African trypanosomiasis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Pilar Almonacid, Aditya Ganti M.B.B.S. [2]

Overview

The clinical course of human African trypanosomiasis has two stages. In the first stage, the parasite is found in the peripheral circulation but it has not yet invaded the central nervous system. Once the parasite crosses the blood-brain barrier and infects the central nervous system, the disease enters the second stage. The subspecies that cause African trypanosomiasis have different rates of disease progression, and the clinical features depend on which form of the parasite (Trypanosoma brucei rhodesiense or Trypanosoma brucei gambiense) is causing the infection. However, infection with either form will eventually lead to coma and death if not treated.

History

Obtaining the history is the most important aspect of making a diagnosis of African trypanosomiasis. It provides insight into cause, precipitating factors, and associated comorbid conditions. A patient suffering from African trypanosimiasis may present with the following history:

• Recent travel to the endemic areas
• Any ill contact with similar complaints

Symptoms

Symptoms of African trypanosomiasis include:

Stages of infection	Symptoms
Systemic	Sweating Anxiety Fever
First stage (hemo-lyphatic stage)	Headaches Myalgias Pruritis
Second stage (neurological or meningoencephalic stage)	Changes in behavior Confusion Sensory disturbances Poor coordination Disturbance of the sleep cycle

The subspecies that cause African trypanosomiasis have different rates of disease progression and the clinical features depend on which form of the parasite (Trypanosoma brucei rhodesiense or Trypanosoma brucei gambiense) is causing the infection.

Disease	Pathogen	Geographic distrubution	Progression	Symptoms
				First stage	Second stage
East African sleeping sickness	Trypanosoma brucei rhodesiense	East and Southeast Africa	Rapid (1-2 weeks)	A large sore (a chancre) will develop at the site of the tsetse bite Fever, headache, muscle and joint aches, and enlarged lymph nodes	Mental deterioration and other neurologic problems. Death ensues usually within months.
West African sleeping sickness	Trypanosoma brucei gambiense	West and Central Africa	Slow (1-2 years)	Intermittent fevers, headaches, muscle and joint aches, and malaise Itching of the skin, swollen lymph nodes, and weight loss	Personality changes, daytime sleepiness with nighttime sleep disturbance, and progressive confusion. Other neurologic signs, such as partial paralysis or problems with balance or walking may occur, as well as hormonal imbalances. The course of untreated infection rarely lasts longer than 6-7 years and more often kills in about 3 years.

References

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