African Trypanosomiasis (Sleeping Sickness)

African trypanosomiasis, or sleeping sickness, is a parasitic infection transmitted by the bite of infected tsetse flies. It progresses from an early stage affecting the blood to a later stage affecting the nervous system, and is fatal without treatment.

• Early stage: fever, headache, joint pain, and itching, sometimes with a painful sore at the site of the fly bite
• Swollen lymph nodes, particularly at the back of the neck
• Later stage (nervous system involvement): confusion, personality changes, disturbed sleep pattern (giving the disease its name), and, without treatment, progressive decline in consciousness

• Caused by Trypanosoma parasites, transmitted through the bite of infected tsetse flies found in certain parts of sub-Saharan Africa, particularly in bush, woodland, and riverine areas.
• Occupational and lifestyle exposure to tsetse fly habitats, such as farming, fishing, or hunting in affected areas, increases risk.

• Suspected based on a compatible history of exposure in an endemic area together with symptoms, particularly swollen lymph nodes and unexplained fever.
• Blood testing and, in the later stage, examination of cerebrospinal fluid via lumbar puncture confirm the diagnosis and stage of disease, which is essential for guiding treatment choice.

Treatment depends on the stage of disease and the specific parasite subtype and is managed at a specialised treatment centre with access to the appropriate medicines.

Early-stage disease, before the nervous system is affected, is treated with medicines that do not need to cross into the brain, generally with good outcomes.

Later-stage disease, once the nervous system is involved, requires medicines capable of reaching the brain and is managed with close specialist monitoring, as this stage is more complex to treat.

Without treatment, the disease is fatal, making prompt diagnosis and referral essential.

• Use insect repellent and wear long, thick clothing (tsetse flies can bite through thin fabric) in known endemic areas.
• Avoid resting in bushes or under trees where tsetse flies rest during the hottest part of the day.
• Support tsetse fly control programmes in affected regions.
• Seek prompt medical assessment for unexplained fever after time spent in a known tsetse fly area.