ArtsAutosBooksBusinessEducationEntertainmentFamilyFashionFoodGamesGenderHealthHolidaysHomeHubPagesPersonal FinancePetsPoliticsReligionSportsTechnologyTravel

African Trypanosomiasis: Clinical Presentations, Diagnosis, Treatment And Prevention

Updated on March 31, 2014

Clinical Presentation Of African Trypanosomiasis

Source

Clinical Manifestations Of Sleeping Sickness

The incubation period varies from one to three weeks. Though, the symptoms of T. gambiense and T. rhodesiense infection are broadly similar, the Rhodesian type is usually more severe and runs a more acute course with a higher mortality.

The initial lesion is the formation of a nodule at the site of the bite (trypanosomal chancre). Trypanosomes are seen in this lesion. Irregular fever and parasitemia occur within 1 to 2 weeks. Cervical femoral and axillary groups of lymph nodes enlarge. Lymph nodes are more pronounced in the posterior triangle of the neck in T. gambiense infection. Enlargement of these groups of lymph nodes is called “Winterbottom’s signs”. The spleen is often enlarged. Anemia develops in due course due to slow inanition and hemolysis. Fever, lymphadenitis, anemia and debility continue for several months. The CNS involvement is late in the Gambian type while symptoms of the CNS involvement develop within a few months in the Rhodesian type. The whole course runs over 2 to 3 years, but the course is shorter in the Rhodesian type and death may occur in 6 to 9 months.

Several unusual manifestations may develop. These include circinate erythematous skin rashes, localized edema over the face, eyelids and neck, tibial tenderness (Kerandel’s sign) neuralgic pains, formication, myocarditis, pericardial effusion and jaundice. The sleeping sickness stage sets in when the parasites enter the CNS. The debility and languor increase, the gait becomes slow, shuffling and swaying, the speech becomes slurred and tremors of the tongue and lips develop. The patient may become demented. Mask-like vacant expressions, drooping of eyelids, tendency to fall asleep during day time and restlessness at night are all seen in endemic areas. The patient becomes severely emaciated and serious complications like Pneumonia, dysentery, hyperpyrexia, convulsions and coma may supervene and prove fatal. Though untreated cases of sleeping sickness and generally fatal, the Gambian type may recover spontaneously at times.

How To Diagnose Sleeping Sickness

Source

Diagnosis & Treatment Of Sleeping Sickness

Diagnosis Of Sleeping Sickness

History of residence in an endemic area, irregular fever, enlargement of cervical lymph nodes and hepatosplenomegaly should point to this diagnosis. Trypanosomes can be demonstrated in peripheral blood, lymph gland aspirate or the CSF. When the parasites are scanty concentration methods using centrifugation are more helpful. The CSF findings give evidence of neurological involvement. Serological tests like the indirect fluorescent antibody test and the enzyme linked immune-sorbent assay (ELISA) are helpful in diagnosis.

Treatment

The early cases: Suramin, which is a derivative of urea, is effective when the infection is limited to the blood and lymph nodes. Suramin treatment is indicated in cases which do not show neurological involvement and CSF abnormalities. The course consists of 5 doses of suramin 20 mg/Kg given intravenously as a 10% solution on days 1, 3, 7, 14 and 21. Toxic effects include sudden fatal anaphylactic reactions and renal tubular damage manifesting as proteinuria. When proteinuria occurs, the drug should be temporarily stopped. Since suramin does not enter the central nervous system, it is ineffective in the late cases.

Late Cases: Neurological involvement is treated with melarsoprol (Mel B). It is a trivalent arsenical condensed with BAL. Melarsoprol glycol. It is given intravenously at a slow rate in a dose of 3.6 mg/Kg limited to a maximum of 200 mg (3.5 to 5ml) given on alternate days. In severe cases, the course may have to be repeated after 3 weeks. Melarsoprol is very effective in curing even advanced T. rhodensiense infections. Untoward side effects include local necrosis, anaphylactic reactions and encephalopathy.

A water soluble derivative of Mel B (Trimelarsan [Mel W] Melarsonyl) can be given intramuscularly or subcutaneously and it is useful to treat children.

Effect of treatment: Nearly all clinical signs and CSF abnormalities return to normal with early treatment and remain so even after two years. Even advanced cases are curable by modern therapy. The patients should be observed for two years with repeated CSF examination to detect relapse early.

Prevention: It is achieved by anti-tsetse measures such as the use of a tsetse repellant cream (Di-Meepol), avoidance of reservoir hosts and chemoprophylaxis. A single dose of suramin (25 mg?Kg) or of pentamidine (4 mg/Kg) gives protection for up to 6 months.

© 2014 Funom Theophilus Makama

working

This website uses cookies

As a user in the EEA, your approval is needed on a few things. To provide a better website experience, hubpages.com uses cookies (and other similar technologies) and may collect, process, and share personal data. Please choose which areas of our service you consent to our doing so.

For more information on managing or withdrawing consents and how we handle data, visit our Privacy Policy at: https://corp.maven.io/privacy-policy

Show Details
Necessary
HubPages Device IDThis is used to identify particular browsers or devices when the access the service, and is used for security reasons.
LoginThis is necessary to sign in to the HubPages Service.
Google RecaptchaThis is used to prevent bots and spam. (Privacy Policy)
AkismetThis is used to detect comment spam. (Privacy Policy)
HubPages Google AnalyticsThis is used to provide data on traffic to our website, all personally identifyable data is anonymized. (Privacy Policy)
HubPages Traffic PixelThis is used to collect data on traffic to articles and other pages on our site. Unless you are signed in to a HubPages account, all personally identifiable information is anonymized.
Amazon Web ServicesThis is a cloud services platform that we used to host our service. (Privacy Policy)
CloudflareThis is a cloud CDN service that we use to efficiently deliver files required for our service to operate such as javascript, cascading style sheets, images, and videos. (Privacy Policy)
Google Hosted LibrariesJavascript software libraries such as jQuery are loaded at endpoints on the googleapis.com or gstatic.com domains, for performance and efficiency reasons. (Privacy Policy)
Features
Google Custom SearchThis is feature allows you to search the site. (Privacy Policy)
Google MapsSome articles have Google Maps embedded in them. (Privacy Policy)
Google ChartsThis is used to display charts and graphs on articles and the author center. (Privacy Policy)
Google AdSense Host APIThis service allows you to sign up for or associate a Google AdSense account with HubPages, so that you can earn money from ads on your articles. No data is shared unless you engage with this feature. (Privacy Policy)
Google YouTubeSome articles have YouTube videos embedded in them. (Privacy Policy)
VimeoSome articles have Vimeo videos embedded in them. (Privacy Policy)
PaypalThis is used for a registered author who enrolls in the HubPages Earnings program and requests to be paid via PayPal. No data is shared with Paypal unless you engage with this feature. (Privacy Policy)
Facebook LoginYou can use this to streamline signing up for, or signing in to your Hubpages account. No data is shared with Facebook unless you engage with this feature. (Privacy Policy)
MavenThis supports the Maven widget and search functionality. (Privacy Policy)
Marketing
Google AdSenseThis is an ad network. (Privacy Policy)
Google DoubleClickGoogle provides ad serving technology and runs an ad network. (Privacy Policy)
Index ExchangeThis is an ad network. (Privacy Policy)
SovrnThis is an ad network. (Privacy Policy)
Facebook AdsThis is an ad network. (Privacy Policy)
Amazon Unified Ad MarketplaceThis is an ad network. (Privacy Policy)
AppNexusThis is an ad network. (Privacy Policy)
OpenxThis is an ad network. (Privacy Policy)
Rubicon ProjectThis is an ad network. (Privacy Policy)
TripleLiftThis is an ad network. (Privacy Policy)
Say MediaWe partner with Say Media to deliver ad campaigns on our sites. (Privacy Policy)
Remarketing PixelsWe may use remarketing pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to advertise the HubPages Service to people that have visited our sites.
Conversion Tracking PixelsWe may use conversion tracking pixels from advertising networks such as Google AdWords, Bing Ads, and Facebook in order to identify when an advertisement has successfully resulted in the desired action, such as signing up for the HubPages Service or publishing an article on the HubPages Service.
Statistics
Author Google AnalyticsThis is used to provide traffic data and reports to the authors of articles on the HubPages Service. (Privacy Policy)
ComscoreComScore is a media measurement and analytics company providing marketing data and analytics to enterprises, media and advertising agencies, and publishers. Non-consent will result in ComScore only processing obfuscated personal data. (Privacy Policy)
Amazon Tracking PixelSome articles display amazon products as part of the Amazon Affiliate program, this pixel provides traffic statistics for those products (Privacy Policy)
ClickscoThis is a data management platform studying reader behavior (Privacy Policy)