TRYPANASOMIASIS

By Aisha umar
OBJECTIVES
• Definition
• Types
• Epidemiology
• Pathophysiology
• Clinical presentation
• Diagnosis
• Investigations
• Management
• prevention
Definition
Trypanasomiasis is a vector borne parasitic disease

There are two types;

a)African trypanasomiasis
b) American trypanasomiasis
African trypanosomiasis (sleeping sickness)
African sleeping sickness is caused by trypanosomes conveyed to
humans by the bites of infected tsetse flies, and is unique to sub-
Saharan Africa
It is caused by a protozoa called Trypanosoma brucei
T. brucei is of two types;
a)T. brucei gambiense common to West Africa
b)T.brucei rhodesiense common to East and Central Africa
Epidemiology
• The incidence of sleeping sickness across Africa has declined by over 60%
since 1990 due to better control measures. Trypanosoma brucei gambiense
trypanosomiasis has a wide distribution in West and Central Africa and
accounts for 90% of human African trypanosomiasis (HAT). T. brucei
rhodesiense trypanosomiasis is found in parts of East and Central Africa.
• In West Africa, transmission is mainly at the riverside, where the fly rests in
the shade of trees; no animal reservoir has been identified for T. gambiense. T.
rhodesiense has a large reservoir in numerous wild animals and transmission
takes place in the shade of woods bordering grasslands. Rural populations
employed in agriculture, fishing and animal husbandry are susceptible. Local
people and tourists visiting forests infested with tsetse flies and animal
reservoirs may become infected.
Clinical features
• the site at which the tsetse fly bites becomes painful and swollen
about 10 days later (‘trypanosomal chancre’), associated with regional
lymphadenopathy.
• After the parasite has had access to the blood stream the disease
manifests in two stages;
a) early haematolymphatic (stage 1), in which the parasite multiplies
in peripheral circulation, subcutaneous tissue and lymph
b) late encephalitic phase (stage 2), in which the parasite crosses the
blood–brain barrier and chronic encephalopathy develops.
Without treatment the disease may prove to be fatal
Investigations
• Trypanosomiasis should be considered in any febrile patient from an
endemic area.
Microscopic examination
• In rhodesiense infections, thick and thin malaria blood films will
reveal trypanosomes. (In early stages)
• The trypanosomes may be seen in the blood or from puncture of the
primary lesion in the earliest stages of gambiense infections, but it is
usually easier to demonstrate them by aspiration of a lymph node
Cont….
Screening
The serological test is only available for T. gambiense where an antigen
test is carried out
If the CNS is affected, the cell count (> 20 × 109 leucocytes/L) and
protein content of the CSF are increased and the glucose is diminished.
A very high level of serum IgM or the presence of IgM in the CSF is
suggestive of trypanosomiasis. Recognition of CNS involvement is
critical, as failure to treat it might be fatal.
Management
• Therapeutic options for African trypanosomiasis are limited and most
antitrypanosomal drugs are toxic and expensive. The prognosis is
good if treatment is begun early, before the brain has been invaded.
Cont…
Prevention of African trypanasomiasis
AMERICAN
TRYPANASOMIASIS(CHAGA’S
DISEASE)
THANK YOU

REFERENCES
• Davidson’s Principles and Practice of Medicine, 20th edition
• Kumar and Clarke-Clinical Medicine 6th edition
• Harrison’s principles of internal medicine 14th edition