TRYPANOSOMIASIS

SESSION 20
 LEARNING OBJECTIVES
• Define trypanosomiasis
• Overview of trypanosomiasis
• Describe epidemiology of trypanosomiasis
• List the clinical features of trypanosomiasis
• Describe management of trypanosomiasis
• Explain prevention and control of
trypanosomiasis
 DEFINITION
Human African trypanosomiasis also known
as sleeping sickness, is caused by protozoan
haemoflagellates parasites transmitted via the
bite of a tsetse fly.
 A disease is characterized by chronic fever,
general weakness, cerebral involvement and
death if not treated adequately.
 OVERVIEW & EPIDEMIOLOGY
 African trypanosomiasis (sleeping sickness) is an
illness endemic to sub-Saharan Africa. It is caused by
2 subspecies of the flagellate protozoan
Trypanosoma brucei, which are transmitted to
human hosts by bites of infected tsetse flies.
 The two forms of the disease an acute form
occurring mainly in East Africa and caused by
Trypanosoma brucei rhodesiense, and a more
chronic form occurring mainly in West and Central
Africa, caused by Trypanosoma brucei gambiense .
 CONT……..
o These two species have identical morphologic
appearances and both are transmitted by tsetse flies
of the genus Glossina. However, the clinical features of
infection differ in presentation and prognosis
• Trypanosome brucei gambiense causes slow
progressive ‘sleeping sickness’and is found in West and
Central Africa
• Trypanosome brucei rhodesiense causes acute rapidly
progressive illness with death from cardiac
complications mainly found in East Africa
 Cont…
• In West Africa transmission is mainly at the
riverside ,where the fly rests in the shade of
trees
• Animal reservoir of T.gambiense have not
been identified ,T.rhodesiense has a large
reservoir in numerous wild animals and
transmission takes place in the shade of
woods bordering grasslands.
 CONT…..
• The tsetse flies hunt by sight and attracted by
dark moving objects hence they follow
buffaloes and vehicles
• Tsetse flies become infected when they take a
blood meal from infected persons or animals
• After a period of time, during which the
trypanosomes undergo developmental changes
the fly bites another susceptible host i.e.
human and transmits the disease 
 CONT……
• Contact between human and fly is not always
frequent because of the behaviour of the
Glossina species
• Trypanosomiasis may occur sporadically in
people who live close to infested areas
• Wood cutters, honey collectors, game rangers
and hunters are susceptible to trypanosome
infection because they enter tsetse infested area
 
 CLINICAL FEATURES
• Incubation period is 2 weeks for T. b.
rhodesiense and take months for T. b.
gambiense infections
Primary or chancre stage
– Chancre stage is commonly seen in T. b.
rhodesiense
– This is characterized by indurated erythematous
nodule at the site of bite this resolves after 1 – 2
weeks
 CLINICAL FEATURES
Systemic illness or blood stage
• The blood stage characterized by dissemination
of trypanosomes in blood, lymph and
lymphnodes
• There is associated fever which has no typical
pattern, but tends to recur at interval of days or
weeks
• Debilitation anaemia and general weakness
follow
 CLINICAL FEATURES
• The spleen and several groups of lymph nodes become enlarged
• The supraclavicular and lower posterior lymphnodes are easily
affected in 80% of cases of Trypanosome gambiae (Winterbottom’s
sign)
• The nodes are rubbery often painless, but may form abscess (rarely)
• Rash usually pruritic beginning around 6-8 weeks migratory and last 1
– 2 months
• Hepatosplenomegally
• Anorexia results in weight loss, debilitating, pitting oedema of face
and lower legs
• Impotence and menstrual disturbance
• Cardiac failure (especially T. b. rhodesiense
 CLINICAL FEATURES
• Cerebral or sleeping sickness stage
• This is a terminal stage of trypanosomiasis affecting the brain .
• In T. b. gambiense it takes about 2 years
• Trypanosoma rhodesiense it takes few months
• It is characterized by progressive mental deterioration, coma
and death
• Convulsions and localized signs such as hemiplegia and facial
palsy may occur
• Patients are very weak and they tend to sleep during the day
and restless at night
• If not treated it progresses to death 
 LAB INVESTIGATION
• Blood count reveals anaemia,.
• Elevated erythrocyte sedimentation rate (ESR)
• Thrombocytopenia
• Microscopic examination of chancre fluid for live organism
• Examination of buffy coat of whole blood for organism after centrifuge
– Wet blood smear
– Thick bloods smear
• Serological test IgM level is raised
• Lymph node aspiration – look for live organism
• CSF analysis, animal inoculation and culture techniques
 
 INVESTIGATION
Studies performed to detect trypanosomes
include the following:
• Blood smear (unstained or Giemsa-stained)
• Chancre aspiration
• Lymph node aspiration
• Bone marrow aspiration
• Lumbar puncture and CSF assay
 INVESTIGATION
• CSF assay is also done to measure white blood
cell (WBC) counts, protein, and IgM in patients
with parasitemia or positive serologies or
symptoms.
The following studies may also be considered:
• Computed tomography (CT) of the head
• Magnetic resonance imaging (MRI) of the head
• Electroencephalography (EEG
 DIFFERENTIAL DIAGNOSIS
• Malaria
• Relapsing fever
• Tuberculosis
• Leukaemia
• Typhoid fever
 Treatment

• Drug of choice is Suramin for T.b.rhodesiense

– Dose of Suramin 100-200mg intravenously test dose
– then 1g on 1st 3, 7, 14, 21 days
– The drug is given by slow intravenous infusion of a freshly prepared
10% aqueous solution
• If CSF is altered
– Melarsoprol should be given to adults in 3 courses of 3 days each
– Dose 2 – 3.6mg/kg/day also in 3 divided doses and for 3 days the later
dose is repeated in 10 – 21 days later
• In debilitated patients Suramin is administrated for 2 – 4 days
before therapy with melarsoprol is initiated
 CONT ….
• In Trypanosoma brucei Gambiense Infection
• Pentamidine is the drug of choice for T. b. gambiense
• If CSF is normal give suramin or pentamidine if not taken locally as
prophylaxis
• If CSF is altered give Melarsoprol preferably proceeded by injection
of suramin or one injection pentamindine plus suramin
• Eflornithine is a new drug – recommended schedule 400 mg/kg/day
• Give IV in 4 divided doses for14 days followed by oral treatment
with 300mg/kg/day for 3-4 weeks
• Dose for children should be calculated on bases of body weight .
 PREVENTION AND CONTROL

• Control of trypanosomiasis focuses on

– Early detection
– early treatment
– vector control by clearing the bush
– wear protective clothing against bites
• Other methods used
– Use of insecticides but expensive and temporary benefit
– Baited flytraps
– Reduce fly populations by as much as 95% in 6 months