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    Sleeping sickness

    Human African trypanosomiasis

    Sleeping sickness is infection with germs carried by certain flies. It results in swelling of the brain.

    Causes

    Sleeping sickness is caused by two germs (protozoa), Trypanosoma brucei rhodesiense and Trypanosomoa brucei gambiense. The more severe form of the illness is caused by T. b. rhodesiense.

    Tsetse flies carry the infection. When an infected fly bites you, the infection spreads through your blood.

    Risk factors include living in parts of Africa where the disease is found and being bitten by tsetse flies. The diseasedoes not occurin the United States. But travelers who have visited or lived in Africa can have the infection.

    Symptoms

    General symptoms include:

    • Anxiety
    • Drowsiness during the day
    • Fever
    • Headache
    • Insomnia at night
    • Mood changes
    • Sleepiness (may be uncontrollable)
    • Sweating
    • Swollen lymph nodes all over the body
    • Swollen, red, painful nodule at site of fly bite
    • Weakness

    Exams and Tests

    A physical exam may show signs of inflammation of the brain and its covering, the meninges (meningoencephalitis).

    Tests include the following:

    • Blood smear
    • Cerebrospinal fluid tests
    • Complete blood count (CBC)
    • Lymph node aspiration

    Most antibody and antigen tests are not helpful because they cannot tell the difference between current and past infection. Specific IgM levels in the cerebrospinal fluid may be morehelpful.

    Treatment

    Medicines used to treat this disorder include:

    • Eflornithine (for T. b. gambiense only)
    • Melarsoprol
    • Pentamidine (for T. b. gambiense only)
    • Suramin (Antrypol)
    • Some patients may receive combination therapy

    Outlook (Prognosis)

    Without treatment, deathcan occur within 6 months from cardiac failure or from T. b. rhodesiense infection itself. T. b. gambiense infection causes the classic sleeping sickness disease and gets worse more quickly, often over a few weeks.Either diseaseneeds tobe treated immediately.

    Possible Complications

    Complications include:

    • Injury related to falling asleep while driving orduring other activities
    • Gradualdamage to the nervous system
    • Uncontrollable sleep as the disease gets worse
    • Coma

    When to Contact a Medical Professional

    Seeyour health care provider right awayif you have symptoms. It is important to begin treatment as soon as possible.

    Prevention

    Pentamidine injections protect against T. b. gambiense. But not against T. b. rhodesiense. Becausethis medicineis toxic, using it for prevention is not recommended.

    Insect control measures can help prevent the spread of sleeping sickness in high-risk areas.

    References

    Kirchoff LV. Agents of African trypanosomiasis (sleeping sickness). In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA: Elsevier Churchill-Livingstone; 2009:chap 278.

    Petri Jr WA. African sleeping sickness. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 354.

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                  Review Date: 11/10/2012

                  Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

                  The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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