Trypanosomiasis

What is trypanosomiasis?

Trypanosomiasis is a serious type of parasitic infection that affects different parts of your body as it spreads, including your:

1. Skin.
2. Blood.
3. Lymph nodes.
4. Brain and the fluid surrounding your brain and spinal cord (cerebrospinal fluid).

It spreads through the bites of tsetse flies that live in equatorial Africa. Tsetse flies are large, yellowish-brown or dark brown flies that feed on blood. They may range from 0.2 to 0.6 inches (6 to 16 millimeters) in length. Equatorial Africa is an area of Africa below the Sahara Desert through which the equator passes. Symptoms may develop a few weeks or months after infection.

Trypanosomiasis is curable. But without proper treatment, trypanosomiasis usually causes death.

Other names for trypanosomiasis include:

• African sleeping sickness.
• African trypanosomiasis.
• Human African trypanosomiasis (HAT).

Why is trypanosomiasis called African sleeping sickness?

People commonly refer to trypanosomiasis as African sleeping sickness because tsetse flies in equatorial Africa transmit the parasites that cause the condition, and its symptoms can affect your sleep.

How common is trypanosomiasis?

Trypanosomiasis was at one time very common. The World Health Organization (WHO) reported about 30,000 cases in the late 1990s and early 2000s. But control efforts over the last 20 years have drastically reduced the number of cases. As of 2020, there were fewer than 700 reported cases of trypanosomiasis.

What are the symptoms of trypanosomiasis?

Trypanosomiasis symptoms include:

1. A swollen, discolored (red, purple or brown) bump that may be painful.
2. A fever that comes and goes (recurrent fever).
3. Chills.
4. Headache.
5. Muscle pain.
6. Joint pain.
7. Skin rash.
8. Low red blood cell levels (anemia).
9. Swelling in your face and/or lymph nodes.
10. Trouble staying awake (drowsiness).
11. Confusion or inability to concentrate.
12. Difficulty walking or talking.

Without treatment, trypanosomiasis can lead to seizures, coma and even death.

What is trypanosomiasis caused by?

Two types of single-celled microscopic parasites (protozoa) cause trypanosomiasis:

• Trypanosoma brucei gambiense. This causes over 90% of all trypanosomiasis cases.
• Trypanosoma brucei rhodesiense. This causes less than 10% of all trypanosomiasis cases.

How do humans get infected with trypanosomiasis?

Humans get trypanosomiasis from the bites of infected tsetse flies. Tsetse flies acquire parasites from infected animals (cattle, sheep, goats, pigs, horses, camels) or other infected people.

Is trypanosomiasis contagious?

Most cases of trypanosomiasis occur from the bite of an infected tsetse fly. But if you’re pregnant, you may be able to pass trypanosomiasis to your fetus.

There’s a very small chance that you could get trypanosomiasis from a blood transfusion. But it’s very rare. Healthcare providers take many precautions to ensure that blood transfusions are safe.

Who does trypanosomiasis affect?

Tsetse flies are diurnal (active during the daytime). They live in wooded areas or the savanna (a biome that combines characteristics of a forest and desert) in equatorial Africa. You’re more likely to get trypanosomiasis if you spend time in these areas.

How is trypanosomiasis diagnosed?

A healthcare provider can diagnose trypanosomiasis after reviewing your medical history, asking about your symptoms and recent travel, and conducting a physical examination.

The provider may order tests to help confirm a trypanosomiasis diagnosis.

What tests will be done to diagnose trypanosomiasis?

The following tests can help diagnose trypanosomiasis:

• Blood tests. During a blood test, your healthcare provider will use a thin needle to withdraw a small amount of blood from a vein in your arm. They’ll then use a microscope to look for parasites in your sample.
• Lymph node fluid test. A provider will use a needle to remove fluid from a lymph node and look for parasites.
• Spinal tap. A provider will insert a needle between two spinal bones (vertebrae) in the lower part of your back (lumbar) to withdraw spinal fluid and look for parasites and other signs of infection, including a high white blood cell count.

Does trypanosomiasis have a cure?

Yes, with early diagnosis and proper treatment, trypanosomiasis is curable. Treatment depends on what type of protozoa caused the infection and whether the infection has spread to other areas of your body.

If trypanosomiasis hasn’t spread to your brain or cerebrospinal fluid, a healthcare provider may prescribe:

• Suramin if you have Trypanosoma brucei rhodesiense.
• Fexinidazole or pentamidine if you have Trypanosoma brucei gambiense.

If trypanosomiasis affects your brain or cerebrospinal fluid, a provider may prescribe:

1. Melarsoprol if you have Trypanosoma brucei rhodesiense.
2. Fexinidazole, eflornithine, nifurtimox or melarsoprol if you have Trypanosoma brucei gambiense.

In some cases, they may also prescribe corticosteroids to help reduce swelling and joint and muscle pain.

You may take these medicines orally (as a pill with water) or intravenously (through a needle in a vein). It’s very important that you take your full course of antibiotics, even if you start to feel better. If you don’t, trypanosomiasis can come back and be more difficult to treat.

What are the complications of trypanosomiasis treatment?

There aren’t any tests that can confirm that you no longer have a trypanosomiasis infection. Healthcare providers will continue to monitor you for signs of trypanosomiasis for up to two years after treatment. They may need to order more blood and fluid tests to check for parasites if you develop symptoms again.

How soon after treatment will I feel better?

Your best resource is your healthcare provider. They can estimate when you should start to feel better after treatment according to the severity of your infection.

Can trypanosomiasis be prevented?

You can help protect yourself from tsetse fly bites by:

• Not traveling to infected areas.
• Wearing thick clothes, including long pants and sleeves. Tsetse flies can bite through thin clothes.
• Wearing neutral-colored clothes. Dark colors and bright colors attract tsetse flies. Look for clothes that are white, gray, cream, brown or beige.
• Avoiding bushes and shrubs during the day. Tsetse flies are active during the day. But they sometimes seek shade in bushes and shrubs during the hottest parts of the day.
• Putting screens over windows and doors.
• Staying indoors when tsetse flies are most active.
• Treating clothing, tents and net coverings with sprays or chemicals that repel tsetse flies.
• Sleeping in a fine-mesh tent or using protective netting when you sleep. Make sure to completely zip your tent shut.
• Look inside cars or trucks for tsetse flies before entering. They’re attracted to motion and the dust that kicks up from moving vehicles.

Is there a trypanosomiasis vaccine?

No, there isn’t a vaccine or other type of medicine that prevents trypanosomiasis.

What can I expect if I have trypanosomiasis?

With early diagnosis and proper treatment, the outlook for trypanosomiasis is good. Most people recover if they receive treatment within two to three weeks after infection.

Without proper treatment, many people die from trypanosomiasis. Treatment is still possible once the parasite affects your brain and cerebrospinal fluid. But the survival rate is low.

What is the survival rate of sleeping sickness?

With proper treatment, more than 95% of people with trypanosomiasis survive.

What is the outlook for trypanosomiasis?

Efforts to reduce cases of trypanosomiasis over the last 20 years have been excellent. The WHO set a goal to eliminate trypanosomiasis as a public health problem by 2030. It hopes to achieve this goal through:

• Increased funding for research.
• Better testing methods.
• Prompt treatment.
• Limiting tsetse fly contact with humans.

How do I take care of myself if I have trypanosomiasis?

It’s important to see a healthcare provider if you start to feel sick after traveling to areas where trypanosomiasis is common. Let the provider know if you were at risk of a tsetse fly bite, even if you don’t remember a bite. Follow their treatment plan to help ensure a full recovery.

You may also be able to help speed up your recovery by getting plenty of rest and drinking lots of fluids.

When should I see a healthcare provider?

Reach out to a healthcare provider if you spend time in areas where you’re at risk of a tsetse fly bite and notice symptoms of trypanosomiasis.

You should schedule regular follow-up appointments with your healthcare provider — usually every six months for at least two years. If you have any signs of reinfection, your provider will take blood and cerebrospinal fluid samples.

When should I go to the ER?

Go to the nearest emergency room or call 911 or your local emergency number if you have symptoms of a severe illness, including:

• A fever over 103 degrees Fahrenheit (40 degrees Celsius).
• Confusion or disorientation.
• Seizures.

What questions should I ask a healthcare provider?

1. How exactly did I get trypanosomiasis?
2. If I don’t have trypanosomiasis, what other condition might I have?
3. How serious is my condition?
4. What tests will you conduct to diagnose trypanosomiasis?
5. What treatment do you recommend?
6. Are there any side effects to your recommended treatment?
7. When will I start to feel better?
8. What else can I do to help my recovery?
9. Should I be aware of any new or worsening symptoms?
10. When should I schedule follow-up appointments?

Can I get trypanosomiasis more than once?

Yes, you can get trypanosomiasis more than once. Successfully treating trypanosomiasis won’t make you immune from getting it again.

What is the difference between African trypanosomiasis and American trypanosomiasis?

American trypanosomiasis is another name for Chagas disease. It’s another type of parasitic infection. The infection results from the parasite Trypanosoma cruzi. Trypanosoma cruzi most commonly spreads from the bite of an infected kissing bug (triatomine).