Sleeping sickness

  • Definition
    • Sleeping sickness is an infection caused by germs carried by certain flies. It results in swelling of the brain.

  • Alternative Names
    • Human African trypanosomiasis

  • Causes
    • Sleeping sickness is caused byTrypanosoma brucei rhodesiense and Trypanosomoa brucei gambiense. T. b. rhodesiense causes the more severe form of the illness.

      Tsetse flies carry the infection. When an infected fly bites you, the infection spreads through your blood.

      Risk factors include living in parts of Africa where the disease is found and being bitten by tsetse flies. The disease does not occur in the United States, but travelers who have visited or lived in Africa can be infected.

  • Symptoms
  • Exams and Tests
    • A physical exam may show inflammation of the brain and its covering.

      Tests include the following:

      Most antibody and antigen tests are not helpful because they cannot tell the difference between current and past infections. Specific levels of antibodies called IgM in the cerebrospinal fluid may be more helpful.

  • Treatment
    • Medicines used to treat this disorder include:

      • Eflornithine (for T. b. gambiense only)
      • Melarsoprol
      • Pentamidine (for T. b. gambiense only)
      • Suramin (Antrypol)

      Some people may receive a combination of these medicines.

  • Outlook (Prognosis)
    • Without treatment, death can occur within 6 months from cardiac failure or from T. b. rhodesiense infection itself.

      T. b. gambiense infection causes sleeping sickness disease and gets worse quickly, often over a few weeks. The disease needs to be treated immediately.

  • Possible Complications
    • Complications include:

      • Injury related to falling asleep while driving or during other activities
      • Gradual damage to the nervous system
      • Uncontrollable sleep as the disease gets worse
      • Coma
  • When to Contact a Medical Professional
    • See your health care provider right away if you have symptoms. It is important to begin treatment as soon as possible.

  • Prevention
    • Pentamidine injections protect against T. b. gambiense, but not against T. b. rhodesiense. Because this medicine is toxic, using it for prevention is not recommended.

      Insect control measures can help prevent the spread of sleeping sickness in high-risk areas.

  • References
    • Kirchoff LV. Agents of African trypanosomiasis (sleeping sickness). In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2014:chap 279.

      Petri Jr WA. African sleeping sickness. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 354.