1. Trypanosoma brucie gambiense
Trisha Patel
“From the beginning of Arab and European influence in the hinterland of tropical Africa, trypanosomiasis of man and animals has curbed the realization of human ambitions and the mobilization of the continent’s vast resources.”
--Herbert S. Gasser

2. WEST AFRICAN SLEEPING SICKNESS
Found in western and central Africa
Transmitted human to human via tsetse fly vector
Slow onset of symptoms
Two stages:
First stage- Before crossing the blood-brain barrier
Second stage- After crossing the blood-brain barrier and entering the Central Nervous System

3. DISCOVERY
The first documented case of Trypanasoma brucei was in 1902 by R.M. Forde. In The Journal of Tropical Medicine, Forde records his account of a 42 year-old European male colonialist who came to him in May 1901 in Gambia Colony. The patient complained about having a fever and malaise. Forde presumed the gentleman to have malaria and therefore gave him anti-malarial medication. After days the condition had remained the same. A blood sample from the patient was taken and it showed no malarial parasites. Later, Dutton, another physician from the Liverpool School of Tropical Medicine, identified the parasite within the patient’s blood as Trypanasoma brucei. Due to the location of the parasite within the patient, it is assume that the species was of T.b. gambiense.

4. TIMELINE 14th Century: First described case in Mali
: First major recorded endemic
1902: R.M. Forde & Dutton identified one
causative agent of the sleeping disease
1903: Castellani working in Uganda observed
the parasite in the cerebrospinal fluid
of one of his patients
1903: Sir David Bruce recognized Tsetse fly as vector
1906: Ayres Kopke introduced Atoxyl, an arsenic compound, as a treatment
1920: Second major recorded endemic (first noted by Jamrot, a colonel for the French army)
1970- now: Third major recorded endemic
1984: The World Health Organization (WHO) launched a program to control trypanosomiasis
Sir David Bruce

5. MAJOR ENDEMICS Three Major Endemics:
1896 through 1906 (mostly in Uganda and the Congo Basin)
1920 (several African countries)
- Contained due to screening of millions of people at risk
- The disease has practically disappeared from
- Surveillance was relaxed causing a relapse
1970-now
- With the help of the World Health Organization, national control programs, and nongovernmental organizations efforts to control the spread have been implemented

6. PREVELANCE
Thirty-six countries in equatorial Africa could be affected, including 22 of the world's most underdeveloped countries.
In the United States, 31 cases of trypanosomiasis have been reported; mostly Eastern Sleeping Sickness.
In 1998, almost 40,000 cases were reported but about 300, ,000 went undiagnosed
In the Congo, more people die from sleeping sickness than from AIDS.
Fifty-five to 60 million people in equatorial Africa that are exposed to the risk of a bite from the tsetse fly.
The number of cases have decreased. From 1998 to now, reported cases feel from 37,991 to 17,616.
It costs about a thousand dollars to treat a victim of the parasite.
Recently, in the Democratic Republic of Congo, Angola and Southern Sudan, prevalence has reached 50%. This is greater than those infected with HIV/AIDS in these areas.

7. PREVANECE CONTINUED

8. SPREAD Transmitted by Tsetse fly War
A pregnant women pass it to her fetus (rare)
Through a blood transfusion (rare)
Homosexual males (very rare)
The migration of people

9. ENVIRONMENTAL CHANGES
Glossina papalis tsetse fly - lives near vegetation associated with drainage lines, rivers, and other permanent bodies of water
Removal of waterways are ineffective since:
They are also habitats for other insects and animals
They are a source of water for people
Vegetation around these areas need water
Sanitation of waterways will not effect the spread of the organism.

10. TREATMENT First stage treatments Pentamidine:
Discovered in around 1941
Highly effective
Few side-effects; usually tolerable
Second stage treatments
Melarsoprol:
Discovered in 1949
Arsenic base
Many side-effects including enchephalopathy, myocarditis, renal damage, peripheral neuropathy, etc.
Fatal (3-10%)
Eflornithine:
Also known as “the resurrection drug”
Registered in 1990
Less toxic than melarsoprol
Regime is strict and difficult to apply
Costly

11. PREVENTION Wear khaki or olive colored clothing Wear thick clothing
Use insect repellant
Use bed netting when sleeping
Inspect vehicles for tsetse flies before entering
Do not ride in the back of jeeps, pickup trucks or other open vehicles
Avoid bushes (tsetse fly is less active during the hottest time of the day and rests in bushes—it will bite if disturbed)
Avoid thick shrubbery and trees by rivers and waterholes
Test blood during transfusions

12. SOURCES
“African Trypanosomiasis.” African Sleeping Sickness. 22 May, November, <
“Background to Trypanosoma brucei gambeinse genome project.” 13 November, <
“Behind the Frieze.” Sir David Bruce. London School of Hygiene and Tropical Medicine. 1 August, November, <
“Google Image Search.” 19 November, <
“Reanalyzing the 1900–1920 Sleeping Sickness Epidemic in Uganda.” Center of Disease Control. 12 April, November, <
“Sleeping Sickness.” Wikimedia Foundation, Inc. 15 November, November, <
“Trypanosomiasis.” Leicester. 19 October, November, 2006.
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“Trypanosomiasis/Sleeping Sickness.” Medindia Health Network Pvt Ltd. 13 November, November, <
Watson, Debra. “War, famine and now pestilence.” Sleeping sickness ravages Central Africa. International Committee of the Fourth International. 5 September, November, 2006.
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