African Trypanosomiasis (Sleeping Sickness) Follow-up
- Author: Randy O Odero; Chief Editor: Burke A Cunha, MD more...
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
- 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).
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| Type of Trypanosomiasis | Medications Stage 1 (Hemolymphatic Stage) | Medications Stage 2 (Neurologic [CNS] Stage) |
| East African trypanosomiasis (caused by T brucei rhodesiense) | Suramin 100-200 mg IV test dose, then 1 g IV on days 1, 3, 7, 14, 21 | Melarsoprol 2-3.6 mg/kg/d IV for 3 d; after 1 wk, 3.6 mg/kg/d for 3 d; after 10-21 d, repeat the cycle |
| West African trypanosomiasis (caused by T brucei gambiense) | Pentamidine isethionate 4 mg/kg/d IM for 10 d or Suramin 100-200 mg IV test dose, then 1 g IV on days 1, 3, 7, 14, 21 | Melarsoprol 2-3.6 mg/kg/d IV for 3 d; after 1 wk, 3.6 mg/kg/d for 3 days; after 10-21 d, repeat the cycle or Eflornithine 400 mg/kg/d IV in 4 divided doses for 14 d |

