African Sleeping Sickness
African Sleeping Sickness
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Newsfeed display by CaRP There are two types of African trypanosomiasis also called sleeping sickness; each is named for the region of Africa in which they are found. The disease is caused by a parasite named Trypanosoma brucei rhodesiense, carried by the tsetse fly. Worldwide, approximately 25,000 new cases of both East and West African trypanosomiasis are reported to the World Health Organization each year. However, many cases are not reported due to a lack of infrastructure and the true number of new cases is undoubtedly much higher. Since 1967, thirty-six cases of East African trypanosomiasis have been reported within the United States, all among individuals who had traveled to Africa.

An individual will get East African trypanosomiasis if they are bitten by a tsetse fly infected with the Trypanosoma brucei rhodesiense parasite. The tsetse fly is common only to Africa.

Trypanosomiasis is a systemic disease caused by the parasite Trypanosoma brucei. East African trypanosomiasis is caused by T. b. rhodesiense and West African trypanosomiasis by T. b. gambiense. Both forms are transmitted by the bite of the tsetse fly, a gray-brown insect about the size of a honeybee.

Yes. If a person fails to receive medical treatment for East African trypanosomiasis, death will occur within several weeks to months.

East African trypanosomiasis is found in parts of Eastern and Central Africa, including Uganda, Kenya, Tanzania, Malawi, Ethiopia, Zaire, Zimbabwe, and Botswana. Areas where infection is spread are largely determined by the location of the infected tsetse fly and wild animal population.

A bite by the tsetse fly is often painful and can develop into a red sore, also called a chancre. Fever, severe headaches, irritability, extreme fatigue, swollen lymph nodes, and aching muscles and joints are common symptoms of sleeping sickness. Some people develop a skin rash. Progressive confusion, personality changes, slurred speech, seizures, and difficulty in walking and talking occur when infection has invaded the central nervous system. If left untreated, infection becomes worse and death will occur within several weeks or months.

Symptoms begin within 1 to 4 weeks of getting an infected tsetse fly bite.

If you suspect that you may have East African trypanosomiasis, immediately consult with your health care provider who will order several tests to look for the parasite. Common tests include blood samples, a spinal tap, and skin biopsies, especially if you have a chancre.

Medical treatment of East African trypanosomiasis should begin as soon as possible and is based on the infected person’s symptoms and laboratory results. Medication for the treatment of East African trypanosomiasis is available through the CDC. Hospitalization for treatment is necessary. Periodic follow-up exams that include a spinal tap are required for 2 years.

No one is immune from East African trypanosomiasis. Even if you had the disease
East African trypanosomiasis is usually found in woodland and savannah areas away from human habitation. Tourists, hunters, game wardens, and other persons working or visiting game parks in East and Central Africa are at greatest risk for illness.

There is neither a vaccine nor recommended drug available to prevent East African trypanosomiasis.

How to prevent African trypanosomiasis and prevent other insect bites?
1. Wear protective clothing, including long-sleeved shirts and pants. The tsetse fly can bite through thin fabrics, so clothing should be made of thick material.
2. Wear khaki or olive colored clothing. The tsetse fly is attracted to bright colors and very dark colors.
3. Use insect repellant. Though insect repellants have not proven effective in preventing tsetse fly bites, they are effective in preventing other insects from biting and causing illness.
4. Use bed netting when sleeping.
5. Inspect vehicles for tsetse flies before entering.
6. Do not ride in the back of jeeps, pickup trucks or other open vehicles. The tsetse fly is attracted to the dust that moving vehicles and wild animals create.
7. Avoid bushes. The tsetse fly is less active during the hottest period of the day. It rests in bushes but will bite if disturbed.

African trypanosomiasis is confined to tropical Africa between 15° north latitude and 20° south latitude, or from north of South Africa to south of Algeria, Libya, and Egypt. According to WHO, 25,000-45,000 cases of trypanosomiasis are reported annually; however, the actual prevalence of cases is estimated to be 300,000 to 500,000.

Tsetse flies inhabit rural areas, living in the woodland and thickets of the savannah and the dense vegetation along streams. Infection of international travelers is rare.

Approximately 1 case per year is reported among U.S. travelers. Most of these infections are caused by T. b. rhodesiense and they are acquired in East African game parks. Travelers visiting game parks and remote areas should be advised to take precautions.

Travelers to urban areas are not at risk.

Signs and symptoms are initially nonspecific - fever, skin lesions, rash, edema, or lymphadenopathy; however, the infection progresses to meningoencephalitis. Symptoms generally appear within 1 to 3 weeks of infection. East African trypanosomiasis is more acute clinically, with earlier central nervous system involvement than in the West African form of the disease. Untreated cases are eventually fatal.

No vaccine is available to prevent this disease. Tsetse flies are attracted to moving vehicles and dark, contrasting colors. They are not affected by insect repellents and can bite through lightweight clothing. Areas of heavy infestation tend to be sporadically distributed and are usually well known to local residents. Avoidance of such areas is the best means of protection. Travelers at risk should be advised to wear clothing of wrist and ankle length that is made of medium-weight fabric in neutral colors that blend with the background environment.

Travelers who sustain tsetse fly bites and become ill with high fever or other manifestations of African trypanosomiasis should be advised to seek early medical attention. Travelers should be advised to consult an infectious disease or tropical medicine specialist.
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Submitted: 08/03/06

Description: What is African trypanosomiasis? There are two types of African trypanosomiasis also called sleeping sickness; each is named for the region of Africa in which they are found. The disease is caused by a parasite named Trypanosoma brucei rhodesiense, carried by the tsetse fly. Worldwide, approximately 25,000 new cases of both East and West African trypanosomiasis are reported to the World Health Organization each year. However, many cases are not reported due to a lack of infrastructure and the true number of new cases is undoubtedly much higher.

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