ANGELES UNIVERSITY FOUNDATION

Angeles City
COLLEGE OF NURSING

MICROBIOLGY AND PARASITOLOGY

In Partial Fulfillment of the Requirements

for Microbiology and Parasitology

SMALL GROUP DISCUSSION WRITTEN REPORT

ON AFRICAN TRYPANOSOMIASIS

David, Alyssa Marie H.

Jackson, Sarah Gabrielle N.
Navarro, Pauline S.
Sendaydiego, Teresa D.
BSN 1-D Group 7

Submitted to:

Ms. Sarah S. Nares

June 04, 2019

A. Brief Definition

African trypanosomiasis also called as Sleeping Sickness, is a febrile illness caused

by protozoa of the genus Trypanosoma. It occurs in two forms: Gambian
trypanosomiasis, which is found most often in west and central Africa, and Rhodesian
trypanosomiasis, a more virulent type that prevails in the drier areas of east Africa.
Native African wildlife are considered to be reservoirs for Rhodesian trypanosomiasis
while Gambian trypanosomiasis are known to be a primary human parasite. All
members of the genus Trypanosoma particularly the brucei complex rely on the tsetse
flies as their vectors or mode of transmission. Both types namely the Gambian and
Rhodesian trypanosomiasis usually affect young men. The infection can be diagnosed
through observation of the parasite on the blood or the cerebrospinal fluid. In addition,
with prompt and adequate treatment, prognosis is good. Untreated sleeping sickness,
however, especially the Rhodesian type, is invariably fatal.

B. Illustrations
C. Causative Agent
The causative agent that is involved in the African Trypanosomiasis is Trypanosoma
brucei which is transmitted via vector or what is known to be the Tsetse fly. It is also
a flagellated eukaryotic pathogen responsible for sleeping sickness in central Africa.
Based on studies, because of the presence of a long motile flagellum and its
amenity to genetic manipulation, it is becoming an attractive model to study the
assembly and the functions of cilia and flagella. There are two forms of African
Trypanosomiasis based on the parasite that is involve namely the Trypanosoma
brucei gambiense and Trypanosoma brucei rhodesiense.

D. Signs and Symptoms

 Following the bite of the infected fly (both male and female can transmit
infection), the parasite multiplies in the lymph and the blood of the person
bitten, causing unspecific symptoms and signs such as headaches, fever,
weakness, pain in the joints, lymphadenopathy, and stiffness.
 People who become infected may or may not show signs of illness
immediately, but over time the parasite crosses the blood-brain barrier and
migrates to the central nervous system. Here it causes various neurological
changes which include the sleep disorder (hence the name “sleeping
sickness”), deep sensory disturbances, abnormal tone and mobility, ataxia,
psychiatric disorders, seizures, coma and ultimately death.
 In the case of T.b. rhodesiense infections, the disease is acute, lasting from a
few weeks to several months while in T.b. gambiense infections the disease
is chronic, generally progressing slowly over several years.
E. Preventive Measures

There is no vaccine or drug for prophylaxis against African trypanosomiasis.

Preventive measures are aimed at minimizing contact with tsetse flies.

 Wear long-sleeved shirts and pants of medium-weight material in neutral colors

that blend with the background environment. Tsetse flies are attracted to bright or
dark colors, and they can bite through lightweight clothing.
 Inspect vehicles before entering. The flies are attracted to the motion and dust
from moving vehicles.
 Avoid bushes. The tsetse fly is less active during the hottest part of the day but
will bite if disturbed.
 Use insect repellent. Permethrin-impregnated clothing and insect repellent have
not been proved to be particularly effective against tsetse flies, but they will
prevent other insect bites that can cause illness.

In addition, the control for the transmission or cause of African trypanosomiasis rests
on two strategies: reducing the disease reservoir and controlling the tsetse fly vector.
As said above, humans are the significant disease reservoir for T. b. gambiense,
thus the main control strategy for this subspecies is active case-finding through
population screening, followed by treatment of the infected persons that are
identified. On the other hand, the reduction of the reservoir of infection is more
difficult for T. b. rhodesiense, since there are a variety of animal hosts. Vector
control is the primary strategy in use. This is usually done with traps or screens, in
combination with insecticides and odors that attract the flies.
F. Management and Treatment

In some cases wherein the CNS is not involved, a therapy of suramin I.V with a 4-day
interval until a total dose of 10g is achieved can be prescribed. In patients with signs
of CNS involvement, treatment consist of three courses of melarsoprol given I.V for 3
days, with 7-day rest periods in between. In the United States, these drugs are
available only from the Center for Disease Control. Suramin medication is a
contraindication for patients who have renal diseases, in such patients, an effective
alternative medication, named pentamidine, against Gambian trypanosomiasis can be
given. Close medical follow-up is required for early detection and treatment of
relapses. For Gambian trypanosomiasis cases, follow-up includes CSF analysis for
trypanosomes every 6 months for 2 years; since relapses tend to occur sooner in
Rhodesian trypanosomiasis, follow-up should be performed more frequently.

G. Nursing Responsibilities

 The nurse’s care plan should constructed with a detailed and emphasized
patient’s history, cautious antibiotic therapy, and first-rate supportive care.
 Take note that before administering medications such as Suramin, the nurse
should obtain or validate first the detailed history of the patient. Remember, this
drug is contraindicated to patients with renal diseases. If the patient has no such
history, give a test dose first.
 Throughout the suramin therapy, observe and report for any side effects such as
papular eruptions, peripheral neuritis, agranulocytosis, and severe renal damage
(as evidenced by casts. Hematuria, and proteinuria).
 Throughout the melarsoprol therapy, observe and report any severe reactions
such as exfoliative dermatitis, toxic hepatitis, nephritis, agranulocytosis, and
severe encephalopathy, as a result of massive trypanosomal death in the brain.
 With both suramin and melarsoprol, monitor the IV line closely, and watch for
phlebitis and extravasation at the IV site.
 If a patient is suspected to have the disease, obtain a history of recent travels.
Also ask the patient’s family for any changes in behavior or if the patient
displayed other unusual symptoms.
 Watch closely for ills and fever. Monitor the patient’s WBC count to document
response to therapy and detect relapse.
 Perform proper hand hygiene by hand washing and other infection control
measures to prevent secondary infection and spread of the disease.
 Maintain adequate nutrition and keep calorie count.
 For prevention, educate and advice visitors or residents of endemic areas to
wear protective clothing and use insect repellent if possible.
References:

Engelkirk, P.G., Duben-Engelkirk, J. (n.d). Burton’s Microbiology for the Health

Sciences. Lippincott Williams & Wilkins. pages 420-421
Baron, E.J., Chang, R.S., Howard, D.H., Miller, J.N., Turner J.A. (n.d). Medical
Microbiology - A short Course. John Willey & Sons Inc. pages 953-955
Wilson, W.R., Sande, M.A., 2001. Current Diagnosis & Treatment in Infectious
Diseases. The McGraw-Hill Companies, Inc. page 852
Loker, E.S., Hofkin, B.V., 2015. Parasitology A Conceptual Framework. Garland
Science, Tayor & Francis Group, LLC. page 431

Höög, J.L., Gull, K. 2010. Methods in Cell Biology. Retrieved June 01, 2019 from
https://www.sciencedirect.com/topics/immunology-and-microbiology/trypanosoma-
brucei
https://www.cdc.gov/parasites/sleepingsickness/publications.html

https://www.who.int/tdr/publications/disease_watch/afrtryp/en/

https://www.google.com/search?q=trypanosoma&source=lnms&tbm=isch&sa=X&ved=0
ahUKEwijxM7_g8jiAhUH7GEKHcxvCvkQ_AUIECgB&biw=1366&bih=651#imgrc=waK8
09RFHHy0SM:
https://www.google.com/search?biw=1366&bih=651&tbm=isch&sa=1&ei=lk3yXOadB8S
moASOmaOYDw&q=african+trypanosoma&oq=african+t&gs_l=img.1.0.0i67l2j0l8.3098
6.33472..34401...0.0..1.907.3686.0j1j5-2j3......0....1..gws-wiz-
img.....0.hOj32qg1Suc#imgrc=t4Qq-U5xi9ZZ2M:
https://www.google.com/search?biw=1366&bih=651&tbm=isch&sa=1&ei=5k3yXLH_A4n
W-Qbn-
pvIDw&q=tsetse+fly&oq=tset&gs_l=img.1.0.0i67l2j0j0i67j0j0i67j0l4.5874.6976..8368...0.
0..0.1152.2246.0j1j1j6-1j1......0....1..gws-wiz-img.....0.DSpWkEEU3l4#imgrc=-
TIWA3_HKv-7CM:
https://www.google.com/search?biw=1366&bih=651&tbm=isch&sa=1&ei=8U3yXL_kOZ
SA-
QbN7IHwAQ&q=african+sleeping+sickness+signs+and+symptoms&oq=african+sleepin
g+sickness+signs&gs_l=img.1.0.0i24.22543.33914..34614...0.0..0.242.5001.1j15j12......
0....1..gws-wiz-img.....0..0i67j0j0i8i30.S6pnmHRSsGY#imgrc=RSOAybc7TEY_lM:
https://www.google.com/search?q=signs+and+symptoms+of+african+trypanosomiasis&
source=lnms&tbm=isch&sa=X&ved=0ahUKEwjPorKNicjiAhUGat4KHdi8At0Q_AUIECgB
&biw=1366&bih=651#imgrc=0NHPw2Cf5eebaM: