TSE TSE infection

2. Introduction
Sleeping Sickness is a parasitic disease that is caused by two subspecies
of the protozoan parasite Trypanosoma brucei, namely T. brucei
gambiense and T. brucei rhodesiense. These parasites are transmitted to
humans and other mammals by the bite of infected tsetse flies (Glossina
spp.). The disease is prevalent in sub-Saharan Africa, where the tsetse fly
is commonly found.

3. Transmission
The tsetse fly is the primary vector for Sleeping Sickness. When an
infected tsetse fly bites a human or animal, it injects the parasites into
the bloodstream. The parasites then multiply in the bloodstream and
lymphatic system, causing a range of symptoms.

4. life cycle of tsetse fly
Female tsetse mate just once. After 7 - 9 days she produces a single egg which develops into a
larva within her uterus. About nine days later, the mother produces a larva which burrows into
the ground where it pupates. The mother continues to produce a single larva at roughly nine day
intervals for her entire life.
The adult fly emerges from the pupa in the ground after about 30 days. Over a period of 12-14
days it matures, mates and, if it is a female, deposits its first larva. Thus 50 days elapse between
the emergence of one female fly and the subsequent emergence of the first of its progeny.
This life cycle, with a slow reproductive rate and substantial parental investment in the care of
young, is a relatively unusual example of an insect with a so-called 'K-type' life history.
This slow rate of reproduction means that tsetse populations can be eradicated by killing just 2-
3% of the female population per day.

5. life cycle of tsetse fly

6. epidemiology

7. Types
There are two types of Sleeping Sickness
1-the chronic form caused by T. brucei gambiense
2-the acute form caused by T. brucei rhodesiense
The chronic form is responsible for about 98% of cases and progresses
more slowly than the acute form, which can lead to death within a few
months if left untreated.

8. Signs and symptoms
African trypanosomiasis symptoms occur in two stages: the
hemolymphatic stage and the neurological stage (the latter being
characterised by parasitic invasion of the central nervous
system). Neurological symptoms occur in addition to the initial
features, however, and the two stages may be difficult to
distinguish based on clinical features alone.

9. Signs and symptoms
Incubation period is 1–3 weeks for T. b. rhodesiense, and longer (but less precisely characterised) in T. b.
gambiense infection. The first/initial stage, known as the hemolymphatic phase, is characterized by non-
specific, generalised symptoms like: fever (intermittent), headaches (severe), joint pains, itching,
weakness, malaise, fatigue, weight loss, lymphadenopathy, and hepatosplenomegaly.
Diagnosis may be delayed due to the vagueness of initial symptoms. The disease may also be mistaken
for malaria (which may in fact occur as a co-infection).
Intermittent fever :
Fever is intermittent, with attacks lasting from a day to a week, separated by intervals of a few days to a
month or longer Episodes of fever become less frequent over the course of the disease
Hemolymphatic phase

10. Signs and symptoms
Lymphadenopathy
Invasion of the circulatory and lymphatic systems by the parasite is associated with severe swelling of
lymph nodes, often to tremendous sizes. Posterior cervical lymph nodes are most commonly affected,
however, axillary, inguinal, and epitrochlear lymph node involvement may also occur. Winterbottom's sign,
the tell-tale swollen lymph nodes along the back of the neck, may appear. Winterbottom's sign is common
in T. b. gambiense infection
Other features
Those affected may additionally present with: skin rash, haemolytic anaemia, hepatomegaly and abnormal
liver function, splenomegaly, endocrine disturbance, cardiac involvement (e.g. pericarditis, and congestive
heart failure), and ophthalmic involvement.
Hemolymphatic phase

11. Signs and symptoms
The second phase of the disease, the neurological phase (also called the meningoencephalic stage),
begins when the parasite invades the central nervous system by passing through the blood–brain
barrier. Progression to the neurological phase occurs after an estimated 21–60 days in case of T. b.
rhodesiense infection, and 300–500 days in case of T. b. gambiense infection.
In actuality, the two phases overlap and are difficult to distinguish based on clinical features alone;
determining the actual stage of the disease is achieved by examining the cerebrospinal fluid for the
presence of the parasite.
Sleep disorders
Sleep-wake disturbances are a leading feature of neurological stage and gave the disease its common
name African sleeping sickness.[ Infected individuals experience a disorganized and fragmented sleep-
wake cycle.Those affected experience sleep inversion resulting in daytime sleep and somnolence,and
nighttime periods of wakefulness and insomnia. Additionally, those affected also experience episodes of
sudden sleepiness.
Neurological phase

12. Signs and symptoms
Neurological/neurocognitive symptoms
Neurological symptoms include: tremor, general muscle weakness, hemiparesis, paralysis of a
limb, abnormal muscle tone, gait disturbance, ataxia, speech disturbances, paraesthesia, hyperaesthesia,
anaesthesia, visual disturbance, abnormal reflexes, seizures, and coma. Parkinson-like movements might
arise due to non-specific movement disorders and speech disorders.
Psychiatric/behavioural symptoms
Individuals may exhibit psychiatric symptoms which may sometimes dominate the clinical diagnosis and
may include aggressiveness, apathy, irritability, psychotic reactions and hallucinations, anxiety, emotional
lability, confusion, mania, attention deficit, and delirium.
Neurological phase

13. Diagnosis
Diagnosis of Sleeping Sickness can be
challenging, as the symptoms are similar to
many other diseases. A blood sample is
usually taken and examined under a
microscope to look for the parasites.
However, as the parasites are only present
in the blood during certain stages of the
disease, multiple tests may be needed to
confirm a diagnosis

14. Treatment
The treatment of Sleeping Sickness depends on the stage of the disease
and the type of parasite involved. Drugs such as pentamidine and suramin
are used for early-stage infections, while more potent drugs like
melarsoprol and eflornithine are used for late-stage infections. However,
these drugs can have severe side effects, and the treatment may require
hospitalization.

15. Prevention
Prevention of Sleeping Sickness involves controlling the tsetse fly
population through the use of insecticides, traps, and the removal of
animal reservoirs. Other prevention measures include wearing protective
clothing, using insect repellents, and avoiding areas known to have high
tsetse fly populations. Research is ongoing to develop vaccines to prevent
Sleeping Sickness

16. Conclusion
Sleeping Sickness is a serious disease that affects thousands of people in
sub-Saharan Africa each year. While treatment is available, prevention
measures such as controlling the tsetse fly population and taking
precautions to avoid infection are critical in reducing the spread of the
disease. Awareness, education, and research are essential in preventing
and controlling Sleeping Sickness.

17. By
Dr/M.IBRAHIM ALHAMECH – DR/ M.KHAIR ALABDULLAH