Faculty of science

) Microbiology & Biochemistry (

Protista

BMD-429

Research in Protista about:

African sleeping sickness

(2023/2024)

Under the supervision of:

Prof. Dr. Mohamed Sayed

By: Enjy Mohamed Fathy

 African sleeping sickness

Human African sleeping sickness is an infection caused by the protozoan

species Trypanosoma brucei gambiae or Trypanosoma brucei rhodesiense.
It is transmitted by the bite of a tsetse fly.

Sleeping sickness occurs only in tropical Africa.

A sore, painful bump, or ulcer may form at the site of the fly bite, followed
by fever, chills, headache, and swollen lymph nodes, sometimes with a
rash. Eventually drowsiness and walking problems occur; If the disease is
not treated, coma occurs, and death occurs.

Doctors usually confirm the diagnosis by identifying protozoa (single-

celled organisms that cause infections) in a sample of blood or fluid taken
from a lymph node or cerebrospinal fluid.

All infected people should be treated with one of several drugs effective
against trypanosomes.

Sleeping sickness occurs only in parts of tropical Africa, where tsetse flies
live. There are two forms of sleeping sickness; each form is caused by a
different type of Trypanosoma.

One form (caused by Trypanosoma brucei rhodesiense) occurs in West and

Central Africa. The other form (caused by Trypanosoma brucei
rhodesiense) occurs in West and Central Africa. Caused by Trypanosoma
brucei rhodesiense, it occurs in East Africa. Both occur in Uganda.
The World Health Organization is trying to eradicate African
trypanosomiasis, and as a result of control efforts, there has been a
significant decline in infections over the past 20 years (incidence rate
decreased by more than 95%, approximately 800 cases recorded in 2021).
On average, one case is diagnosed. annually in the United States, and
almost always among travelers or immigrants from endemic areas (areas of
the world where the disease is widespread).

Another species, Trypanosoma cruzi , is endemic to South and Central

America and causes Chagas disease (trypanosomiasis).

moving in

Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense are

usually transmitted to patients when an infected tsetse fly bites them and
injects the protozoa into the skin. These protozoa move to the lymphatic
system and bloodstream, where they multiply Organs and tissues
throughout the body , and eventually reaches the brain. The infection
spreads when a fly bites an infected person or animal, and then bites
another person.

An infected mother can also transmit the protozoa to her baby during
pregnancy or childbirth. Rarely, people become infected through blood
transfusions. In theory, the infection can be transmitted through organ
transplantation from an infected donor.
Symptoms of African sleeping sickness

In African sleeping sickness, infection affects different parts of the body in

the following order:

• Skin
• Blood and lymph nodes
• Brain and cerebrospinal fluid (fluid that surrounds the brain and spinal
cord)
How quickly the infection gets worse and the symptoms it causes depend
on the causative type.

Skin

A bump or bump may appear at the site of a tsetse fly bite within a few
days to two weeks; it then turns dark red and may become a painful,
swollen sore.

Blood and lymph nodes

The infection spreads to the blood and lymph over a period of weeks or
months; patients then develop fever that comes and goes (alternating),
chills, headache, and muscle and joint pain. The face may swell
temporarily. In some people, a skin rash develops, and swollen lymph
nodes appear. Along the back of the neck. Anemia may also occur.

Brain and cerebrospinal fluid (cerebrospinal fluid)

When the brain and cerebrospinal fluid are affected, headaches become
persistent. People become drowsy, lose concentration, and have problems
with balance and walking. The drowsiness then worsens, and people may
fall asleep in the middle of activities.

If the disease is left untreated, damage to brain cells worsens, leading to

coma and death. Death occurs within months or within 2 or 3 years of the
appearance of symptoms, depending on the type causing it. Death results
from nutritional deficiency or other infections. sometimes.

Diagnosis of African sleeping sickness

• Examination of a sample of blood or fluid taken from a lymph node

• Spinal tap and cerebrospinal fluid analysis

Doctors diagnose African sleeping sickness by examining a sample of

blood or fluid taken from a lymph node and detecting the protozoa in them.
Doctors sometimes detect the protozoa by examining a sample of bone
marrow or fluid oozing from a sore.

Doctors usually do what's called a spinal tap, or lumbar puncture , using a

needle inserted along the lower part of the spine to get a sample of
cerebrospinal fluid and then determine whether the infection has spread to
the brain. Doctors look for protozoa and other signs of infection in the fluid
sample. These signs include increased cerebrospinal fluid pressure and the
number of white blood cells in the fluid.

Treatment of African sleeping sickness

Drugs effective against these protozoa.

Treatment of African sleeping sickness in Africa is directed by the type and
stage of the disease.
Sleeping sickness should be treated as soon as possible with medications
that are effective against this infection. However, this medication can cause
serious side effects.

The medication used depends on the type causing the infection (Gambiae or
Rhodesian) and whether the infection has spread to the brain and
cerebrospinal fluid.

If the infection has not spread to the brain and cerebrospinal fluid, effective
medications include:

• For Rhodesian, suramin

• For gambiae, fexinidazole, or pentamidine
• Fexinidazole is an oral medication that is an effective option in the
treatment of non-severe T. gambiae infection, with or without brain and
cerebrospinal fluid involvement.

If the infection spreads to the brain and cerebrospinal fluid, effective

medications include:

• To treat non-severe gambiae gambiae, fexinidazole

• For severe cases of gambiae, eflornithine alone or in combination with
nifurtimox, or melarsoprol (if eflornithine is not available)
• For Rhodesian, melarsoprol

There is no test available to confirm that a person has been cured.

Therefore, doctors monitor people for 24 months after treatment, and if
symptoms recur, they take a sample of cerebrospinal fluid to check for
parasites.
▪ https://www.who.int/news-room/fact-sheets/detail/trypanosomiasis-
human-african-(sleeping-sickness)

▪ https://wwwnc.cdc.gov/travel/diseases/african-sleeping-sickness-
african-trypansosomiasis