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Trypanosoma brucei-gambiense (African sleeping sickness)
Etiologic agent of west African trypanosomiasis (classic African sleeping sickness).
Epidemiology:
1) West Africa
2) transmitted by the bite of the tsetse fly (genus Glossina)
3) humans are primary reservoir
4) accounts for virtually all reported cases of Trypanosoma brucei (African sleeping sickness)
Clinical manifestations:
1) chronic course
2) intermittent fevers, night sweats, malaise
3) lymphadenopathy, especially of cervical nodes (Winterbottom's sign)
4) CNS involvement occurs with time
a) somnolence, confusion, fatigue
b) psychotic changes
c) uncontrollable urge to sleep
d) chorea & athetosis
e) progression to stupor, coma & death
Management:
1) suramin (stage I, normal CSF)
a) 100-200 mg IV test dose to detect hypersensitivity
b) adults: 1 g IV on days 1,3,7,14 & 21
c) children: 20 mg/kg/day (max 1 g) IV on days 1,3,7,14 & 21
d) slow IV infusion of freshly prepared 10% aqueous solution
2) eflornithine (stage I normal CSF or stage II, abnormal CSF)
a) highly effective for stage I or stage II
b) 90% cure rate for stage II disease
c) 400 mg/kg/day IV in 4 divided QID for 2 weeks
d) followed by 300 mg/kg/day PO for 3-4 weeks
3) pentamidine
a) alternative agent for stage I
b) 4 mg/kg/day IV or IM for 10 days
4) no vaccine available
Related
fly/gnat-borne infection
General
Trypanosoma brucei (African trypanosomiasis)
Properties
KINGDOM: animal
PHYLUM: protozoa
References
- Clinical Diagnosis & Management by Laboratory Methods,
19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia,
PA. 1996, pg 1266
- Stedman's Medical Dictionary 26th ed, Williams &
Wilkins, Baltimore, 1995
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1193-96