Sleeping sickness or trypanosomiasis, which occurs predominantly in Africa, is a tropical disease that is usually transmitted through the bite of an infected tsetse fly. Left untreated, sleeping sickness leads to death as a result of destruction of the central nervous system.
What is sleeping sickness?
Sleeping sickness (trypanosomiasis) is a parasitic disease of humans and animals caused by protozoa of the genus Trypanosoma brucei. The disease is transmitted by the tsetse fly. See bittranslators for About Menorrhagia (or Long and Heavy Menstrual Bleeding).
The endemic sleeping sickness occurs mainly south of the Sahara in more than 35 countries. It is estimated that at least 100,000-300,000 people are infected annually. In 2008 alone, 48,000 people died from sleeping sickness. The term “sleeping sickness” is derived from the symptoms of the neurological phase:
Confusion, reduced coordination and disruption of the sleep cycle, bouts of fatigue with manic episodes, interrupted sleep for days, and nocturnal insomnia. Left untreated, sleeping sickness progresses from progressive mental deterioration to coma and death.
Causes
Sleeping sickness is caused by the parasite Trypanosoma brucei, transmitted by a bite from the tsetse fly (Glossina genus). For further treatment, infection by Trypanosoma brucei gambiense, Trypanosoma brucei brucei and Trypanosoma brucei rhodesiense must be distinguished.
The large, brown tsetse fly transfers metacyclic trypomastigote cells into the skin tissue of the host with a risk of 1:1,000 during blood feeding. In the space between the cells, the cells transform into unicellular parasites, which penetrate ever deeper into the host via the lymphatic system and the bloodstream while constantly multiplying.
Furthermore, sleeping sickness can be transmitted through mother-to-child infection if the placenta is affected. Contaminated medical devices or blood transfusions as well as sexual contact can also be sources of infection of sleeping sickness.
Symptoms, Ailments & Signs
Sleeping sickness is transmitted by the bite of the tsetse fly. It can take a few days or weeks before the puncture site turns red and starts to hurt. The technical term for this is trypanosome chancre. Increasingly, the punctures are found in the area of the neck or face. After the puncture, the germs spread throughout the body.
The lymph nodes swell and fever occurs. The person concerned feels weak and experiences headaches and body aches. In addition to chills, kidney problems can also occur if the organ is affected. In the further course, the central nervous system is affected.
The disease owes its name to the disturbances in the sleep-wake cycle that now occur. The patient suffers convulsions and paralysis. The symptoms also spread to general behavior. Those affected are moody and irritable. In the final stages of the disease, the patient falls into a coma. If left untreated, sleeping sickness is fatal.
A distinction is made between West African and East African sleeping sickness. The West African form is slower and it can take weeks for symptoms to appear. It can take years for personality changes to become noticeable. East African sleeping sickness progresses faster and more aggressively. The symptoms described appear after just a few days, and death from organ failure occurs after a few months.
Diagnosis & History
After infection, it can often be several months before the first symptoms of sleeping sickness appear. The proliferation of the trypanosomes (hemolymphatic phase) initially brings with it fever attacks, headaches, joint pain and itching can also occur. In the second stage of sleeping sickness (neurological phase), the parasites overcome the blood-brain barrier and invade the central nervous system.
At this point, the symptoms of sleeping sickness are obvious: behavioral changes, confusion, impaired cognition, and poor coordination. The most important feature of the second stage of sleeping sickness is the disruption of the sleep cycle.
After possible infection (visible reddening of the skin), screening can include microscopic examination of lymph node fluid, blood, or bone marrow, and a review of clinical signs (swollen lymph nodes along the neck). If sleeping sickness is present, a diagnosis of the disease status can be made by cerebrospinal fluid puncture.
The earlier the disease is detected, the better the chance of a cure. Diagnosis before the onset of the neurological phase can avoid complicated and risky treatment of sleeping sickness.
Complications
Sleeping sickness is transmitted by a bite from the tsetse fly, and the bite itself is very painful. Of course, sleeping sickness is also associated with various complications, which should usually always be treated by a doctor. In many cases, severe swelling occurs immediately after the sting.
Permanent cooling of the affected area can counteract this complication very well. Sleeping sickness progresses in stages. This means that even a short-term improvement can occur. Nevertheless, various complications can occur afterwards, which urgently require medical treatment. An elevated temperature often occurs in connection with sleeping sickness, which can cause a general feeling of discomfort. Swelling of the lymph nodes, body aches and headaches can also occur.
If no appropriate doctor is consulted for these symptoms, then further complications can definitely be expected. The increased temperature can develop into a very strong fever. Bacteria and viruses spread throughout the body, which can lead to a serious infection. In general, if you want to avoid possible complications from sleeping sickness, you should seek medical and drug treatment at an early stage.
When should you go to the doctor?
Occasional daytime sleepiness is not a cause for concern and can be normal. If a strong urge to sleep occurs, which may be associated with a loss of muscle control (cataplexy), an abnormal sleep/wake cycle and sleep paralysis, sleeping sickness (narcolepsy) should be considered. If you have these symptoms, it makes sense to see a doctor. People affected by narcolepsy may also fall asleep while walking, which is dangerous when driving.
It is difficult for physicians to clearly diagnose narcolepsy because the symptoms cannot be clearly distinguished from depression or epilepsy, or can be misconstrued as laziness. Sometimes it can take years to get the right diagnosis. In any case, those affected should always go to the doctor if they observe several of the symptoms themselves and are severely restricted in everyday life as a result. This is particularly the case when, in addition to drowsiness, cataplexy and brief states of paralysis occur. The faster the diagnosis can be made, the better it is for the patient.
Treatment & Therapy
The exclusively medicinal type of inpatient treatment depends on the stage of the sleeping sickness. The drugs of the first stage of treatment have lower toxicity and are easier to handle. Despite not inconsiderable side effects, the intravenously or intramuscularly used pentamidine (Tb gambiense) is generally well tolerated.
The intravenously used active substance suramin (Tb rhodesiense) can cause side effects on the urinary tract or allergic reactions. The current standard therapy for the second stage (neurological phase) of sleeping sickness is the daily intravenous administration of 2.2 mg/kg body weight melarsoprol for 12 consecutive days, but this can cause significant side effects – in the worst case fatal encephalopathy.
The newer drug eflornithine (Tb gambiense) – previously only used as an alternative treatment for sleeping sickness due to the labor-intensive administration and cost intensity – is more tolerable and very successful. The combination treatment of nifurtimox and eflornithine introduced in 2009 for the treatment of sleeping sickness further simplifies the use of eflornithine in monotherapy.
Prevention
There is currently no vaccine or preventive medication to prevent sleeping sickness infection. Although the preventive administration of pentamidine has proven itself, this is medically controversial. Travelers are therefore recommended to avoid insect bites by wearing light-colored clothing that fully covers the body and the use of insect nets.
Aftercare
The self-care of the sufferer of narcolepsy is particularly related to cataplexy. Despite taking medication, acute muscle failure can occur in connection with a strong need for sleep. Since these cannot be foreseen, one’s own actions should, if possible, be adapted in such a way that no injuries or as few injuries as possible occur in the event of a fall.
The “correct” way of falling to avoid pain can be learned professionally from a physiotherapist, for example. Furthermore, if possible, one person should always accompany the person concerned in public in order to be able to intervene in dangerous situations if necessary. However, if this cannot be implemented permanently, strangers should also be informed in potentially dangerous places, such as long (escalator) stairs, so that they can act correctly in an emergency and prevent accidents.
Despite the bouts of sleep during the day, it is important to maintain a regular night’s sleep in order to maintain the natural sleep rhythm and not provoke avoidable narcoleptic attacks the next day by missing sleep overnight. If narcolepsy occurs in public without accompanying persons, the name and a short description of the disease in the form of a small piece of paper in the jacket or trouser pocket can quickly provide the helpers or paramedics with information and prevent unnecessary treatment.
You can do that yourself
There is nothing that can be done to prevent sleeping sickness, or narcolepsy, nor can it be cured according to the current state of science. Nevertheless, in addition to medical care, patients have a number of options that they can use to ensure that they can cope better in their professional and everyday lives.
First of all, those affected should realize that they are not alone. For this purpose it can be useful to join a self-help group. Since narcolepsy patients often tend to withdraw socially, mutual exchange in a group can give those affected new courage. On this occasion, patients are also given tips and coping strategies that can make their life with the disease easier. In addition, those affected should inform their social environment about the disease. This creates understanding and in tricky situations, such as sudden sleep attacks or cataplexy (seizures), help is quickly on the spot. Several sleep episodes of five to fifteen minutes each day can improve your ability to concentrate.
Eating smaller meals more often and not drinking alcohol also relieves the body. Sporting activities can have a positive effect on longer periods of wakefulness.
Choosing a competent specialist is very important. In the best case, this is a trained sleep medicine specialist. The physician should address the personal needs and questions of the narcolepsy patient.
