African Trypanosomiasis (Sleeping Sickness) Clinical Presentation

Updated: Feb 01, 2019
  • Author: Hazem Alsalman Hnaide, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Symptoms of stage 1 (early or hemolymphatic stage) African trypanosomiasis (sleeping sickness) include the following:

  • Painful skin chancre that appears about 5-15 days after the bite, resolving spontaneously after several weeks (less commonly seen in T brucei gambiense infection)

  • Intermittent fever (refractory to antimalarials), general malaise, myalgia, arthralgias, and headache; usually 3 weeks after the bite

  • Generalized or regional lymphadenopathy - Posterior cervical lymphadenopathy (Winterbottom sign) is characteristic of T brucei gambiense African trypanosomiasis

  • Facial edema (minority of patients)

  • Transient urticarial, erythematous, or macular rashes 6-8 weeks after onset

  • Trypanids (ill-defined, centrally pale, evanescent, annular, or blotchy edematous erythematous macules on the trunk)

Symptoms of stage 2 (late or neurologic stage) African trypanosomiasis include the following:

  • Persistent headaches (refractory to analgesics)

  • Daytime somnolence followed by nighttime insomnia

  • Behavioral changes, mood swings, and, in some patients, depression

  • Loss of appetite, wasting syndrome, and weight loss

  • Seizures in children (rarely in adults)


Physical Examination

Physical findings in stage 1 (early or hemolymphatic stage) African trypanosomiasis include the following:

  • Indurated chancre at bite site

  • Skin lesions (trypanids) in light-skinned patients

  • Lymphadenopathy - Axillary and inguinal lymphadenopathy are more common in East African trypanosomiasis, and cervical lymphadenopathy is more common in the West African form; the classic Winterbottom sign (ie, enlarged, nontender, mobile posterior cervical lymph node) is clearly visible

  • Fevers, tachycardia, irregular rash, edema, and weight loss

  • Organomegaly, particularly splenomegaly (T brucei gambiense African trypanosomiasis)

Physical findings in stage 2 (late or neurologic stage) African trypanosomiasis include the following:

  • CNS manifestations - Onset is slower in West African trypanosomiasis (months to a year), and manifestations may include irritability, tremors, increased muscle rigidity and tonicity, occasional ataxia, and hemiparesis, with overt meningeal signs being rare; East African trypanosomiasis usually has a faster onset (weeks to a month) and does not exhibit a clear distinction between the 2 stages

  • Kerandel sign (delayed pain on compression of soft tissue)

  • Behavioral changes consistent with mania or psychosis, speech disorders, and seizures

  • Stupor and coma (giving rise to the name sleeping sickness)

  • Psychosis

  • Sensory disorders



Complications of African trypanosomiasis may include the following:

  • Anemia and fatigue

  • Wasting syndrome

  • Meningoencephalitis and seizures

  • Stupor or coma (sleeping sickness)

  • Death

  • Perinatal death or abortion (after congenital infection)