African trypanosomes

Trypanosoma brucei gambiense and

Trypanosoma brucei rhodesiense cause
African trypansomiasis in humans.
The disease is also known as sleeping
sickness

Distribution
African trypanosomiasis occurs in the
tsetse fly areas of sub-Saharan Africa
between 15N and 20S.
Tsetse flies are found only in Africa.
It is estimated that 50 million people in 34
countries are at risk of becoming infected.

 Only 5 10 millions have access to some

form of protection or treatment.

 T. b. gambiense found in West Africa,

Central Africa, extending from Senegal
across to Sudan down to Angola.
T. b. rhodesiense found in East Africa,
Central and Southern Africa extending
from Ethiopia down to Botswana
Both species overlaps in the Great Lakes
of East Africa

Transmission
African trypanosomes are transmitted by
tsetse fly of a genus Glossina.
Both male and female can transmit the
parasite.
African trypanosomes can be transmitted
by blood transfusion (fresh blood).

Life cycle
Metacyclic trypomastigote are inoculated
through the skin.
The parasite develop into long slender
trypomastigote which multiply at the site of
inoculation and later in the blood,
lymphatic system and tissue fluids.

 The trypomastigotes are carried to the

heart, and various organs of the body and
in the later stages they invade the CNS.
The trypomastigotes are ingested by a
tsetse fly when it sucks blood. In the
midgut of the fly, the parasite develop and
multiply.

 After 2 3 weeks, the trypomastigotes

migrate to the salivary glands where they
multiply further and become epimastigotes
then develop into metacyclic
trypomastigotes.

 Once infected the tsetse fly remains a

vector for the rest of its life, which is about
3 months.

Clinical features and pathology

African trypanosomiasis is usually fatal
unless treated.
In rhodesiense trypanosomiasis and less
commonly in gambiense infections ,a
painful swelling called chancre develops
and can be seen at the site of inoculation
of the trypomastigotes.

 The chancre contains multiplying

trypomastigotes and it disappears after
about 10 days.

Early stages of African

trypanosomiasis
In early stages of the disease there is a
high irregular fever with shivering,
sweating and an increased pulse rate.
There is a persistent headache, and
usually pain in the neck, shoulders and
calves, and occasionally a delayed intense
pain to knocks and pressure known as
Kerandels sign.

 The lymph glands near the bite often

become swollen.
In gambiense infections the glands at the
back of the neck are involved
(Winterbottoms sign), while in
rhodesiense infections it is usually the
glands under the jaw, in the arm-pits, at
the base of the elbow are involved.

 As the disease progresses the spleen

becomes enlarged, and there is oedema
of the eyelids and face, sleeplessness,
aimless scratching of the skin, and often a
transient rash.

 In men impotence may occur and in

women, abortion amenorrhoea.
Other features include rapid fall in
haemoglobin, reduction in platelets
number, and significant rapid rise in the
ESR.

Late stages of African

trypanosomiasis
In the late stages of the disease, the
parasite invade the CNS, giving symptoms
of meningoencephalitis including
trembling, inability to speak properly,
progressive mental dullness, apathy,
excessive sleeping and incontinence

 There is usually rapid weight loss,

continuing irregular fever, oedema of the
limbs and inability to walk without help.
If untreated, coma develops and finally
death.