African trypanosomiasis, also called African sleeping sickness, is a systemic disease caused by a parasite and transmitted by the bite of the infected tsetse fly. There are two types of the disease, named for the areas of Africa in which they are found. West African trypanosomiasis, which causes a chronic infection lasting years, is caused by the parasite Trypanosoma brucei gambiense. East African trypanosomiasis, which causes acute illness lasting several weeks, is caused by Trypanosoma brucei rhodesiense. Infection of international travelers is quite rare, with an average of one case in a U.S. citizen per year, typically acquired in East Africa game parks.
African trypanosomiasis is confined mainly to tropical Africa between 15 degrees North and 20 degrees South latitude. The greatest risk of contracting the disease occurs in the following areas:
Because tsetse flies inhabit rural areas only, living in woodland thickets of the savanna and dense vegetation along streams, visitors to urban areas are generally not at risk.
The following are the most common symptoms of African trypanosomiasis. However, each individual may experience symptoms differently.
Tsetse fly bites can be quite painful and travelers often recall the bite. Commonly a painful sore, called a chancre, will develop within a week or so at the sight of the bite. Symptoms, which occur within one to four weeks of infection, are often initially nonspecific and may include fever, skin lesions, rash, edema, or swollen lymph nodes on the back of the neck. After many weeks, the infection then generally progresses to meningoencephalitis, which is an infection of the brain and the fluid surrounding the brain and spinal cord. As the illness progresses, symptoms may include:
If left untreated, death will occur within several weeks to months. The symptoms of African trypanosomiasis may resemble other medical conditions or problems. Always consult a doctor for a diagnosis.
There is no vaccine or recommended drug available to prevent African trypanosomiasis. Therefore, preventive measures should be aimed at avoiding insect bites. The CDC recommends the following:
See a doctor as soon as possible if you suspect an infection. He or she will order several tests to detect the parasite. Common tests include blood samples and a spinal tap. A sample of chancre fluid or tissue, or fluid from swollen lymph nodes may also be taken.
Specific treatment for African trypanosomiasis will be determined by your doctor based on:
Medication for the treatment of African trypanosomiasis is available. Hospitalization is necessary and periodic follow-up exams, which include a spinal tap, are generally necessary for about two years. Because this infection is so rare, doctors are recommended to consult with an infectious disease or tropical medicine specialist for diagnosis and treatment. Doctors can also consult with the CDC for assistance with dianosis and clinical management.
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