Abstract
Human African Trypanosomiasis also known as sleeping sickness is a
common disease in South Sudan. There are two recognized sstage, The
early hemolymphatic stage and The late encephalitic stage when the CNS
is involved specially with Gambians infection, broad neurologic spectrum
has been reported such as psychiatric, motor, sensory.
INTRODUCTION
Human African trypanosomiasis (HAT), also known as sleeping sickness, is
caused by protozoan parasites. There are two forms of the disease: an
acute form which occurs mainly in East Africa and caused by Trypanosoma
brucei rhodesiense, and a more chronic form which mainly occurs in West
and Central Africa, caused by Trypanosoma brucei gambiense.
Human African trypanosomiasis (HAT) is characterized by an early stage,
known as the hemolymphatic stage, during which trypanosomes circulate in
the blood or lymphatics, and a late stage, in which there is involvement
of the central nervous system (CNS). Trypanosoma brucei gambiense causes
a slowly progressive infection, and an oligo symptomatic phase can last
for months or years.
Early infection (stage I) — Early symptoms of HAT infection include
intermittent headache, fevers, malaise, and arthralgia. These symptoms
may correspond with successive waves of parasitemia and antibody
production. Hepatomegaly and particularly splenomegaly may be observed,
and generalized lymphadenopathy may also be present. Other nonspecific
symptoms may be present including pruritus, rash, weight loss, and
facial swelling. Neuroendocrine disturbances leading to amenorrhea in
women or impotence in men may also occur. The duration of this phase is
approximately three years in T. b. gambiense infection. In contrast, T.
b. rhodesiense presents as an acute illness with poor demarcation
between stages and leading to death within months.
Late infection (stage II) — Late infection refers to involvement of
the central nervous system (CNS). The death rate is 100% in the absence
of treatment. Stage II is defined by an increase in the number of white
blood cells (> 5 cells / microL) in the cerebrospinal
fluid. Activated plasma cells with eosinophilic inclusions containing
IgM, called Mott morule cells, can be seen in cerebrospinal fluid (CSF),
Following early T. b. gambiense infection, progressive diffuse
meningoencephalitis and parenchymal edema of the brain develop, with
perivascular and meningeal inflammatory infiltrates, cerebral micro
hemorrhages, and widespread multifocal white matter demyelination (Stage
II). Symptoms include headache, difficulty concentrating, difficulty
performing complex tasks (2 or 3 step activities), personality changes,
psychosis, sensory disturbances, tremors, and ataxia. Meningismus and
focal neurologic signs may occur, but are unusual. Disturbed circadian
sleep / wakefulness frequently develops a cycle leading to daytime
sleepiness. Seizures can occur, especially in children. The
deterioration progresses gradually until the patient is in a stupor or
coma.