International Journal of Emergency Mental Health and Human Resilience
Open Access

African Trypanosomiasis, Tsetse Fly, Neurological complications

Sleeping sickness, medically known as African trypanosomiasis, is a parasitic disease caused by protozoan parasites of the Trypanosoma species. It is primarily transmitted to humans through the bite of infected tsetse flies, which are found in rural areas of sub-Saharan Africa. The disease has two stages: the first affects the blood and lymphatic system, while the second involves the central nervous system, leading to severe neurological symptoms (Deborggraeve S, 2010). This article provides a detailed overview of sleeping sickness, including its history, symptoms, diagnosis, treatment, and preventive measures. Sleeping sickness has been known to humanity for centuries, with early records dating back to the 19th century. The disease has historically been a significant public health concern in many African countries. It was named "sleeping sickness" because one of its most debilitating symptoms is a disruption of the sleep-wake cycle, leading to excessive daytime sleepiness and insomnia at night (Enanga B, 2002).

The first major outbreak of sleeping sickness was reported in the late 19th century in Uganda, where it caused widespread mortality and morbidity. In the early 20th century, various measures were implemented to control the disease, including the use of insecticides and the establishment of tsetse fly control programs (Hide G, 1999). Despite these efforts, sleeping sickness remains endemic in many areas, particularly in rural regions with limited access to healthcare. This subspecies causes the chronic form of the disease and is responsible for the majority of cases in Central and West Africa. This subspecies causes the acute form of the disease and is primarily found in East Africa. Transmission occurs through the bite of an infected tsetse fly, which typically resides in wooded or bushy areas near rivers and lakes (Kennedy PG,2019). The fly becomes infected by feeding on the blood of infected animals, particularly livestock and wild game. Once the fly bites a human, the parasites enter the bloodstream and begin to multiply. The symptoms of sleeping sickness can vary depending on the stage of the disease (Malvy D, 2011). During the first stage, the following symptoms may occur. A low-grade fever is often one of the initial symptoms. General fatigue and malaise are common. Enlargement of lymph nodes, particularly in the back of the neck can occur. Persistent headaches may develop. Some patients report joint pain. This stage can last for several weeks to months, and if untreated, it can progress to the second stage (Rijo-Ferreira F, 2011).

In the second stage, the parasites invade the central nervous system, leading to more severe symptoms. Patients may experience extreme fatigue during the day and insomnia at night, hence the name sleeping sickness. Cognitive dysfunction and confusion can occur as the disease progresses. Behavioral changes and emotional instability may be observed. Some patients experience seizures due to neurological involvement. In advanced cases, patients may enter a coma (Stanghellini A,2001). Without treatment, sleeping sickness can lead to death within a few months to several years, depending on the subspecies and the stage of the disease. Diagnosing sleeping sickness can be challenging due to the nonspecific nature of early symptoms. Diagnosis typically involves. Healthcare providers assess symptoms and medical history. Blood tests can detect antibodies or antigens specific to the Trypanosoma parasite. A definitive diagnosis is made by identifying the parasites in blood, lymphatic fluid, or Cerebrospinal Fluid (CSF). A spinal tap may be performed to examine the CSF for the presence of parasites, especially in suspected second-stage cases. Early diagnosis is crucial for effective treatment, as delays can result in severe complications.  The treatment of sleeping sickness varies depending on the stage of the disease and the causative Trypanosoma subspecies. For the second stage, more potent medications are required due to the involvement of the central nervous system. Despite the availability of effective treatments, challenges remain, including drug resistance, side effects, and limited access to healthcare in endemic regions (Wastling SL,2011).

Prevention and Control: Preventing sleeping sickness involves a combination of strategies including. Implementing measures to reduce tsetse fly populations, such as insecticide spraying, trapping, and habitat modification, is crucial in controlling the disease. Individuals in endemic areas are advised to wear protective clothing, use insect repellent, and avoid areas with high tsetse fly populations. Public health education campaigns can raise awareness about the disease, promote early detection, and encourage individuals to seek medical attention if they experience symptoms. Efforts to eliminate sleeping sickness have intensified in recent years, with international organizations such as the World Health Organization (WHO) leading initiatives to control the disease. These efforts include improved access to diagnosis and treatment, community education, and ongoing research to develop new tools for prevention and treatment (Welburn SC, 2001).

Sleeping sickness poses a major public health challenge in affected African regions, with severe social and economic impacts. The disease exists in two forms: Trypanosoma brucei gambiense, which causes chronic infection in West and Central Africa, and Trypanosoma brucei rhodesiense, which causes an acute, rapidly progressing infection in East Africa. T. b. gambiense infections may go unnoticed for months or even years, gradually leading to neuropsychiatric complications, such as mood swings, personality changes, and excessive sleepiness, often mistaken for other illnesses. By contrast, T. b. rhodesiense typically shows more immediate and severe symptoms, often leading to death within weeks if untreated. Diagnosis involves detecting trypanosomes in blood, lymph, or spinal fluid samples, often using specialized techniques like the Card Agglutination Test for Trypanosomiasis (CATT). Despite advances in treatment, access to care remains limited in rural areas, where the disease burden is highest. Newer drugs like fexinidazole, an oral medication, offer hope by simplifying treatment, but continued surveillance, tsetse control measures, and education are essential to prevent resurgence (Welburn SC,2009).

Sleeping sickness remains a significant public health challenge in many parts of sub-Saharan Africa. Understanding the disease, its transmission, symptoms, diagnosis, and treatment is essential for effective prevention and control. Continued global efforts to reduce the burden of sleeping sickness, along with ongoing research, are critical to achieving the goal of eliminating this debilitating disease. Through awareness, education, and access to healthcare, we can work towards a future free from the threat of sleeping sickness.

Deborggraeve, S., Buscher, P (2010). Molecular diagnostics for sleeping sickness: what is the benefit for the patient. Lancet Infect Dis. 1;10(6):433-9.

Indexed at, Google Scholar, Cross Ref

Enanga, B., Burchmore, RJ., Stewart, ML., Barrett, MP (2002). Sleeping sickness and the brain. Cell  Mol Life Sci. 59:845-58.

Indexed at, Google Scholar, Cross Ref

Hide, G (1999). History of sleeping sickness in East Africa. Clin Microbiol Rev.1;12(1):112-25.

Indexed at, Google Scholar, Cross Ref

Kennedy, PG (2019). Update on human African trypanosomiasis. J Neurol. 1;266:2334-7.

Indexed at, Google Scholar, Cross Ref

Malvy, D., Chappuis, F (2011). Sleeping sickness. Clin Microbiol Infect.  1;17(7):986-95.

Google Scholar

Rijo-Ferreira, F., Carvalho, T (2018). Sleeping sickness is a circadian disorder.  4;9(1):62.

Indexed at, Google Scholar, Cross Ref

Stanghellini, A., Josenando, T (2001). The situation of sleeping sickness in Angola: a calamity. Trop Med Int Hea. 6(5):330-4.

Indexed at, Google Scholar, Cross Ref

Wastling, SL., Welburn, SC (2011). Diagnosis of human sleeping sickness: sense and sensitivity. Trends Parasitol.  1;27(9):394-402.

Indexed at, Google Scholar, Cross Ref

Welburn, SC., Fèvre, EM., Coleman, PG (2001). Sleeping sickness: a tale of two diseases. Trends Parasitol. ;17(1):19-24.

Indexed at, Google Scholar, Cross Ref

Welburn, SC., Maudlin, I., Simarro, PP (2009). Controlling sleeping sickness–a review. Para.136(14):1943-9.

Indexed at, Google Scholar, Cross Ref