eMedicine Specialties > Infectious Diseases > Parasitic Infections

African Trypanosomiasis (Sleeping Sickness): Follow-up

Author: Randy O Odero, MB, ChB, Infectious Disease Fellow, University of Tennessee at Memphis
Coauthor(s): Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis; Kitonga P Kiminyo, MD, Consulting Staff, ID Consultants Inc; Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Contributor Information and Disclosures

Updated: Feb 16, 2009

Follow-up

Further Inpatient Care

  • If late or CNS disease complications and coma occur, intensive care unit (ICU) staff are needed while treatment is administered (ie, melarsoprol for East African trypanosomiasis or eflornithine for West African trypanosomiasis). Monitor potential adverse effects from such drugs, including hematologic, renal, and hepatic function.

Further Outpatient Care

  • In both early- and late-stage trypanosomiasis, treatment usually resolves symptoms and clears the parasitemia on repeat blood smears.
  • Patients who have recovered from late-stage East African trypanosomiasis should undergo lumbar punctures every 3 months for the first year. Patients who have recovered from West African trypanosomiasis should undergo lumbar punctures every 6 months for 2 years. A relapse is suggested if symptoms return, the CSF WBC count is above 20 cells/µL, CSF pleocytosis occurs, or if trypanosomes are still present in blood or CSF. A persistently elevated CSF WBC count can be observed in recovering patients, however, so the change (increase or decrease) in WBC count is more helpful diagnostically. If a relapse is noted, consider repeat treatment with melarsoprol or eflornithine.

Deterrence/Prevention

  • No vaccine is available for African trypanosomiasis (sleeping sickness).
  • Chemoprophylaxis in unavailable.
  • Avoidance of travel to areas of heavy infestation with tsetse flies is recommended. Tsetse flies are attracted to moving vehicles and dark contrasting colors.
  • Tsetse flies are not affected by insect repellants and can bite through lightweight clothing. The CDC recommends that travelers at risk should be advised to wear clothing of wrist and ankle length that is made of medium-weight fabric in neutral colors.
  • Treatment of asymptomatic carriers is possible, and infection can be detected with CATT or node aspirate and confirmed with smears.

Complications

  • Anemia, fatigue
  • Wasting syndrome
  • Aspiration pneumonia
  • Meningoencephalitis, seizures
  • Stupor or coma (sleeping sickness)
  • Death
  • Perinatal death or abortion (following congenital infection)

Prognosis

  • In early, or stage 1, trypanosomiasis, most patients experience full recovery following treatment.
  • In late, or stage 2, trypanosomiasis, the CNS manifestations are ultimately fatal if untreated. The cure rate approaches 95% with drugs that work inside the CNS (eg, melarsoprol).

Miscellaneous

Medicolegal Pitfalls

  • Failure to obtain adequate travel history
  • Delay in diagnosis, especially in a patient with late or CNS disease
  • Failure to monitor for toxicities from drug therapies
 


More on African Trypanosomiasis (Sleeping Sickness)

Overview: African Trypanosomiasis (Sleeping Sickness)
Differential Diagnoses & Workup: African Trypanosomiasis (Sleeping Sickness)
Treatment & Medication: African Trypanosomiasis (Sleeping Sickness)
Follow-up: African Trypanosomiasis (Sleeping Sickness)
Multimedia: African Trypanosomiasis (Sleeping Sickness)
References
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References

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Further Reading

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Keywords

sleeping sickness, African trypanosomiasis, human African trypanosomiasis, HAT, Trypanosoma brucei, T brucei, Trypanosoma brucei rhodesiense, Trypanosoma brucei gambiense, tsetse flies, Glossina species, East African trypanosomiasis, Rhodesian African trypanosomiasis, West African trypanosomiasis, Gambian African trypanosomiasis, trypanosomes

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Contributor Information and Disclosures

Author

Randy O Odero, MB, ChB, Infectious Disease Fellow, University of Tennessee at Memphis
Randy O Odero, MB, ChB is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Coauthor(s)

Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis
Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Kitonga P Kiminyo, MD, Consulting Staff, ID Consultants Inc
Kitonga P Kiminyo, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Daniel R Lucey, MD, MPH, Chief, Fellowship Program Director, Department of Internal Medicine, Division of Infectious Diseases, Washington Hospital Center; Professor, Department of Internal Medicine, Uniformed Services University of the Health Sciences
Daniel R Lucey, MD, MPH is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Medical Editor

Gary L Gorby, MD, Program Director of Adult Infectious Diseases Fellowship, Associate Professor, Department of Internal Medicine, Division of Infectious Disease, St Joseph Medical Center, Creighton University School of Medicine
Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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