Published On: Sun, Oct 14th, 2012

Minneapolis woman contracts sleeping sickness during Zimbabwe safari

A 64-year-old Minneapolis woman, who traveled to Zimbabwe with her husband for a three-week safari trip last month, has been reported as an imported case of African trypanosomiasis, or sleeping sickness.

In a letter to ProMED Mail Friday from a physician, the woman’s history and condition is described:

She returned on 4 Oct 2012 and developed high fever, nausea, and diffuse myalgias on 6 October. She presented to the emergency department on 10 Oct 2012 and was admitted after trypanosomes were seen on a peripheral blood malaria/parasite smear. Rapid clinical deterioration and normal CSF studies were consistent with Trypanosoma brucei rhodesiense infection or East African sleeping sickness. The patient received treatment with suramin with multi-system organ failure and remains in the intensive care unit at Abbott Northwestern Hospital in Minneapolis, Minnesota.

Often a fatal disease with 15,000-20,000 cases reported annually, more than 60 million people are at risk in more than 30 African countries. A rare American tourist is reported with this devastating disease annually.

One of the true tropical diseases, African sleeping sickness is endemic only in sub-Sahara Africa bounded by 15° North and South latitudes.

Two varieties of African sleeping sickness exist: one primarily in East Africa caused by the parasite Trypanosoma brucei rhodesiense. T.B. rhodesiense produces an acute infection that will usually cause severe illness and death in weeks to months.

African sleeping sickness

This Giemsa-stained light photomicrograph revealed the presence of two Trypanosoma brucei parasites, which were found in a blood smear. Image/CDC

The other species is Trypanosoma brucei gambiense. This parasite is found in West and Central Africa. However, the 2 species are showing some geographic overlap.

This infection progresses more slowly and may require months to years for disease to occur.

Both types of sleeping sickness are caused by the bite of a tse tse fly. These vicious little bugs depend on blood meals for its nutrients. It gets the blood from mammals including humans. The tse tse fly  has a very painful bite and a traveler will certainly remember getting bit.

When taking a blood meal, the fly injects the parasite into the skin. From here the parasite is carried to the lymphatic system and eventually the bloodstream.

They go through stages in the body and eventually end up in the spinal fluid.

Symptoms are as follows:

• East African sleeping sickness: the development of a chancre at the bite site followed by fever, fatigue, aching muscles and joints and swollen lymph nodes are characteristic. After central nervous system (CNS) invasion neurological manifestations may occur followed by death if untreated.

• West African sleeping sickness: symptoms are similar to the above however taking longer to appear. Progressive confusion, personality changes, daytime sleepiness with nighttime sleep disturbances are late stage symptoms. Death will happen after several years if left untreated.

There is no immunity produced so reinfection is possible.

Diagnosis of African sleeping sickness is based on finding the parasite in blood , spinal fluid or lymph node aspirates.

According to the Centers for Disease Control and Prevention, treatment should be started as soon as possible and is based on the infected person’s symptoms and laboratory results.  The drug regimen depends on the infecting species and the stage of infection.  Pentamidine isethionate* and  suramin (under an investigational New Drug Protocol from the CDC Drug Service) are the drugs of choice to treat the hemolymphatic stage of West and East African Trypanosomiasis, respectively.  Melarsoprol is the drug of choice for late disease with central nervous system involvement (infections by T.b. gambiense or T. b. rhodiense).

There is no vaccine for African trypanosomes. The Centers for Disease Control and Prevention recommends the following preventive measures:

1. Wear protective clothing, including long-sleeved shirts and pants. The tsetse fly can bite through thin fabrics, so clothing should be made of medium-weight material.
2. Wear neutral-colored clothing. The tsetse fly is attracted to bright colors and very dark colors.
3. Inspect vehicles for tsetse flies before entering. The tsetse fly is attracted to moving vehicles.
4. Avoid bushes. The tsetse fly is less active during the hottest period of the day. It rests in bushes but will bite if disturbed.
5. Use insect repellant. Though insect repellants have not proven effective in preventing tsetse fly bites, they are effective in preventing other insects from biting and causing illness.

Areas of heavy infestation tend to be sporadically distributed and are usually well known to local residents. Avoidance of such areas is the best means of protection.

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About the Author

- Writer, Co-Founder and Executive Editor of The Global Dispatch. Robert has been covering news in the areas of health, world news and politics for a variety of online news sources. He is also the Editor-in-Chief of the website, Outbreak News Today and hosts the podcast, Outbreak News Interviews on iTunes, Stitcher and Spotify Robert is politically Independent and a born again Christian Follow @bactiman63

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