African Trypanosomiasis (Sleeping Sickness) Follow-up

  • Author: Randy O Odero; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

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.
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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.
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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.
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Complications

  • Anemia, fatigue
  • Wasting syndrome
  • Meningoencephalitis, seizures
  • Stupor or coma (sleeping sickness)
  • Death
  • Perinatal death or abortion (following congenital infection)
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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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Contributor Information and Disclosures
Author

Randy O Odero  MB, ChB, Attending Physician, Infectious Diseases

Randy O Odero 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, 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.

Specialty Editor Board

Gary L Gorby, MD  Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Joseph F John Jr, MD, FACP, FIDSA, FSHEA  Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina College of Medicine; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

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.

References

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  3. Kohagne TL, M'eyi MP, Kamkuimo RG, Kaba D, Louis JF, Mimpfoundi R. Transmission of human African trypanosomiasis in the Komo-Mondah focus, Gabon. Pan Afr Med J. 2011;8:36. [Medline]. [Full Text].

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  6. Priotto G, Kasparian S, Ngouama D, Ghorashian S, Arnold U, Ghabri S, et al. Nifurtimox-eflornithine combination therapy for second-stage Trypanosoma brucei gambiense sleeping sickness: a randomized clinical trial in Congo. Clin Infect Dis. Dec 1 2007;45(11):1435-42. [Medline].

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  19. Schmid C, Richer M, Bilenge CM, Josenando T, Chappuis F, Manthelot CR, et al. Effectiveness of a 10-day melarsoprol schedule for the treatment of late-stage human African trypanosomiasis: confirmation from a multinational study (IMPAMEL II). J Infect Dis. Jun 1 2005;191(11):1922-31. [Medline].

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African trypanosomiasis (sleeping sickness). Human trypanosomes blood smear.
Table 1. Medications Recommended for Treatment of African Trypanosomiasis
Type of TrypanosomiasisMedications



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, 21Melarsoprol 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



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