Sleeping sickness

Sleeping sickness is an infection caused by tiny parasites carried by certain flies. It results in swelling of the brain.

Causes

Sleeping sickness is caused by two types of parasites Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense. T b rhodesiense causes the more severe form of the illness.

Tsetse flies carry the infection. When an infected fly bites you, the infection spreads through your bloodstream.

Risk factors include living in parts of Africa where the disease is found and being bitten by tsetse flies. The disease does not occur in the United States, but travelers who have visited or lived in Africa can get infected.

Symptoms

General symptoms include:

• Mood changes, anxiety
• Fever, sweating
• Headache
• Weakness

  Weakness

  Weakness is reduced strength in one or more muscles.

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• Insomnia at night
• Sleepiness during the day (may be uncontrollable)
• Swollen lymph nodes all over the body

  Swollen lymph nodes

  Lymph nodes are present throughout your body. They are an important part of your immune system. Lymph nodes help your body recognize and fight germ...

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• Swollen, red, painful nodule at site of the fly bite

  Nodule

  Skin nodules are solid or cystic raised bumps in the skin that are wider than 1 centimeter (cm), but less than 2 cm.

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Exams and Tests

Diagnosis is often based on a physical examination and detailed information about the symptoms. If the health care provider suspects sleeping sickness, you'll be asked about recent travel. Blood tests will be ordered to confirm the diagnosis.

Tests include the following:

• Blood smear to check for parasites
• Cerebrospinal fluid tests (fluid from your spinal cord)

  Cerebrospinal fluid tests

  A cerebrospinal fluid (CSF) culture is a laboratory test to look for bacteria, fungi, and viruses in the fluid that moves in the space around the spi...

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• Complete blood count (CBC)

  Complete blood count

  A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...

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• Lymph node aspiration

  Aspiration

  Aspiration means to draw in or out using a sucking motion. It has two meanings:Breathing in a foreign object (for example, sucking food into the air...

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Treatment

Medicines used to treat this disorder include:

• Eflornithine (for T b gambiense only)
• Melarsoprol
• Pentamidine (for T b gambiense only)
• Suramin (Antrypol)

Some people may receive a combination of these medicines.

Outlook (Prognosis)

Without treatment, death can occur within 6 months from cardiac failure or from T b rhodesiense infection itself.

T b gambiense infection causes sleeping sickness disease and gets worse quickly, often over a few weeks. The disease needs to be treated immediately.

Possible Complications

Complications include:

• Injury related to falling asleep while driving or during other activities
• Gradual damage to the nervous system
• Uncontrollable sleep as the disease gets worse
• Coma

When to Contact a Medical Professional

See your provider right away if you have symptoms, especially if you've traveled to places where the disease is common. It is important to begin treatment as soon as possible.

Prevention

Pentamidine injections protect against T b gambiense, but not against T b rhodesiense. Because this medicine is toxic, using it for prevention is not recommended.

Insect control measures can help prevent the spread of sleeping sickness in high-risk areas.