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Sleeping sickness
Parasite infection - human African trypanosomiasis
Sleeping sickness is an infection caused by tiny parasites carried by certain flies. It results in swelling of the brain.
Causes
Sleeping sickness is caused by two types of parasites Trypanosoma brucei rhodesiense and Trypanosomoa brucei gambiense . T b rhodesiense causes the more severe form of the illness.
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 disease does not occur in the United States, but travelers who have visited or lived in Africa can be infected.
Symptoms
General symptoms include:
-
Mood changes
,
anxiety
Mood changes
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
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Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
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- Headache
- Weakness
- Insomnia at night
- Sleepiness during the day (may be uncontrollable)
-
Swollen lymph nodes
all over the body
Swollen lymph nodes
Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...
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Swollen, red, painful
nodule
at site of the fly bite
Nodule
Skin nodules are solid or cystic raised bumps in the skin that are wider than 1 centimeter (cm), but less than 2 cm.
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Exams and Tests
Diagnosis is often based on a physical examination and detailed information about the symptoms. If the health care provider suspects sleeping sickness, you'll be asked about recent travel. Blood tests will be ordered to confirm the diagnosis.
Tests include the following:
- Blood smear to check for parasites
-
Cerebrospinal fluid tests
(fluid from your spinal cord)
Cerebrospinal fluid tests
A cerebrospinal fluid (CSF) culture is a laboratory test to look for bacteria, fungi, and viruses in the fluid that moves in the space around the spi...
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Complete blood count
(CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of red blood cells (RBC count)The number of white blood cells (WBC count)The tota...
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Lymph node
aspiration
Aspiration
Aspiration means to draw in or out using a sucking motion. It has two meanings:Breathing in a foreign object (sucking food into the airway). A medic...
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Treatment
Medicines used to treat this disorder include:
- Eflornithine (for T b gambiense only)
- Melarsoprol
- Pentamidine (for T b gambiense only)
- Suramin (Antrypol)
Some people may receive a combination of these medicines.
Outlook (Prognosis)
Without treatment, death can occur within 6 months from cardiac failure or from T b rhodesiense infection itself.
Cardiac failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
T b gambiense infection causes sleeping sickness disease and gets worse quickly, often over a few weeks. The disease needs to be treated immediately.
Possible Complications
Complications include:
- Injury related to falling asleep while driving or during other activities
- Gradual damage to the nervous system
- Uncontrollable sleep as the disease gets worse
- Coma
When to Contact a Medical Professional
See your provider right away if you have symptoms, especially if you've traveled to places where the disease is common. It is important to begin treatment as soon as possible.
Prevention
Pentamidine injections protect against T b gambiense, but not against T b rhodesiense . Because this medicine is toxic, using it for prevention is not recommended. T b rhodesiense is treated with suranim.
Insect control measures can help prevent the spread of sleeping sickness in high-risk areas.
References
Bogitsh BJ, Carter CE, Oeltmann TN. Blood and tissue protozoa I: hemoflagellates. In: Bogitsh BJ, Carter CE, Oeltmann TN, eds. Human Parasitology . 4th ed. Waltham, MA: Elsevier Academic Press; 2012:chap 6.
Kirchhoff LV. Agents of African trypanosomiasis (sleeping sickness). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 279.
Review Date: 11/14/2016
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, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
