Sleeping sickness is an infectious parasitic disease carried by tsetse flies from the Trypanosoma brucei family of parasites and characterized by inflammation of the brain and the covering of the brain (meninges).

Alternative Names

African trypanosomiasis

Causes, incidence, and risk factors

Sleeping sickness is caused by two organisms, T. brucei rhodesiense and T. brucei gambiense . Rhodesiense produces the more severe form of the illness. After a person is bitten by an infected fly, a red painful swelling develops at the site of the fly bite, similar to that seen in Chagas disease . From this site of inoculation, the parasite invades the blood stream causing episodes of fever , headache , sweating , and generalized enlargement of the lymph nodes. Parasites then invade the central nervous system (early with rhodesiense and later with gambiense) where they produce the symptoms typical of sleeping sickness. Ultimately the parasites invade the brain, causing first behavioral changes such as fear and mood swings followed by headache, fever, and weakness . Simultaneously, the patient may develop myocarditis . Death may occur within 6 months from cardiac failure or infection if the person is infected with rhodesiense. Gambiense infection may require up to 2 years before symptoms of infection in the central nervous system appear. Gambiense-infected people develop drowsiness during the day, but insomnia at night. Sleep becomes uncontrollable as the disease progresses until the patient becomes comatose . Risk factors include living in those parts of Africa where the disease is found and being bit by tsetse flies. The incidence is extremely low in the U.S., and is only found in travelers from those areas.

Signs and tests

Physical examination may show signs of meningoencephalitis (inflammation of the brain and meninges). Tests include the following:

Treatment

Medications used to treat this disorder include:

Expectations (prognosis)

Untreated rhodesiense infection is almost universally fatal. Gambiense infection causes the classic "sleeping sickness" disease. Both diseases should be treated immediately upon diagnosis. The diseases are easier to treat during the blood-borne stage and more difficult to treat once meningoencephalitis develops.

Complications

Calling your health care provider

Call your health care provider if symptoms of this disorder develop. It is important to begin treatment as soon as possible.

Prevention

Pentamidine injections protect against gambiense, but have not yet been demonstrated as effective against rhodesiense. Insect control could help prevent the spread of sleeping sickness.