosoma), which are transmitted by tsetse flies (genus Glossina). Two morphologically indistinguishable Trypanosoma brucei subspecies cause disease in humans. In west and central sub-Saharan Africa, infection with T b gambiense leads to a chronic disease that may last for years. In east and southern Africa, T b rhodesiense infection causes an acute disease that may be fatal within months. The parasite is initially found in lymph and blood (haemolymphatic stage), but after a variable period, it crosses the blood-brain barrier and invades the CNS (meningoencephalitic stage).Also known as sleeping sickness.
History and exam
Key diagnostic factors
- presence of risk factors
- previous stay in rural west and central Africa (T b gambiense)
- previous stay in game parks in east and southern Africa (T b rhodesiense)
- enlarged cervical lymph nodes/Winterbottom's sign (T b gambiense)
- chancre (T b rhodesiense)
- disturbances of consciousness and sleep
Other diagnostic factors
- history of several treatments against malaria with no improvement
- fatigue and general malaise
- history of infertility, menstrual disorders, high miscarriage rate (women)
- reduced libido, impotence (men)
- impaired motor functions
- mental changes
- signs of cardiac failure (T b rhodesiense)
- sensory disorders
- exposure to tsetse fly
- living or working in an area with people infected with Gambiense trypanosomiasis
- living or working in an area with animals infected with Rhodesiense trypanosomiasis
1st investigations to order
- full blood count
- erythrocyte sedimentation rate
- serum immunoglobulins
- card agglutination test for trypanosomiasis (CATT)
- rapid diagnostic tests
- chancre aspirate microscopy
- lymph node aspirate microscopy
- blood microscopy
- microhaematocrit centrifugation technique
- quantitative buffy coat technique
- mini-anion exchange centrifugation technique (mAECT)
Investigations to consider
- cerebrospinal fluid (CSF) white blood cell (WBC) count
- CSF microscopy
- double centrifugation of CSF
- modified single centrifugation of CSF
- CSF protein
- polymerase chain reaction (PCR)
- intrathecal immunoglobulin production
- stage biomarkers
- immune trypanolysis
- MRI brain
T b gambiense infection
T b rhodesiense infection
Veerle Lejon, PhD
Director of Research
Institut de Recherche pour le Développement
VL is an author of several references cited in this monograph. VL declares that he has no competing interests.
José Ramón Franco, MD, MPH
Control of Neglected Tropical Diseases
Human African Trypanosomiasis Control Program
World Health Organization
JRF is an author of several references cited in this monograph. JRF declares that he has no competing interests.
Pere P. Simarro, MD, PhD
Former head of WHO HAT control and surveillance programme
WHO temporary advisor
World Health Organization
PPS is an author of several references cited in this monograph.
Sanjeev Krishna, MA (Cantab), BMChB (Oxon), DPhil, FRCP, ScD (Cantab), FMedSci
Professor of Molecular Parasitology and Medicine
Centre for Infection
Division of Cellular and Molecular Medicine
University of London
SK is a consultant for the Foundation for Innovative Diagnostics, a non-profit organization developing diagnostics for neglected diseases such as HAT. SK is an author of a reference cited in this monograph.
Mike Barrett, BSc, PhD
Division of Infection and Immunity
Institute of Biomedical and Life Sciences
The Glasgow Biomedical Research Centre
University of Glasgow
MB declares that he has no competing interests.
- Malaria infection
- Typhoid fever
- Relapsing fever
- CDC yellow book: infectious diseases related to travel - trypanosomiasis, African (sleeping sickness)
- Parasites - African trypanosomiasis (also known as sleeping sickness), resources for health professionals: diagnosis and treatment
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