Sleeping sickness is the common term for the disease Human African Trypanosomiasis (HAT), which is a disease that is transmitted through the bite of Tsetse fly that is infected with certain species of Trypanosoma brucei. This form of the disease is normally found in the provincial areas of Sub-Saharan Africa. However, there are only a few of the Tsetse flies that are infected even in areas where the disease is prevalent. Tsetse flies are described as diurnal because they are actively biting in the daytime. They commonly have colors of brown and grey and are of the same size as honey bees. A single bite from an infected Tsetse fly is painful and once it starts sipping on the primary host’s blood infects the host with parasites that cause African Trypanosomiasis. Not only humans can be infected with the parasites, but also cattle and some animals found in the wild.
The common way for the parasites to be transmitted is through the bite of an infected Tsetse fly. However, there are also other ways to transmit these parasites. The parasites can be transmitted by organ transplant or blood transfusion from a donor who’s initially infected with the disease. It can also be transmitted through pregnancy. When a pregnant woman is bitten by an infected Tsetse fly, the parasites can go to the baby either through the womb or after delivery.
Causes of Sleeping Sickness
As mentioned previously, the disease is transmitted through infected Tsetse flies and the real culprit behind the infection are certain species of Trypanosoma brucei. There are two species that cause the disease, and these are Trypanosoma brucei rhodesiense, which causes the East African Sleeping Sickness, and Trypanosoma brucei gambiense, which causes the West African Sleeping Sickness. East African Sleeping Sickness is an acute disease, which means that the disease is short-term and is more dangerous because its development is rapid. West African Sleeping Sickness is a chronic or long-term disease.
Signs and Symptoms of Sleeping Sickness
The two types of sleeping sickness, West and East African, may have some similarities when it comes to their signs and symptoms but varies a lot on when the symptoms appear. The main difference is that the severity of symptoms of the East African Sleeping Sickness occurs more rapidly compared to the West African Sleeping Sickness.
East African Sleeping Sickness
The symptoms of this acute disease may occur as early as three days to four weeks after the initial entry of the T. b. rhodesiense in the skin. Since the most common transmission of the parasite is through the bite of an infected Tsetse fly, the initial symptom that would occur is a chancre, or a small ulcer, located on the fly bite. You may also experience aching of your muscles and joints, headache, irregular fever, feeling irritable, extreme tiredness, lymph nodes that are swollen and rashes.
Other symptoms that you may experience are struggling when talking and walking, seizure, shift in personality and developing confusion. These symptoms may occur when the parasites’ infection has already reached your central nervous system. Rare circumstances of complications in the kidney & heart and spleen enlargement may occur. The worst symptom that may occur when left untreated is death in a few months.
West African Sleeping Sickness
The symptoms of this chronic illness occur a few months to years after initial entry of the T. b. gambiense in the skin. Similar to East African Sleeping Sickness, chancre may also occur on the area bitten by the infected fly, but this may occur in a couple of weeks. Most common symptoms are somehow similar to the East African Sleeping Sickness. The differences are that an infected person will possibly lose weight and that the area around the eyes and hands will swell. You may also experience insomnia, difficulty in sleeping at night time, and hypersomnia, excessive sleepiness during day time.
Similarly, you may also have neuro problems like the shift in personality, developing confusion, sleep disruption, and weak coordination. If left untreated, the illness becomes deadly in a few years.
Diagnosing Sleeping Sickness
Diagnosing the Sleeping Sickness are mainly performed through the use of laboratory tests. This is a necessary step in diagnosing the illness because sleeping sickness doesn’t show that much signs and symptoms that would help specifically pinpoint the cause of the illness. One method used in diagnosing is by getting a sample of an infected person’s tissue or body fluid and examine it under a microscope. When comparing the two species, the West African Sleeping Sickness has a lower parasite load compared to the East African Sleeping Sickness.
The easiest way to diagnose the East African Sleeping Sickness is by getting a blood sample of the patient and examining it under a microscope. They can also be detected through a tissue sample of the chancre or a sample of lymph node fluid. However, it sometimes difficult to detect T. b. gambiense through the blood sample.
Whenever a diagnosis is established, the patient is also asked to have her cerebrospinal fluid checked to see if there are traces of Trypanosomes in the fluid. The result for this examination tells if the central nervous system is already infected by the parasites. The treatment recommended by the doctor may vary on the stage of the illness.
How to Prevent Sleeping Sickness
Protecting ourselves from Sleeping Sickness lies solely on physical prevention methods because there is not a single vaccination or medicine that can protect us from this form of illness. Here are some of the precautions you may take to protect yourself from infection:
- Cover your body by wearing shirts that have long sleeves and make sure to tuck it in always.
- Avoid wearing shorts and sandals as it just increases the risk of Tsetse fly bites.
- Make sure to wear closed shoes and a hat.
- Make sure to wear heavy fabrics because Tsetse flies can bite through thin clothing.
- Wear earth tone or light-colored apparel. The flies are attracted to dark colors, especially blue.
- You may apply insect repellent, but this doesn’t guarantee protection from Tsetse fly bites.
- Avoid going to locations that are heavily infested with Tsetse flies. If situated in countries that are found in the sub-Saharan, avoid areas like river banks and lakes because cases of sleeping sickness initially occur around these areas.
- Before entering a vehicle, make sure to check areas if there are Tsetse flies present. This is one thing to consider because cars normally accumulate dust and the flies are also attracted to dust and they are also attracted to anything large and is moving.
- Refrain from doing organ transplants or blood transfusions. If it’s an emergency situation, you must be sure that the organ or blood doesn’t have traces of Trypanosomes. If it’s positive or unconfirmed, it is best to not have the transplant or transfusion.
Treating Sleeping Sickness
Sleeping sickness is a disease that is hard to cure due to its complicated administering methods. Four drugs, that are recognized and registered as official treatments for human sleeping sickness: Eflornithine, Melarsoprol, Pentamidine, and Suramin. Other than the 4 registered drugs, there is another drug called Nifurtimox that can be used in special circumstances and only when permitted.
Eflornithine is a drug used to effectively treat Sleeping Sickness caused by T. b. gambiense. The brand name of the drug that is commonly used is Vaniqa. This drug is also considered as an alternative medication for Melarsoprol in treating stage 2 of Sleeping Sickness. It may have some side effects but is known to be limited. Some of the side effects that you may experience when treated with this drug are occasional temporary hearing loss, seizure, vomiting, and diarrhea. This drug is administered to a patient through injecting it.
Melarsoprol is primarily used to treat the second stage of Sleeping Sickness, specifically on a case when T. b. rhodesiense, the parasite that caused the illness, already infected the central nervous system. The drug is considered to be highly toxic and brings about side effects like headache, fever, vomiting, necrosis at the site of injection, jaundice, diarrhea, hepatic toxicity, etc. This can only be administered through injection and is the only drug available to treat late-stage Sleeping Sickness. The brand name of the drug normally used is Arsobal.
Pentamidine is an anti-microbial drug administered to treat early stages of Sleeping Sickness or before the CNS involvement. It is also administered through injection either on the veins or the muscle. It is considered as the alternative drug for Suramin.
Suramin is the primary drug used to treat Sleeping Sickness, before CNS involvement. This drug is administered through injection in the vein. You may experience common side effects like headache, nausea, weakness, vomiting, etc.