1. بسم الله الرحمن الرحيم جامعة أم درمان الإسلامية قسم طب المجتمع African Trypansomiasis (sleeping sickness)

2. Is a widespread vector-borne parasitic tropical disease that can be fatal if not treated. It is spread by the bite of an infected different species of tsetse fly (Glossina Genus; mainly Glossina palpalis in west & central Africa) Glossina is native to the African continent. Tsetse flies different species have different habitats. People who live mainly in rural parts of East, West and Central Africa are at risk of contracting sleeping sickness.

3. Tsetse flies are mainly found in vegetation by rivers and lakes, in forests and in vast stretches of wooded savannah. Tsetse flies acquire their infection from human beings or from animals (harboring the human pathogenic parasites). For reasons that are so far unexplained, there are many regions where tsetse flies are found, but sleeping sickness is not there.

4. In the first stage (haemolymphatic involvement):- the site of bite erupts into a red sore( painful chancre), and within few weeks there may be fever, swollen lymph glands, aching muscles and joints, intense headaches and irritability & insomnia. In second stage (neurological involvement):- people present body wasting & somnolence & signs referable to CSN changes (e.g. in personality, seizures, difficulty in walking and talking). These health problems can develop over many years, if not treated, the patient dies.

5. The infectious agent: A-Human African Trypansomiasis: Has two forms, depending on parasitic agent involved:

6. 1-Trypanosoma brucei gambiense (T.b.g.): causes a chronic infection. A person can be infected for months or even years without major signs or symptoms of the disease. When symptoms emerge, the patient is often already in an advanced disease stage (CNS is affected). 2-Trypanosoma brucei rhodesiense (T.b.r.): less common, but causes an acute infection (rapidly invades CNS).

7. B-Human American Trypansomiasis or Chagas disease: Another form of Trypansomiasis occurs in Central and South American countries. The causal organism is a different species from those causing the African form of the disease.

8. C-Animal Trypansomiasis: Other parasite species of the Trypanosomes are pathogenic to animals. Animals can host the human pathogen parasites, especially T.b. rhodesiense; thus domestic and wild animals are an important parasite reservoir. Animals can also be infected with T.b. gambiense, however the epidemiological role of this reservoir is not yet well known. The disease in domestic animals, particularly cattle, sheep& goats is an obstacle to the economic development of the rural areas

9. Occurrence: The disease is confined to the tropical Africa,corresponding to the distribution of the tsetse fly. In endemic region : prevalence is about 0.1- 2% of population & is up to 70% during epidemics

10. Geographical distribution of major endemic foci of HAT

11. The incubation period: for T brucei rhodesiense infection: is usually 5 - 14 days; for T brucei gambiense infection, the incubation period : usually is longer and variable, ranging from several months to years.

12. Reservoir: Humans are the main reservoir for Trypanosoma brucei gambiense, but can also be found in pigs and other animals. Wild animals (e.g. lions) &domestic animals as sheep and cattle are the main reservoir of T. b. rhodesiense. Tsetse flies serve as a vector to transmit the disease between infected humans and animals

13. Mode of transmission: 1-the bite of an infected Glossina; the tsetse fly( once infected, the tsetse fly remains infective for life (average 3 months, but can be up to 10 months). 2-In rare cases, Mother-to-child infection can occur. 3- by blood transfusion or organ transplant( very rare). 4- Accidental infections in laboratories, (due to pricks from contaminated needles). 5-Mechanical transmission by blood on the proboscis of Glossina is possible. 6- Transmission through other blood-sucking insects can occur (e.g. horse flies)

14. Laboratory diagnosis (Diagnosis must be made as early as possible before the neurological stage) 1-Thin blood smear stained with Giemsa & examine by microscope. 2- A wet blood smear preparation is for examining the motile trypanosomes. 3-lymph node aspirate. 4- CSF. 5- by inoculation of rats or mice by the parasite is limited to T. b. rhodesiense. 6-Antibody detection has sensitivity & specificity that are too variable for clinical decisions

16. Treatment 1-First stage treatment (drugs can not cross the blood- brain barrier ):- a-Pentamidine (IV): for treatment of T.b. gambiense b-Suramin (IV): for treatment of T.b. rhodesiense. c-Eflornithine (iv): only effective against T.b. gambiense. It was found safe as first-line sleeping sickness treatment in 2008, in Southern Sudan 2-Second stage treatment: (drugs can cross the blood- brain barrier to reach the parasite). Such drugs are quite toxic and complicated to administer e.g. Melarsoprol (IV): it is used in both forms of infection. An increase of resistance to the drug has been observed in central Africa.

17. 3-All treated patients should be checked (follow up)at: 3,6,12 &24 months after treatment for possible relapse of infection.

18. Prevention and control: focused mainly on, the eradication of the tsetse fly 1-Two strategies have been used & they are the backbone for control of sleeping sickness. A-The first (medical or veterinary) targets the actual cases directly: using prophylaxis(traps &screens). Active case finding,treatment&follow up. and surveillance to reduce the number of infected persons & animals. B-The second strategy is entomological and intends to disrupt the cycle of transmission by reducing the number of flies (fly control).

19. 2-Systematic screening of communities to identify foci: by mobile clinics or fixed screening centers where teams travel daily to the foci. This allows early disease detection and treatment, and removal of the potential human reservoir. There is no vaccine or recommended drug available to prevent trypanosomiasis.

20. 3-Preventive measures to avoid fly bites include:- a-Wearing of protective clothing, such as long-sleeved shirts. (Tsetse flies can bite through material, so clothing should be made of thick material). b-Wearing khaki, olive, or other neutral-colored clothing. (Tsetse flies are attracted to bright and dark contrasting colors). c-Using bed nets. d-Avoid riding in open vehicles. (the flies are attracted to the dust created by moving vehicles and animals). e-Avoid bushes. (During the hottest part of the day, the tsetse fly will rest in bushes, but will bite if disturbed!). f-Tsetse flies are not affected by insect repellents.

21. HAT(human African trypanosomiasis )control & surveillance programme is based on: 1- Access of people at risk to the diagnosis and treatment through National Programmes. 2- Strengthened surveillance through mobile teams for active case-finding and the establishment of a network for passive surveillance. 3-Guidelines jointly elaborated with health services of endemic countries, to national implementing bodies through seminars.

22. The success in implementing HAT control faced by a number of difficulties:- 1-The disease occurs only in Africa, south of the Sahara where poverty, social instability, insecurity and weak health systems are widely spread. 2-The disease is rural, occurring mostly in remote, difficult to access areas &distributed over wide spreads of land. 3-The current tools to control the disease require technical and medical competence & specialized staff for the implementation of control activities

23. و بالله التوفيق

24. فضائل الصحابة من محاضرات الشيخ ابى اسحق الحوينى

25. عن أبي سعيد أن رسول الله ﷺ جلس على المنبر فقال : عبد خيره الله بين أن يؤتيه زهرة الدنيا وبين ما عند الله فاختار ما عنده ، فبكى أبو بكر ، وبكى ( أي أجهش في البكاء أي بكاء بكاء متصلا ) ثم قال ابوبكر : فديناك بآبائنا وأمهاتنا ، قال أبو سعيد : فعجبنا لهذا الشيخ وقلنا : لم يبكي؟ قال أبو سعيد : فكان رسول الله ﷺ هو المخير وكان أبو بكر أعلمنا به

26. فوائد الحديث : الفائدة الأولى : هي فطنة أبي بكر رضي الله عنه ، وفهمه لتعريض النبي ﷺ ، ولا يفهم التعريض على وجهه إلا محب للغاية, فالنبي ﷺ ما قال ولا أشار إلى نفسه أبداً إنما قال ؟ عبد خيره الله عز وجل بين أن يؤتيه زهرة الدنيا وبين ما عنده فاختار ما عنده فما المشكلة ؟ كل الصحابة بما فيهم عمر بن الخطاب رضي الله عنه لم يفهم مراد رسول الله ﷺ الذي فهمه أبو بكر رضي الله عنه،

27. وقال رسول الله ﷺ : إن أمن الناس علي في ماله وصحبته أبو بكر ، ولو كنت متخذا ًخليلاً لاتخذت أبا بكر خليلاً ، ولكن أخوة الإسلام ،لا تبقين في المسجد خوخة إلا خوخة أبي بكر

28. وقد فهم أبو بكر رضي الله عنه أن المخير هو النبي ﷺ ، قال ابو سعيد : فعجبنا لهذا الشيخ وقلنا : لم يبكي؟ بمعنى ما الذي قاله النبي ﷺ ليبكي أبو بكر هذا البكاء؟ و لكن لما علموا أن رسول الله ﷺ هو المخير؟ علموا أن أبا بكر كان أعلمهم به ، وما كان هذا الا لشدة محبته له وأنه سخر كل مواهبه له ﷺ ، فسخر سمعه وبصره وفؤاده وبدنه كله وماله كله لرسول الله ﷺ

29. الفائدة الثانية : أنه ما من نبي يموت إلا ولابد أن؟ يخير قبل أن يموت ، وقد صرح النبي ﷺ هذا تصريحاً كما في حديث عائشة اذ قال : أن الله عز وجل يخير أنبياءه قبل قبض أرواحهم

30. الفائدة الثالثة : قول النبي ﷺ : " ولو كنت متخذا ًخليلاً لاتخذت أبا بكر خليلاً " أصل الخلة : أن تتخلل المحبة مسام القلب فلا تدع فيه موضعاً إلا للمحبوب, وعلى هذا التعريف فلا ينبغي لأحد قط أن يكون كذلك في قلب النبي ﷺ إلا الله, هذا هو المناسب لكمال إيمانه : فالنبي عليه الصلاة والسلام لما قال لو كنت متخذا ًمن أهل الأرض خليلاً ؟ فكفى أبا بكر شرفاً أن يكون هذا الإنسان ، أن يكون بعد الله مباشرة بالنسبة للنبي ﷺ فيما يتعلق بالمحبة,

31. الفائدة الرابعة : لا تبقين في المسجد خوخة إلا خوخة أبي بكر الخوخة : وهو باب الوسط ، وهو الباب الذي يكون بين دارين فكان النبي ﷺ له خوخة وكان أبو بكر له خوخة في المسجد أي باب يدخل منه أبو بكر الصديق على المسجد مباشرة، وكان علي بن أبي طالب أيضا له باب, فقال :" كل الأبواب تغلق في المسجد ولا يبقى إلا باب واحد ، ألا وهو باب أبي بكر رضي الله عنه ". والعلماء احتجوا بمثل هذا الحديث على أن النبي ﷺ أشار إلى خلافة أبي بكر بعده

32. قال مسلم : عن عبد الله بن مسعود يحدث عن النبي ﷺ أنه قال : « لو كنت متخذاً خليلاً لأتخذت أبا بكر خليلا ، ولكنه أخي وصاحبي وقد اتخذ الله صاحبكم خليلا » ، وجه الدلالة : هذا الحديث دليل من جملة أدلة على جواز أن يقول المرء ( لو ) فيما يستقبل من الأحداث وهذا لا ينافي قول النبي ﷺ : « لا يقولن أحدكم لو فعلت كذا لكان كذا فإن لو تفتح عمل الشيطان ».

33. و بالله التوفيق