Human african trypansomiasis (sleeping sickness) - Revision history

Danbot: Add peer-reviewed reference

2026-03-22T10:17:06Z

Add peer-reviewed reference

← Older revision		Revision as of 10:17, 22 March 2026
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	==Background==		==Background==
	*Caused by the protozoan parasite Trypanosoma brucei		*Caused by the protozoan parasite Trypanosoma brucei<ref>Kennedy PG. Clinical features, diagnosis, and treatment of human African trypanosomiasis (sleeping sickness). Lancet Neurol. 2013;12(2):186-194. PMID 23260189</ref>
	**Two distinct sub-species exist T. brucei rhodesiense and T. brucei gambiense		**Two distinct sub-species exist T. brucei rhodesiense and T. brucei gambiense
	***rhodesiense - Eastern and Southeastern Africa		***rhodesiense - Eastern and Southeastern Africa

Danbot: Strip excess bold

2026-03-22T09:38:43Z

Strip excess bold

← Older revision		Revision as of 09:38, 22 March 2026
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	***rhodesiense - Eastern and Southeastern Africa		***rhodesiense - Eastern and Southeastern Africa
	****Transmitted by tsetse flies that live in woodlands on the savanah		****Transmitted by tsetse flies that live in woodlands on the savanah
	***gambiense - Central and Western Africa ~~'''~~(More common of the two infections)~~'''~~		***gambiense - Central and Western Africa (More common of the two infections)
	****Transmitted by tsetse flies that live in denser vegetation and along rivers		****Transmitted by tsetse flies that live in denser vegetation and along rivers
	***Crude demarcation line runs through the Great Rift Valley		***Crude demarcation line runs through the Great Rift Valley
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	*Known as the hemolymphatic stage		*Known as the hemolymphatic stage
	*Chancre		*Chancre
	**~~'''~~May be earliest sign~~'''~~		**May be earliest sign
	**Painless, well circumscribed, [[rash\|rubbery lesion]]. (More common with rhodesiense sp.)		**Painless, well circumscribed, [[rash\|rubbery lesion]]. (More common with rhodesiense sp.)
	*''Winterbottom's sign''		*''Winterbottom's sign''
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	===Late symptoms===		===Late symptoms===
	*100% fatal if untreated		*100% fatal if untreated
	*~~'''~~Involvement of the CNS~~'''~~		*Involvement of the CNS
	**Progressive [[meningitis\|meningoencephalitis]]		**Progressive [[meningitis\|meningoencephalitis]]
	**Brain edema		**Brain edema
Line 42:		Line 42:

	==Evaluation==		==Evaluation==
	*~~'''~~Direct visualization of the trypanosomes~~''' '''~~''(Gold Standard)~~'''~~''		*Direct visualization of the trypanosomes ''(Gold Standard)''
	**Blood smears with either Giemsa or Wright's stain		**Blood smears with either Giemsa or Wright's stain
	**Samples can include CSF, blood, lymph node aspirates, and chancre aspirates		**Samples can include CSF, blood, lymph node aspirates, and chancre aspirates
	***'''Must''' examine CSF to staging and treatment purposes		***'''Must''' examine CSF to staging and treatment purposes
	**Low levels of parasitemia may require concentration of sample		**Low levels of parasitemia may require concentration of sample
	*~~'''~~Serologic testing~~'''~~		*Serologic testing
	**Card agglutination test for trypanosomiasis (CATT)		**Card agglutination test for trypanosomiasis (CATT)
	***Agglutination of freeze dried trypanosomes		***Agglutination of freeze dried trypanosomes
	**Useful for epidemiologic studies		**Useful for epidemiologic studies
	*~~'''~~[[LP\|CSF]] analysis~~'''~~		*[[LP\|CSF]] analysis
	**Pleocytosis		**Pleocytosis
	**Elevated protein levels		**Elevated protein levels
	**Mott cells		**Mott cells
	**Direct visualization of trypanosome		**Direct visualization of trypanosome
	*~~'''~~Imaging~~'''~~		*Imaging
	**[[brain MRI\|MRI]] - hyperintense signals in periventricular white matter		**[[brain MRI\|MRI]] - hyperintense signals in periventricular white matter
	**EEG - Delta waves		**EEG - Delta waves
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	==Management==		==Management==
	===Early treatment (Hemolymphatic stage)===		===Early treatment (Hemolymphatic stage)===
	*[[Pentamidine]] ~~'''~~(T.b. gambiense)~~'''~~		*[[Pentamidine]] (T.b. gambiense)
	*Sumarin ~~'''~~(T.b. rhodesience)~~'''~~		*Sumarin (T.b. rhodesience)
	===Late Treatment (Neurologic stage)===		===Late Treatment (Neurologic stage)===
	*Eflornithine (DMFO) for 14 days ~~'''~~(T.b. gambiense only, no activity against T.b. rhodesience)~~'''~~		*Eflornithine (DMFO) for 14 days (T.b. gambiense only, no activity against T.b. rhodesience)
	**Can combo with [[nifurtimox]]		**Can combo with [[nifurtimox]]
	***More effective than Eflornithine alone		***More effective than Eflornithine alone
	*Melarsoprol for 12 days ~~'''~~(T.b. rhodesience)~~'''~~		*Melarsoprol for 12 days (T.b. rhodesience)
	**Can combo with nifurtimox also		**Can combo with nifurtimox also
	**Less effective than Eflornithine		**Less effective than Eflornithine

ClaireLewis at 00:44, 2 October 2019

2019-10-02T00:44:36Z

← Older revision		Revision as of 00:44, 2 October 2019
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	*Chancre		*Chancre
	**'''May be earliest sign'''		**'''May be earliest sign'''
	**Painless, well circumscribed, rubbery lesion. (More common with rhodesiense sp.)		**Painless, well circumscribed, [[rash\|rubbery lesion]]. (More common with rhodesiense sp.)
	*[Winterbottom's sign]		*''Winterbottom's sign''
	**Lymphadenopathy of posterior cervical lymph nodes-characteristic but not always present		**[[Lymphadenopathy]] of posterior cervical lymph nodes-characteristic but not always present
	*Intermittent symptoms corresponding to waves of parasitemia		*Intermittent symptoms corresponding to waves of parasitemia
	**Fever, headache, malaise, ~~arthralgias~~, rash, pruritus		**[[Fever]], [[headache]], malaise, [[arthralgia]]s, [[rash]], [[pruritus]]
	===Late symptoms===		===Late symptoms===
	*100% fatal if untreated		*100% fatal if untreated
	*'''Involvement of the CNS'''		*'''Involvement of the CNS'''
	**Progressive meningoencephalitis		**Progressive [[meningitis\|meningoencephalitis]]
	**Brain edema		**Brain edema
	**Cerebral microhemorrhages		**Cerebral microhemorrhages
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	***Activated plasma cells with IgM inclusions		***Activated plasma cells with IgM inclusions
	**Neurologic symptoms		**Neurologic symptoms
	***Headache, personality changes, inability to concentrate, difficulty with complex mental tasks, psychosis, ataxia, alteration of wake/sleep cycles, parkinsonian like movements		***[[Headache]], personality changes, inability to concentrate, difficulty with complex mental tasks, [[psychosis]], [[ataxia]], alteration of wake/sleep cycles, parkinsonian like movements
	***Eventually progresses to the point where the patient is stuporous and/or in a ~~comatose~~ state		***Eventually progresses to the point where the patient is stuporous and/or in a [[coma]]tose state

	==Differential Diagnosis==		==Differential Diagnosis==
			{{AMS and fever DDX}}

	==Evaluation==		==Evaluation==
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	**Low levels of parasitemia may require concentration of sample		**Low levels of parasitemia may require concentration of sample
	*'''Serologic testing'''		*'''Serologic testing'''
	**Card agglutination test for ~~trypansomiasis~~ (CATT)		**Card agglutination test for trypanosomiasis (CATT)
	***Agglutination of freeze dried trypanosomes		***Agglutination of freeze dried trypanosomes
	**Useful for epidemiologic studies		**Useful for epidemiologic studies
	*'''CSF analysis'''		*'''[[LP\|CSF]] analysis'''
	**Pleocytosis		**Pleocytosis
	**Elevated protein levels		**Elevated protein levels
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	**Direct visualization of trypanosome		**Direct visualization of trypanosome
	*'''Imaging'''		*'''Imaging'''
	**MRI - hyperintense signals in periventricular white matter		**[[brain MRI\|MRI]] - hyperintense signals in periventricular white matter
	**EEG - Delta waves		**EEG - Delta waves

	~~===Work-Up===~~
	*LP & CSF studies
	*Analysis for trypanosomes
	*MRI
	*EEG

	==Management==		==Management==
	===Early treatment (Hemolymphatic stage)===		===Early treatment (Hemolymphatic stage)===
	*Pentamidine '''(T.b. gambiense)'''		*[[Pentamidine]] '''(T.b. gambiense)'''
	*Sumarin '''(T.b. rhodesience)'''		*Sumarin '''(T.b. rhodesience)'''
	===Late Treatment (Neurologic stage)===		===Late Treatment (Neurologic stage)===
	*Eflornithine (DMFO) for 14 days '''(T.b. gambiense only, no activity against T.b. rhodesience)'''		*Eflornithine (DMFO) for 14 days '''(T.b. gambiense only, no activity against T.b. rhodesience)'''
	**Can combo with nifurtimox		**Can combo with [[nifurtimox]]
	***More effective than Eflornithine alone		***More effective than Eflornithine alone
	*Melarsoprol for 12 days '''(T.b. rhodesience)'''		*Melarsoprol for 12 days '''(T.b. rhodesience)'''

Neil.m.young: Text replacement - "pruritis" to "pruritus"

2016-10-27T16:40:02Z

Text replacement - "pruritis" to "pruritus"

← Older revision		Revision as of 16:40, 27 October 2016
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	**Lymphadenopathy of posterior cervical lymph nodes-characteristic but not always present		**Lymphadenopathy of posterior cervical lymph nodes-characteristic but not always present
	*Intermittent symptoms corresponding to waves of parasitemia		*Intermittent symptoms corresponding to waves of parasitemia
	**Fever, headache, malaise, arthralgias, rash, ~~pruritis~~		**Fever, headache, malaise, arthralgias, rash, pruritus
	===Late symptoms===		===Late symptoms===
	*100% fatal if untreated		*100% fatal if untreated

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-24T05:25:30Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 05:25, 24 July 2016
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	==~~Diagnosis~~==		==Evaluation==
	*'''Direct visualization of the trypanosomes''' '''''(Gold Standard)'''''		*'''Direct visualization of the trypanosomes''' '''''(Gold Standard)'''''
	**Blood smears with either Giemsa or Wright's stain		**Blood smears with either Giemsa or Wright's stain

Ostermayer: Text replacement - "Category:TropMed" to "Category:Tropical Medicine"

2016-03-22T16:59:12Z

Text replacement - "Category:TropMed" to "Category:Tropical Medicine"

← Older revision		Revision as of 16:59, 22 March 2016
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	[[Category:ID]]		[[Category:ID]]
	[[Category:~~TropMed~~]]		[[Category:Tropical Medicine]]

Mholtz: Mholtz moved page Human African Trypansomiasis (Sleeping sickness) to Human african trypansomiasis (sleeping sickness)

2015-08-18T03:54:35Z

Mholtz moved page Human African Trypansomiasis (Sleeping sickness) to Human african trypansomiasis (sleeping sickness)

← Older revision	Revision as of 03:54, 18 August 2015
(No difference)

Mholtz at 03:54, 18 August 2015

2015-08-18T03:54:20Z

← Older revision		Revision as of 03:54, 18 August 2015
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	***Headache, personality changes, inability to concentrate, difficulty with complex mental tasks, psychosis, ataxia, alteration of wake/sleep cycles, parkinsonian like movements		***Headache, personality changes, inability to concentrate, difficulty with complex mental tasks, psychosis, ataxia, alteration of wake/sleep cycles, parkinsonian like movements
	***Eventually progresses to the point where the patient is stuporous and/or in a comatose state		***Eventually progresses to the point where the patient is stuporous and/or in a comatose state

			==Differential Diagnosis==


	==Diagnosis==		==Diagnosis==
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	**EEG - Delta waves		**EEG - Delta waves

	==Work-Up==		===Work-Up===
	*LP & CSF studies		*LP & CSF studies
	*Analysis for trypanosomes		*Analysis for trypanosomes
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	*EEG		*EEG

	==~~Treatment~~==		==Management==
	===Early treatment (Hemolymphatic stage)===		===Early treatment (Hemolymphatic stage)===
	*Pentamidine '''(T.b. gambiense)'''		*Pentamidine '''(T.b. gambiense)'''
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	===Monitoring===		===Monitoring===
	*Repeat LP Q 6months for 2 years		*Repeat LP Q 6months for 2 years

			==Disposition==


	==See Also==		==See Also==
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	*[[Chagas Disease]] (American Trypanosomiasis)		*[[Chagas Disease]] (American Trypanosomiasis)

	==~~Source~~==		==External Links==
	*http://www.who.int/trypanosomiasis_african/en/		*http://www.who.int/trypanosomiasis_african/en/
	*[[Wikipedia:African trypanosomiasis]]
	*[[Wikipedia:tsetse]]
	*http://www.who.int/mediacentre/factsheets/fs259/en/
	*http://www.cdc.gov/parasites/sleepingsickness/		*http://www.cdc.gov/parasites/sleepingsickness/
	*https://www.doctorswithoutborders.org/news/issue.cfm?id=2401
	*Uptodate.com
	*Despommier, D., Gwadz, R., Hotez, P., Knirsch, C. ''Parasite Diseases: Fifth Edition'' Apple Tree Productions, 2005.

	[[Category:ID]] [[Category:TropMed]]		==References==
			<References/>

			[[Category:ID]]
			[[Category:TropMed]]

Silas Chiu: Added medicatinos

2014-07-21T23:17:06Z

Added medicatinos

← Older revision		Revision as of 23:17, 21 July 2014
Line 20:		Line 20:
	*Chancre		*Chancre
	**'''May be earliest sign'''		**'''May be earliest sign'''
	**~~Painful~~, well circumscribed, rubbery lesion. (More common with rhodesiense sp.)		**Painless, well circumscribed, rubbery lesion. (More common with rhodesiense sp.)
			*[Winterbottom's sign]
			**Lymphadenopathy of posterior cervical lymph nodes-characteristic but not always present
	*Intermittent symptoms corresponding to waves of parasitemia		*Intermittent symptoms corresponding to waves of parasitemia
	**Fever, headache, malaise, arthralgias, rash, pruritis		**Fever, headache, malaise, arthralgias, rash, pruritis
	*Physical exam features
	**Hepatomegaly, splenomegaly, generalized lymphadenopathy (posterior cervical chain most common [Winterbottom's sign])
	===Late symptoms===		===Late symptoms===
	*100% fatal if untreated		*100% fatal if untreated
Line 40:		Line 40:
	==Diagnosis==		==Diagnosis==
	*'''Direct visualization of the trypanosomes''' '''''(Gold Standard)'''''		*'''Direct visualization of the trypanosomes''' '''''(Gold Standard)'''''
	**~~Can use~~ either ~~wet~~ or ~~dry prep~~		**Blood smears with either Giemsa or Wright's stain
	**Samples can include CSF, blood, lymph node aspirates, and chancre aspirates		**Samples can include CSF, blood, lymph node aspirates, and chancre aspirates
	***'''Must''' examine CSF to staging and treatment purposes		***'''Must''' examine CSF to staging and treatment purposes
Line 65:		Line 65:
	==Treatment==		==Treatment==
	===Early treatment (Hemolymphatic stage)===		===Early treatment (Hemolymphatic stage)===
	*~~Pentamide~~ '''(T.b. gambiense)'''		*Pentamidine '''(T.b. gambiense)'''
	*Sumarin '''(T.b. rhodesience)'''		*Sumarin '''(T.b. rhodesience)'''
	===Late Treatment (Neurologic stage)===		===Late Treatment (Neurologic stage)===
	*Eflornithine for 14 days '''(T.b. gambiense only, no activity against T.b. rhodesience)'''		*Eflornithine (DMFO) for 14 days '''(T.b. gambiense only, no activity against T.b. rhodesience)'''
	**Can combo with nifurtimox		**Can combo with nifurtimox
	***More effective than Eflornithine alone		***More effective than Eflornithine alone
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	**Can combo with nifurtimox also		**Can combo with nifurtimox also
	**Less effective than Eflornithine		**Less effective than Eflornithine

			===Research and Development===
			*DB289, a new drug that acts like pentamidine with less side effects

	===Monitoring===		===Monitoring===
	*Repeat LP Q 6months for 2 years		*Repeat LP Q 6months for 2 years
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	*https://www.doctorswithoutborders.org/news/issue.cfm?id=2401		*https://www.doctorswithoutborders.org/news/issue.cfm?id=2401
	*Uptodate.com		*Uptodate.com
			*Despommier, D., Gwadz, R., Hotez, P., Knirsch, C. ''Parasite Diseases: Fifth Edition'' Apple Tree Productions, 2005.

	[[Category:ID]] [[Category:TropMed]]		[[Category:ID]] [[Category:TropMed]]

JCMiller: Creation of page

2013-12-16T20:56:19Z

Creation of page

New page

==Background==
*Caused by the protozoan parasite Trypanosoma brucei
**Two distinct sub-species exist T. brucei rhodesiense and T. brucei gambiense
***rhodesiense - Eastern and Southeastern Africa
****Transmitted by tsetse flies that live in woodlands on the savanah
***gambiense - Central and Western Africa '''(More common of the two infections)'''
****Transmitted by tsetse flies that live in denser vegetation and along rivers
***Crude demarcation line runs through the Great Rift Valley
*Endemic in 36 countries in Sub-Saharan Africa and about 30,000 are currently infected
*Spread by the Tsetse fly
*Data from 2009 and 2011 suggest that the prevalence is decreasing
*The Democratic Republic of the Congo reported about 80% of new cases in 2012
*Vertical Transmission (Mother to fetus) is also possible

==Clinical Features==
*Clinical syndromes produced by T. brucei gambiense and T. brucei rhodesiense are similar in nature, however the rhodesience strain is much more rapidly progressive and can present with fulminant disease over the course of a few months, not years like the gambiense strain
*May present differently in travelers
===Early symptoms===
*Known as the hemolymphatic stage
*Chancre
**'''May be earliest sign'''
**Painful, well circumscribed, rubbery lesion. (More common with rhodesiense sp.)
*Intermittent symptoms corresponding to waves of parasitemia
**Fever, headache, malaise, arthralgias, rash, pruritis
*Physical exam features
**Hepatomegaly, splenomegaly, generalized lymphadenopathy (posterior cervical chain most common [Winterbottom's sign])
===Late symptoms===
*100% fatal if untreated
*'''Involvement of the CNS'''
**Progressive meningoencephalitis
**Brain edema
**Cerebral microhemorrhages
**Multifocal white matter demyelination
**Mott cells in CSF
***Activated plasma cells with IgM inclusions
**Neurologic symptoms
***Headache, personality changes, inability to concentrate, difficulty with complex mental tasks, psychosis, ataxia, alteration of wake/sleep cycles, parkinsonian like movements
***Eventually progresses to the point where the patient is stuporous and/or in a comatose state

==Diagnosis==
*'''Direct visualization of the trypanosomes''' '''''(Gold Standard)'''''
**Can use either wet or dry prep
**Samples can include CSF, blood, lymph node aspirates, and chancre aspirates
***'''Must''' examine CSF to staging and treatment purposes
**Low levels of parasitemia may require concentration of sample
*'''Serologic testing'''
**Card agglutination test for trypansomiasis (CATT)
***Agglutination of freeze dried trypanosomes
**Useful for epidemiologic studies
*'''CSF analysis'''
**Pleocytosis
**Elevated protein levels
**Mott cells
**Direct visualization of trypanosome
*'''Imaging'''
**MRI - hyperintense signals in periventricular white matter
**EEG - Delta waves

==Work-Up==
*LP & CSF studies
*Analysis for trypanosomes
*MRI
*EEG

==Treatment==
===Early treatment (Hemolymphatic stage)===
*Pentamide '''(T.b. gambiense)'''
*Sumarin '''(T.b. rhodesience)'''
===Late Treatment (Neurologic stage)===
*Eflornithine for 14 days '''(T.b. gambiense only, no activity against T.b. rhodesience)'''
**Can combo with nifurtimox
***More effective than Eflornithine alone
*Melarsoprol for 12 days '''(T.b. rhodesience)'''
**Can combo with nifurtimox also
**Less effective than Eflornithine
===Monitoring===
*Repeat LP Q 6months for 2 years

==See Also==
*[[Neglected Tropical Diseases]]
*[[Chagas Disease]] (American Trypanosomiasis)

==Source==
*http://www.who.int/trypanosomiasis_african/en/
*[[Wikipedia:African trypanosomiasis]]
*[[Wikipedia:tsetse]]
*http://www.who.int/mediacentre/factsheets/fs259/en/
*http://www.cdc.gov/parasites/sleepingsickness/
*https://www.doctorswithoutborders.org/news/issue.cfm?id=2401
*Uptodate.com

[[Category:ID]] [[Category:TropMed]]