African trypanosomiasis

Last reviewed: 1 Sep 2023
Last updated: 06 Dec 2018



History and exam

Key diagnostic 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 sign (T b gambiense)
  • chancre (T b rhodesiense)
  • disturbances of consciousness and sleep
More key diagnostic factors

Other diagnostic factors

  • history of several treatments against malaria with no improvement
  • headache
  • fever
  • fatigue and general malaise
  • history of infertility, menstrual disorders, high miscarriage rate (women)
  • reduced libido, impotence (men)
  • pruritus
  • edema
  • impaired motor functions
  • mental changes
  • signs of cardiac failure (T b rhodesiense)
  • rash
  • hepatosplenomegaly
  • sensory disorders
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • complete blood count
  • erythrocyte sedimentation rate
  • serum immunoglobulins
  • card agglutination test for trypanosomiasis (CATT)
  • rapid diagnostic tests
  • immunofluorescence
  • chancre aspirate microscopy
  • lymph node aspirate microscopy
  • blood microscopy
  • microhematocrit centrifugation technique
  • quantitative buffy coat technique
  • mini-anion exchange centrifugation technique (mAECT)
More 1st investigations to order

Investigations to consider

  • electrocardiogram
  • cerebrospinal fluid (CSF) white blood cell (WBC) count
  • CSF microscopy
  • double centrifugation of CSF
  • modified single centrifugation of CSF
  • CSF protein
More investigations to consider

Emerging tests

  • polymerase chain reaction (PCR)
  • intrathecal immunoglobulin production
  • stage biomarkers
  • immune trypanolysis
  • MRI brain

Treatment algorithm


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

Medical Officer

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.

Peer reviewers

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

St. George's

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.

  • African trypanosomiasis images
  • Differentials

    • Malaria infection
    • Typhoid fever
    • Relapsing fever
    More Differentials
  • Guidelines

    • 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
    More Guidelines
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