1. The Impact and Reduction of Trypanosomiasis Infection within Sub-Saharan Africa Rockefeller F. Cooper II, PhD. Student Walden University Ph 8165-1 Instructor: Dr. Shana Morrell Spring, 2009

2. Stakeholders   The Government of Liberia: Ministry of Health Monrovia City Hall Corp

3. Learning Objectives   What is trypanosomiasis?   What causes it and how is it transmitted?   Who is at risk?   What are the symptoms?   How do we prevent it?   How do we control it?   How do we treat it?   Understanding the etiology and geography.

4. Outline I   Introduction   African Trypanosomiasis   Etiology of African Trypanosomiasis   Geographical Distribution   Mode of Transmission   Symptoms Human African Trypanosomiasis African Animal Trypanosomiasis

5. Outline II   Prevention A-B-C Method   Control use of insecticide traps and screens   Treatment   References

6. Introduction I   Trypanosomiasis is commonly known as “sleeping sickness”(Dias, 1999).   In cattle and other domestic animals, the disease is referred to as Nagana (Dias,1999).   Approximately, 66 million people are victims (Dias,1999). Reference: Reference: Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121. Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121.

7. Introduction II   Acute and chronic phase.   Origin was unknown as caravanners noticed prevailing symptoms of the disease (Dias,1999).   The disease infiltrated the western, eastern and southern parts of Africa   Colonial masters organized campaigns to prevent and control trypanosomiasis.   This effort turned out to be successful due to the use pentamidine, and agronol prevention (Dias,1999).Reference: Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121. Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121.

8. Introduction III   Trypanosomiasis was suppressed but reemerged after African countries started to obtain their independence. as they could not maintained the financial burden of suppressing the disease (Dias,1999).   Trypanosomiasis causes economical instability due to death infliction on cattle as a result of anemia, loss of condition and emaciation.   Disease is caused by: Trypanosoma congolense, Trypanosoma vivax and Trypanosoma brucei brucei. (Grove, 1990). References: Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121. Grove, A.T. (1990). The Changing Geography of Africa. Oxford, England: Oxford University Press. Grove, A.T. (1990). The Changing Geography of Africa. Oxford, England: Oxford University Press.

9. Etiology of African Trypanosomiasis (2008,Dec 5). African Trypanosomiasis. Retrieved May 1, 2009, from CDC Web site: http://www.dpd.cdc.gov/dpdx/html/TrypanosomiasisAfrican.htm

10. Geographical Distribution   African Trypanosomiasis: Tsetse flies are between latitude 15 0 North and 20 0 South.   Central and West Africa serves as host to the Trypanosoma brucei gambiense, which is the most common causal agent of the disease.   In East and Southern Africa, there is the Trypanosoma brucei Rhodesiense. Reference: Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437-440. Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437-440. Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121. Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121.

11. Mode of Transmission   Human African Trypanosomiasis: Glossina are the vectors   African Animal Trypanosomiasis: The vectors are Glossina palpalis, Glossina fusca and Glossina morsitans Other vectors are of the genus Tabanus, Haematopota, Chrysops, Liperosia and StomoxysReferences: Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437-440. Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437-440.

12. symptoms   Human African Trypanosomiasis: Chancre develops from bite. Other manifestations are:   fever   rash   severe headache   severe fatigue   painful muscles and joints   Edema around eyes and hand   Winterbottom’s sign weight loss Reference: Moore, A (2004). Human African Trypanosomiasis: a reemerging public health threat. Washington, D.C: ASM Press.   African Animal Trypanosomiasis:   Infertility   Abortion   Anemia   Weight loss   Intermittent fever Reference: Grove, A.T. (1990). The Changing Geography of Africa. Oxford, England: Oxford University Press. Grove, A.T. (1990). The Changing Geography of Africa. Oxford, England: Oxford University Press.

13. Prevention   A-B-C Method: A wareness of Risk B ite Avoidance C hemoprophylaxis References: Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm Legros, D (2002).Treatment for human African Trypanosomiasis- present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437-440. Legros, D (2002).Treatment for human African Trypanosomiasis- present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437-440.

14. Other Control & Methods   Insecticide   Traps and ScreenReferences: (2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public Health Agency of Canada Web site: http://www- micro.msb.le.ac.uk/224/Trypano.html (2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public Health Agency of Canada Web site: http://www- micro.msb.le.ac.uk/224/Trypano.html Moore, A (2004). Human African Trypanosomiasis: a reemerging public health threat. Washington, D.C: ASM Press. Moore, A (2004). Human African Trypanosomiasis: a reemerging public health threat. Washington, D.C: ASM Press.

15. TreatmentDrugsSpeciesPhaseDosageRoute Common side effects Pentamidine isethionate T. gambiense acute 7-10 doses of 4mg/kg per day IMDiarrheaDizzinessHeadache Upset stomach Nausea Suramin sodium T. gambiense T. rhodisiense acute 5mg/kg on the 1st day, 10 on the 3rd and 20 on the 5th,11th, 23rd and 30th IV Renal failure Anaphylactic shocks Signs of neurotoxicity Severe cutaneous reactions Melasoprol T. gambiense T. rhodisiense chronic 3-4 series of 3-4 injections per day IV Reactive encephalopathic syndrome Elfornithine T. gambiense chronic 400mg/kg per day in 4 daily infusions for 1-2 wks. IVDiarrheaPancytopeniaConvulsionHallucination Nifurtimox T. gambiense T. cruzi chronic 400mg/kg per day in 4 daily infusions for 1-2 wks. OralAnorexia Neurological problems

16. What have we learned ?   The nickname for trypanosomiasis is “sleeping sickness”.   It is an infectious disease that can be transmitted by the tsetse fly.   Two phases are involved.   Infection is specie specific with regards to the geography.   Transmission of the disease into humans and animals are not of the same species as symptoms vastly differs as well.   Prevention using the “ABC Method” as well as traps, screen and insecticide.   Different types of drugs.

17. References   "American Trypanosomiasis of Chagas Disease." Public Health Agency of Canada. 13 June 2001. Public Health Agency of Canada. Retrieved April 10, 2009, from http://www.phac-aspc.gc.ca/tmp-pmv/info/am_trypan_e.html http://www.phac-aspc.gc.ca/tmp-pmv/info/am_trypan_e.html.   Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htmhttp://chagaspace.org/eng/chagas/index.htm   Dias, J.C.P (1999). The evolution of Chagas disease (American trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121.   Dias, J.C.P (1992). Epidemiology of Chagas disease. Retrieved October 5, 2006, from Foreign Animal Diseases Web site: http://www.dbbm.fiocruz.br/tropical/chagas/chapter4.html http://www.dbbm.fiocruz.br/tropical/chagas/chapter4.html   Grove, A.T. (1990). The Changing Geography of Africa. Oxford, England: Oxford University Press.   Legros, D (2002).Treatment for human African trypanosomiasis-present situation and needs for research and development. The Lancelet Infectious Diseases. 2, 437- 440.

18. References II   Mare, C.J. (1998). Foreign animal diseases. Retrieved April 10, 2009, from The Gray Book Web site: http://www.vet.uga.edu/VPP/gray_book/FAD/index.htmhttp://www.vet.uga.edu/VPP/gray_book/FAD/index.htm   Mare, C.J. (1998). In foreign animal diseases. Richmond, VA: United States Animal Health Association.   Moore, A (2004). Human African Trypanosomiasis: a reemerging public health threat. Washington, D.C: ASM Press.   Stich, A (2002).Human African Trypanosomiasis. BMJ. 325, 203-06.   Trail, J.C.M (1985). Productivity of Boran cattle maintained by chemoprophylaxis under Trypanosomiasis risk. Retrieved April 10, 2009, from Economic trade-offs between milk and meat production Web site: http://www.fao.org/wairdocs/ILRI/x5527E/x5527e00.HTM http://www.fao.org/wairdocs/ILRI/x5527E/x5527e00.HTM   (2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public Health Agency of Canada Web site: http://www-micro.msb.le.ac.uk/224/Trypano.htmlhttp://www-micro.msb.le.ac.uk/224/Trypano.html   (2006, Feb 8). West African Trypanosomiasis. Retrieved April 8, 2009, from Division of parasitic Diseases Web site: http://www.cdc.gov/NCIDOD/dpd/parasites/trypanosomiasis/factsht_ea_trypanosomia sis.htm http://www.cdc.gov/NCIDOD/dpd/parasites/trypanosomiasis/factsht_ea_trypanosomia sis.htm

19. Bibliography for further reading   Cooper, Rockefeller (2007). Prevention and Control of Selective Tropical Diseases. Baltimore, MD: Publish America   (2008,June 8). West African Trypanosomiasis. Retrieved May 2, 2009, from CDC Web site: http://www.cdc.gov/ncidod/dpd/parasites/trypanosomiasis/factsht_wa_trypano somiasis.htm  (2009). Trypanosomiasis, Africa. Retrieved May 2, 2009, from World Health Organization Web site: http://www.who.int/topics/trypanosomiasis_african/en/  Kioy, D., & Jannin, N (2004). Human African Trypanosomiasis. Nature Reviews Microbiology. 2, 186-187.