A Family Doctor's Tale - SLEEPING SICKNESS

DOC I HAVE SLEEPING SICKNESS

Sleeping Sickness is a acute infection of humans and cattle caused by the protozoan hemoflagellate of the genus Trypanosoma.

The trypanosoma brucei protozoan is an elongated protozoan hemoflagellate with prominent nucleus kinetoplast and flagellum (hair).

It can occur in 2 forms:
1.West African caused by T.gambiense
This protozoan has a human host and is spread by the tsetse fly (also known as Glossina palpalis)
These flies inhabit shady areas by rivers or streams.

2.East African caused by T.rhodesiense
This protozoan is mainly a parasite of the wild animals especially the the bushbuck.
Humans are incidental hosts.

When the tsetse fly bites an infected host the trypanasomes pass into the midgut , migrates to the salivary glants, muliply in 2 bto 5 weeks and pass out in the saliva when feeding on a new host.

Early in the human disease, the lymph nodes and spleen are enlarged, infiltrated with plasma cells and macrophages (enlarged neutrophils and lymphocytes).

The disease can spread to the brain and result in swelling and damage of the brain.

Symptoms:
Incubation period is usually 10 days.

1.Anodular lesion (chancre) occur at the site of the bite of the tsetse fly and persist for 2-3 weeks.

2.Systemic invasion of the trypanosomes occur months after the bite resulting in:
a.fever
b.lymphadenopathy - nodes are firm but not tender usually
c.spleen enlargement
d.rashes erythematous and urticarial forms
e.localized edema

3.Months after the first symptoms:
a.mild behavior changes
b.mild personality changes
c.hallucinations
d.delusions
e.drowsiness during the day
f.manic depression
g.chorea
h.convulsions
i.coma

In Rhodesian sleeping sickness, the symptoms are more acute in onset:
1.fever
2.jaundice
3.malaise
4.heart failure
Rhodesian sleeping sickness is more rapidly fatal and occur in outbreaks.

Diagnosis:
1.characteristic fever, jaundice and drowsiness

2.Fluid from chancre and enlarged lymph nodes are taken to test for trypanosomes

3.Blood test for trypanosomes using thick blood film especially in Rhodesian Sleeping Sickness

4.Cerebrospinal fluid is taken to examine for trypanosomes in advanced stage of the diesease.
The IgM antibodies may be markedly increased with only moderate increase in total protein.

5.MRI of the brain my be necessary to find cause of drowsiness

The complications of Sleeping Sickness Fever are:
1.Psychiatric disease may affect victims

2.neurological disturbances(seizures,cranial nerve signs and coma) may indicate damage in the brain

3.Coma and death

Treatment:
1.Sleeping Sickness can be treated with Suramin an anti-protozoan drug if the central nervous system is not affected.

2.Melarsoprol with or without suramin is given if the central nervous system is infected.

Both medicines have serious side effects but their use can be life saving.

Other medicines include:

1.Eflornithine (for gambiense only)

2.Pentamidine

3.General measures which are mainly supportive:
1. Rest
2. drinking lots of water to prevent dehydration will help.
3. Paracetamol for fever, severe headaches and body aches to reduce the discomfort.
4. Intravenous fluids for hytopotension and dehydration.
5. Dietary supplements to build up nutrition and health

Prognosis:
1.depends on the virulence of the strain of trypanosome infecting the patient

2.depends on the stage of disease when treatment is instituted.
The earlier the stage of illness, the better will be the effect of the treatment.

Prevention:
Sleeping Sickness Fever is spread only through the bite of the infected tsetse fly.

To prevent Sleeping Sickness fever, you must prevent the breeding of its carrier, the tsetse fly.

1.THe use of mosquito nets prevents bites from the tsetse flies at night.

2.Wear clothes that are not brightly colored and covers the wrists and ankles.

Pentamidine injections protect against Trypanosome gambiense, but not against rhodesiense.