African Trypanosomiasis

Summary
1. Sleeping sickness
2. T brucei group
  1. Gambiense TbG
    1. West + Central
    2. Gradual
      1. Human- Human
  2. rhodesiense TbR
    1. East + South
    2. Rapid
      1. Reservoir
        Game
        Cattle
3. Vector (transmission)
  1. Tsetse fly
    1. Painful bite
    2. Rural woodlands + forest
  2. Rarely
    1. Bloodborne
    2. Congenital
4. Locality
  1. Sub Saharan
    1. DR of Congo
    2. South Sudan
    3. Central African Rebuplic
5. Negelected Tropical Disease
6. misdiagnosis as psychosis after travel
Vector
1. Tsetse fly
  1. warm+ Shaded
  2. 1-6 mo
  3. Low infctn rate
    1. 2-3 per1000
Life cycle
1. 1. Fly bite + injects parasite
  1. 2. Metacyclic trypomastigotes → BS trypomastigotes
    1. 3. Multiply via binary fission
      1. 4. Trypomastigotes in blood
        5. Fly bite + ingest parasite
        6. BS parasite→ procylic parasite@ tsetse fly midgut
        multiply via binary fission
        7. Procyclic parasite leave midgut→ epimastigotes
        8. multiply @ salivary glands epi→ metacyclic
      2. Human Stages
  2. Tsetse fly Stages
Signs and Symptoms
1. Signs
  1. Chancre
    1. localised erythema
    2. Indurated
    3. Tender
    4. Lymphadenopathy
      1. trypanosome move to nearby nodes → lymphadenitis
      2. painless
      3. soft
      4. mobile nodes
      5. Common in TbG
      6. @ posterior cervical "Winterbottom's Sign"
    5. Onset in days
      1. up to 3 weeks
    6. Common in TbR
  2. Hepatosplenomegaly
    1. Anaemia
    2. abnormal LFT
2. Symptoms
  1. Parasitaemia
    1. Myalgia
    2. Fever
    3. Headache
    4. Weightloss
    5. Rash
    6. Itch
3. Complications
  1. CVS
    1. Myocardits
    2. Effusions
  2. Endocrince
    1. Hypothyroidism
    2. Hypoadrenalism
  3. CNS
    1. Psychosis
    2. Convulsions
    3. Insomnia/somnalence
    4. Hyper/Para thenesia
    5. Tremors/Ataxia/Focal signs
  4. General
    1. Wasting
    2. Malnutrition
    3. Infections
Dx
1. Demonstration of Parasite
  1. Aspiration of chancre
  2. Blood Film
    1. blood concentration technique
    2. Quantitative Buffy coat
      1. QBC
  3. Bone marrow
  4. CSF
    1. Mandatory
    2. xclude CNS
    3. Microscopy for trypanosomes
    4. WCC > 5
    5. Morula cells of Mott
      1. Big Eosinophillic Plasma cell contain IgM
  5. Serology
    1. Population screening
    2. CATT (Card Agglutination Test)
2. Ddx
  1. HIV
    1. Toxoplasmosis in HIV
      1. CD<400
  2. TB
  3. Meningitis
  4. Lymphoma
  5. CNS vasculitis
  6. Psychiatric illness
3. Prognosis
  1. Fatal without Tx
Staging
1. Stage 1 (Early)
  1. No CNS involvements
  2. Haemolymphatics
2. Stage 2 (Late)
  1. CNS involvements
Tx
1. TbG
  1. S1- Pentamidine
  2. S2 - Eflornithine / ±Nifurtimox
2. TbR
  1. S1- Suramin
  2. S2- Melarsoprol
3. Steroids often used
4. SE common
5. 1-3 weeks
Control
1. Vector control
2. Population screening
3. Minimise contact
4. Prevention
  1. aerial insecticide
  2. Tsetse fly trap
  3. insectiside impregnated screen
  4. wild animal pop reduction
  5. removal of woody vegetaion

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African Trypanosomiasis

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