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Sleeping sickness – Human trypanosomiasis

Wait a second, let me sound a note of warning. Anytime you notice a child or an adult, sleeping excessively, do not callously label the person lazy. Pause for a minute and ask -”could this be a sleeping sickness”, otherwise known as trypanosomiasis.

   In my long years of medical practice in Jos, Maiduguri, Potiskum, Umuahia and Igbere, I had diagnosed tens of people with trypanosomiasis. The usual trigger was the complaint – “Doc I sleep too much”, an alarm would be triggered, lymphatic fluid collected for investigations, and we usually struck gold.

   I remember a man I diagnosed of trypanosomiasis in Jos, he told me he had done numerous tests ordered by several doctors, and his sleepiness still continued until he met me. He was so grateful and was ready to pay any amount I could mention, unfortunately I was still a young doctor and money was not my priority.

   Note also that, though, the early sign of trypanosomiasis is sleepiness, that if ignored or neglected, the late signs result in confusion, tremor, paralysis and death. Yes, we could say “our loved ones died after a brief illness”, a euphemism, but what did we do when they complained of tiredness and sleepiness.

   So let me advise our younger doctors, please whenever any patient presents with excessive sleepiness, especially those who have just visited the rural areas where animal grazing is common . Let Giemsa stains for trypanosomes or “trypanosome-specific-antibody-tests, be among the tests you will request. Let us err on the side of caution.

How do we define sleeping sickness – trypanosomiasis?

   This disease is due to the trypanosome of the Trypanosoma(T) brucei group which is transmitted by the tse-tse-fly. There are two types of infection in humans, one due to T. gambiense (Gambian sleeping sickness, also found in Nigeria), the other due to T. rhodesiense (Rhodesia now Zimbabwe sleeping sickness). Both are usually transmitted by the bite of an infected tse-tse-fly, and are more common in rural areas, where animals are reared.

    According to WHO(Jan, 2017), the risk of sleeping sickness exists in scattered areas through out Nigeria. There is a higher risk in Gboko vicinity of Benue State (Southeastern areas confluent with endemic areas of Cameroun) and the Southwestern states of Edo and Delta.

What are the signs and symptoms of trypanosomiasis?

  Symptoms occur in two stages A) Haemolytic phase and B) Neurological phase:

A) Haemolytic phase: 1) Fever 2) headaches 3) joint pains 4) itching 5) severe swelling of lymph nodes – Winterbottom sign 6) red sore (chancre) – develops at the location of tse-tse-fly bite. 7) If left untreated the disease overcomes the host’s defenses and can cause more extensive damage like – anaemia, cardiac and kidney dysfunction.

B) Neurological phase:1) Disruption of sleep cycle hence – sleeping sickness. Infected individuals experience a disorganized fragmented 24-hour rhythm of sleep-wake-cycle, resulting in daytime sleep episodes and nighttime periods of wakefulness. 2) confusion 3) tremors 4) general muscle weakness 5) hemi-paresis(partial numbness) 6) paralysis of the limb 7) Parkinson-like movements 8) psychiatric symptoms – such as irritability, psychotic reactions, aggressive behavior or apathy. 9) Without treatment, the disease is invariably fatal, with progressive mental deterioration leading to coma, systemic organ failure and death.

How do we diagnose trypanosomiasis?

   • 1) Samples from chancre fluid, lymphatic-aspirate, blood, bone marrow, cerebrospinal fluids – stained with Giemsa are examined under microscope.

  λ 2) Detection of trypanosome-specific-antibodies in the blood could help.

Treatment of sleeping sickness.

λ Please there should be no self medication.

λ Contact your doctor who will use intramuscular(im) or intravenous(iv) pentamidine or suramin for the treatment.

Epidemiology of trypanosomiasis

   λ Trypanosomiasis causes about 9,000 to 34,000 deaths in Africa.

  λ Over 60 million people living in some 250 locations are at risk of contracting the disease(WHO, Jan 2017)

   λ Trypanosomiasis occurs in 37 Countries, all in Sahara Africa. It is more pronounced in Countries with nomadic cattle rearing culture, like Uganda, Kenya and Nigeria.

What do we know about the vector tse-tse-fly?

   λ The tse-tse-fly genus Glossina is a large brown biting fly, that serves as both a host and a vector for the trypanosome-parasite.

   λ While taking blood from a man-host, an infected tse-tse-fly injects meta cyclic trypomastigotes into skin tissue. The parasites enter the lymphatic system and then pass into the blood stream. Then transferred back to lymphatic system where they replicate and spread through out the whole body.

Prevention of trypanosomiasis.

Spraying: The fly is killed by spraying the vegetation with insecticides such as DDT or dieldrin Mass treatment : Spraying and clearing is often difficult, expensive and unsuccessful, especially in old endemic foci. Instead, the disease is attacked by treating all infected persons. Consult your doctor if you feel very sleepy. Be medically guided.

Please follow me on twitter : @ _ DRSUN

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