sleeping sickness

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Related to African trypanosomaiasis: Trypanosoma brucei gambiense, West African sleeping sickness, Human African trypanosomiasis

Sleeping Sickness

 

Definition

Sleeping sickness (also called trypanosomiasis) is an infection caused by Trypanosoma protozoa; it is passed to humans through the bite of the tsetse fly. If left untreated, the infection progresses to death within months or years.

Description

Protozoa are single-celled organisms considered to be the simplest life form in the animal kingdom. The protozoa responsible for sleeping sickness are a variety that bear numerous flagella (hair-like projections from the cell that help the cell to move). These protozoa exist only on the continent of Africa. The type of protozoa causing sleeping sickness in humans is referred to as the Trypanasoma brucei complex, which can be divided further into Rhodesian (Central and East African) and Gambian (Central and West African) subspecies.
The Rhodesian variety live within antelopes in savanna and woodland areas, and they cause no problems with the antelope's health. The protozoa are then acquired by tsetse flies when they bite and suck the blood of an infected antelope or cow.
Within the tsetse fly, the protozoa cycle through several different life forms; ultimately they migrate to the salivary glands of the tsetse fly. Once the protozoa are harbored in the salivary glands, they are ready to be deposited into the bloodstream of the fly's next source of a blood meal.
Humans most likely to become infected by Rhodesian trypanosomes are people such as game wardens and visitors to game parks in East Africa, who may be bitten by a tsetse fly that has fed on game (antelope) carrying the protozoa. The Rhodesian variety of sleeping sickness causes a much more severe illness, with even greater likelihood of eventual death than the Gambian form.
The Gambian variety of Trypanosoma thrives in tropical rain forests throughout Central and West Africa; it does not infect game or cattle, and is primarily a threat to people dwelling in such areas, rarely infecting visitors.

Causes and symptoms

The first sign of infection with the trypanosome may be a sore appearing at the site of the tsetse fly bite about two to tree days after having been bitten. Redness, pain, and swelling occur, but are often ignored by the patient.

Stage i illness

Two to three weeks later, Stage I disease develops as a result of the protozoa being carried through the blood and lymph circulation of the host. This systemic (meaning that symptoms affect the whole body) phase of the illness is characterized by a fever that rises quite high, then falls to normal, then respikes (rises rapidly). A rash with intense itching may be present, and headache and mental confusion may occur. The Gambian form, in particular, includes extreme swelling of lymph tissue, with enlargement of both the spleen and liver, and greatly swollen lymph nodes. "Winterbottom's sign" is classic of Gambian sleeping sickness, and consists of a visibly swollen area of lymph nodes located behind the ear and just above the base of the neck. During this stage, the heart may be affected by a severe inflammatory reaction, particularly when the infection is caused by the Rhodesian variety of trypanosomiasis.
Many of the symptoms of sleeping sickness are actually the result of attempts by the patient's immune system to get rid of the invading organism. The heightened activity of the cells of the immune system result in damage to the patient's own organs, anemia, and leaky blood vessels. These leaks in the blood vessels end up helping to further spread the protozoa throughout the afflicted person's body.
One reason for the intense reaction of the immune system to the presence of the trypanosomes is also the reason why the trypanosomes survive so well despite the efforts of the immune system to eradicate them. The protozoa causing sleeping sickness are able to rapidly change specific markers (unique proteins) on their outer coats. These kinds of markers usually serve to stimulate the host's immune system to produce immune cells that will specifically target the marker, allowing quick destruction of those cells bearing the markers. Trypanosomes, however, are able to express new markers at such a high rate of change that the host's immune system is constantly trying to catch up.

Stage ii illness

Stage II sleeping sickness involves the nervous system. Gambian sleeping sickness, in particular, has a clearly delineated phase in which the predominant symptoms involve the brain. The patient's speech becomes slurred, mental processes slow, and the patient sits and stares for long periods of time, or sleeps. Other symptoms resemble Parkinson's disease, including imbalance when walking, slow and shuffling gait, trembling of the limbs, involuntary movements, muscle tightness, and increasing mental confusion. Untreated, these symptoms eventually lead to coma and then to death.

Diagnosis

Diagnosis of sleeping sickness can be made by microscopic examination of fluid from the original sore at the site of the tsetse fly bite. Trypanosomes will be present in the fluid for a short period of time following the bite. If the sore has already resolved, fluid can be obtained from swollen lymph nodes for examination. Other methods of trypanosome diagnosis involve culturing blood, lymph node fluid, bone marrow, or spinal fluid. These cultures are then injected into rats, which develop blood-borne protozoa infection that can be detected in blood smears within one to two weeks. However, this last method is effective only for the Rhodesian variety of sleeping sickness.

Treatment

Without treatment, sleeping sickness will lead to death. Unfortunately, however, those medications effective against the Trypanosoma brucei complex protozoa all have significant potential side effects for the patient. Suramin, eflornithine, pentamidine, and several drugs that contain arsenic (a chemical which in higher doses is highly poisonous to humans), are all effective anti-trypanosomal agents. Each of these drugs, however, requires careful monitoring to ensure that the drugs themselves do not cause serious complications such as fatal hypersensitivity (allergic) reaction, kidney or liver damage, or inflammation of the brain.

Prevention

Prevention of sleeping sickness requires avoiding contact with the tsetse fly. Insect repellents and clothing that covers the limbs to the wrists and ankles are advisable. Public health measures have included drug treatment of humans who are infected with one of the Trypanosoma brucei complex. There are currently no immunizations available to prevent the acquisition of sleeping sickness.

Resources

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

sleeping sickness

 
a disease characterized by increasing drowsiness and lethargy, caused by a protozoal infection, such as African trypanosomiasis, or by a viral infection, such as lethargic encephalitis, St. Louis encephalitis, or eastern or western encephalomyelitis.
African sleeping sickness African trypanosomiasis.

Gam·bi·an try·pan·o·so·mi·a·sis

a chronic disease of humans caused by Trypanosoma brucei gambiense in northern and sub-Saharan Africa from Senegal east to Sudan and Uganda; characterized by splenomegaly, drowsiness, an uncontrollable urge to sleep, and the development of psychotic changes; basal ganglia and cerebellar involvement commonly lead to chorea and athetosis; the terminal phase of the disease is characterized by wasting, anorexia, and emaciation that gradually leads to coma and death, usually from intercurrent infection.

sleeping sickness

n.
1. An often fatal, endemic infectious disease occurring in sub-Saharan Africa, caused by either of two trypanosomes (Trypanosoma brucei subsp. gambiense or T. brucei subsp. rhodesiense) transmitted by tsetse flies and characterized by fever, severe headache, and lymph node swelling in the early stages, followed by extreme weakness, sleepiness, and deep coma. Also called African sleeping sickness, African trypanosomiasis.

sleeping sickness

A generic term that classically refers to
(1) East African trypanosomiasis, Rhodesian trypanosomiasis, or acute sleeping sickness, and
(2) West African trypanosomiasis, Gambian trypanosomiasis, or chronic sleeping sickness.
The term can also be applied to
(3) Eastern equine encephalitis
(4) Kleine-Levin syndrome
(5) Narcolepsy

sleeping sickness

1. African trypanosomiasis, see there.
2. Narcolepsy, see there.

Gam·bi·an try·pa·no·so·mi·a·sis

(gam'bē-ăn trī-pan'ō-sō-mī'ă-sis)
A chronic disease of humans caused by Trypanosoma brucei gambiense in Africa; characterized by splenomegaly, drowsiness, an uncontrollable urge to sleep, and the development of psychotic changes; basal ganglia and cerebellar involvement commonly lead to chorea and athetosis; the terminal phase of the disease is characterized by wasting, anorexia, and emaciation that gradually lead to coma and death, usually from intercurrent infection.
Synonym(s): chronic trypanosomiasis.

Rho·de·sian try·pan·o·so·mi·a·sis

(rō-dē'zhŭn trī-pan'ō-sŏ-mī'ă-sis)
A disease of humans caused by Trypanosoma brucei rhodesiense in East Africa; it is clinically similar to Gambian trypanosomiasis but of shorter duration and more acute in form; patients suffer repeated episodes of pyrexia, become anemic, and commonly die from cardiac failure.
Synonym(s): acute African sleeping sickness, acute trypanosomiasis.

sleeping sickness

sleeping sickness

see AFRICAN SLEEPING SICKNESS, ENCEPHALITIS.

von Economo,

Constantin, Austrian neurologist, 1876-1931.
Economo disease - Synonym(s): von Economo disease
von Economo disease - the basis for postencephalitic parkinsonism, suspected to be of viral origin. Synonym(s): Economo disease; encephalitis lethargica; polioencephalitis infectiva; sleeping sickness

sleeping sickness

any disease characterized by drowsiness or somnolence. See also pregnancy toxemia (1) of ewes, equine viral encephalomyelitis, cryptobiacyprini, trypanosomiasis.

Patient discussion about sleeping sickness

Q. Need Help.I could not enjoy the blessings of nature. I have sleep problem which affects me to a great extent. Hi friends, I need your help. I could not enjoy the blessings of nature. I have sleep problem which affects me to a great extent. Is there any remedy that I can try other than sleeping pills?

A. Many things can interfere with sleep ranging from anxiety to an unusual work schedule. But people who have difficulty in sleeping often discover that their daily routine holds the key to night-time woes.

? Cut down on caffeine.
? Stop smoking or chewing tobacco.
? Use alcohol cautiously
? Avoid a sedentary life
? Improve your sleep surroundings.
? Keep a regular schedule
? Keep a sleep diary
? Use strategic naps

If you try all the above suggestions and still have sleep problem, talk to your health-care provider.

More discussions about sleeping sickness
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