African trypanosomiasis

African trypanosomiasis is fatal without treatment. The recommended antitrypanosomal drugs are only available from the Centers for Disease Control and Prevention.

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 antitrypanosomal drugs have severe adverse effects and are complex to use. The availability of oral fexinidazole has improved management in recent years.

The card agglutination test and the rapid diagnostic tests are used for population screening in endemic regions.

Human African trypanosomiasis (HAT) is a fatal disease caused by extracellular parasites (genus Trypanosoma) that 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 (gambiense HAT). In east and southern Africa, T b rhodesiense infection causes an acute disease that may be fatal within months (rhodesiense HAT). The parasite is initially found in lymph and blood (first stage or hemolymphatic stage), but after a variable period, it crosses the blood-brain barrier and invades the central nervous system (second stage or meningoencephalitic stage).​​​[1]Büscher P, Cecchi G, Jamonneau V, et al. Human African trypanosomiasis. Lancet. 2017 Nov 25;390(10110):2397-409. http://www.ncbi.nlm.nih.gov/pubmed/28673422?tool=bestpractice.com ​​​​ ​​HAT is also known as sleeping sickness.