TRYPANOSOMIASIS
KALUPA VINCENT
OVERVIEW OF TRYPANOSOMIASIS
Trypanosomiasis is one of the endemic
tropical disease, with its burden being high in
Africa
The effects of this infection is fatal, hence
need for early diagnosis and treatment
Early diagnosis and treatment will save lives
and prevents complications
GENERAL OBJECTIVE
At the end of the lecture, student nurses should
demonstrate an accurate understanding on the
scope of management of Trypanosomiasis.
SPECIFIC OBJECTIVES
At the end of the lecture, student nurses
should;
Define Trypanosomiasis
State the causative organisms for
Trypanosomiasis
Describe the pathophysiology of
Trypanosomiasis
SPECIFIC OBJECTIVES
Explain the cardinal presentation of
Trypanosomiasis
Discuss the management of Trypanosomiasis
Enumerate the complications of
Trypanosomiasis
Outline the prevention and control of
Trypanosomiasis
What is Trypanosomiasis???
DEFINITION
It is a chronic tropical parasitic infection
which is transmitted through a bite of a
glossina fly (Tsetse fly) of the genus
Trypanosoma and is characterized by
irregular chronic fevers, local oedema,
adenitis and disturbed mental alertness
(lethargy)
DEFINITION
It is a chronic tropical parasitic infection
which is transmitted through a bite of a
glossina fly (Tsetse fly) of the genus
Trypanosoma and is characterized by
irregular chronic fevers, local oedema,
adenitis and disturbed mental alertness
(lethargy)
Do you know that Trypanosomiasis
was discovered in 1895 by a
Scottish Microbiologist David
Bruce???
Do you know that Trypanosomiasis
is also known as Sleeping
Sickness???
What is the aetiology of
Trypanosomiasis???
The vector of Trypanosomiasis is a
Glosina fly (Tse Tse fly) of the
genus Trypanosoma!!!
VECTORS OF THE DISEASE
The main vectors of Trypanosomiasis are;
Glossina palpalis ( Trypanosoma Brucei
gambiense)
Glossina tachinoides (Trypanosoma brucei
gambiense)
Glossina Morsitan (Trypanosoma brucei
rhodesiense)
VECTORS OF THE DISEASE
Glossina pallidipe (Trypanosoma brucei
rhodesiense)
Glossina swynnertoni (Trypanosoma brucei
rhodesiense)
EPIDEMIOLOGY OF
TRYPANOSOMIASIS
Human African Trypanosomiasis takes two
forms, depending on the parasite involved:
Trypanosoma brucei gambiense (T.b.g.) is
found in west and central Africa.
This form represents more than 90% of
reported cases of sleeping sickness and causes
a chronic infection.
EPIDEMIOLOGY OF
TRYPANOSOMIASIS
Trypanosoma brucei rhodesiense (T.b.r.) is
found in eastern and southern Africa.
This form represents less than 10% of reported
cases and causes an acute infection.
First signs and symptoms are observed after a
few months or weeks.
The disease develops rapidly and invades the
central nervous system
What is the incubation period of
Trypanosomiasis???
INCUBATION PERIOD
A person can be infected for months or even
years without major signs or symptoms of the
disease.
When symptoms do emerge, the patient is often
already in an advanced disease stage with the
involvement of the central nervous system.
How is Trypanosomiasis
transmitted???
M.O.T OF TRYPANOSOMIASIS
It is transmitted by a bite of a glossina fly which
injects the trypanosomes during a blood meal.
Mother-to-child infection when trypanosome
crosses the placenta and infect the fetus.
Accidental infections have occurred in
laboratories due to pricks from contaminated
needles.
What the pathophysiology of
Trypanosomiasis???
PATHOPHYSIOLOGY
The pathophysiology of Trypanosomiasis is
divided into three (3) distinct stages;
1. Primary stage
2. Secondary stage (Blood stage)
3. Sleeping sickness stage (Cerebral stage)
Primary Stage!!!
PATHOPHYSIOLOGY
Primary stage
Following the bite from an infected glossina
(Tse tse fly), thousands of trypanosomes are
inoculated under the skin
The Trypanosomes starts to multiply at the site
of inoculation and elicits an immune response.
PATHOPHYSIOLOGY
This leads to local inflammation resulting into
the formation of the primary chancre
The immune response is characterized by the
production of large numbers of macrophages
and other phagocytes to deal with the pathogen
During this stage, the disease may stay
dormant for many months to years at this stage
Secondary Stage
(Blood stage)
PATHOPHYSIOLOGY
Secondary stage (Blood stage)
This stage can be as a result of the primary
infection or re-infection
If the infection (in Primary stage) is not
successfully fought by the immune system,
Trypanosomes are liberated from the site of
inoculation
PATHOGENESIS
The trypanosomes begin to circulate in blood
stream and the infection becomes systemic
As a result of this overwhelming infection, the
Trypanosomes may infiltrate to other body
organs and elicit local or generalised infection
This generalised infection leads to
manifestations of clinical manifestation
PATHOGENESIS
The pathological effects of Trypanosomiasis
are produced by tissue damage and cellular
immunological response
This lead to various signs and symptoms such
as; Fever, lymphadenopathy and muscle
weakness
Sleeping sickness stage
(Cerebral stage)
PATHOPHYSIOLOGY
Sleeping sickness stage (Cerebral stage)
This is the terminal stage of the illness
Due to overwhelming infection, the
Trypanosomes spreads other body systems via
the lymphatics
Trypanosomes infiltrate to the CNS after
crossing the blood brain barrier (meninges).
PATHOPHYSIOLOGY
The Trypanosomes illicit local inflammation
and creates cerebral lesions
This leads into cerebral manifestations, like
headache, drowsiness, confusion and lethargy
The trypanosomes will also continue to elicit
an antibody response until the host fails to
produce anymore antibodies to fight an
infection leading to chronic condition.
What are the cardinal manifestation
of Trypanosomiasis???
SIGNS AND SYMPTOMS
The clinical features will be described
according to the stages:
Primary stage
Fever due to infection and the ensuing
inflammatory response, usually 2-3 weeks
after inoculation
SIGNS AND SYMPTOMS
Trypanosomal chancre at the port of
inoculation due to cellular response to the
invading parasites leading to local inflamation
SIGNS AND SYMPTOMS
Blood stage
This stage is characterized by the following
signs and symptoms;
Fever continues (Hyperpyrexia followed by
periods of apyrexia)
Erythema due to connective tissue infiltration
SIGNS AND SYMPTOMS
Hyperaesthesia (also known as kerandel’s
sign) marked over the tibiae which is tender to
touch because of pain
Sign and symptoms of anemia (pallor, rapid
pulse, easy fatigue) due to haemolysis
SIGNS AND SYMPTOMS
Splenomegally due to spleen involvement by
infiltration of Trypanosomes to the spleen
Persistent tachycardia due to anaemia and fever
Cervical gland enlargement and those of other
areas may be involved and later become tender due
to inflammation
Oedema due to inflammation and renal
involvement
SIGNS AND SYMPTOMS
Sleeping sickness stage (cerebral stage)
It is characterized by progressive mental
deterioration
Poor posture secondary to cerebral
involvement due to neural disturbance
Tendency to lapse into sleep during day and
restlessness at night (hence called sleeping
sickness)
SIGNS AND SYMPTOMS
Twitching muscles and tremors of the hands
and later legs due to cerebral involvement
Speech is difficult as a result of paralysis of
muscles of the mouth
Later convulsive movements of the limbs are
seen due to impaired muscle physiology
secondary to cerebral damage
SIGNS AND SYMPTOMS
Head traction is seen due to cerebral
involvement (encephalitis)
Saliva dribbles from the mouth due to loss of
oral muscle function
Weight loss due to the disease process and
anorexia
Lethargy, convulsion and coma due to
cerebral involvement (Encephalitis)
What is the management of
Trypanosomiasis???
Diagnosis of Trypanosomiasis!!!
DIAGNOSITIC PROCEDURE
History taking;
Visiting an endemic area
Nature and onset of symptoms
History of chancre
Physical examination of signs and symptoms;
Sleepiness (during an interview or by history)
Inoculation chancre
Lymphoedema
DIAGNOSITIC PROCEDURE
Blood slide (rapid test) will reveal the
parasites
Blood analysis: ESR is elevated, as in
parasitic infestation
Lymph node aspiration: Aspirate from the
swollen gland may reveal the causative agent
DIAGNOSITIC PROCEDURE
Lumber Puncture: analysis of CSF will
reveal the parasites in cerebral stage
Blood analysis of antibodies to trypanosomes
will be positive
How is Trypanosomiasis
diagnosed???
TREATMENT OF
TRYPANOSOMIASIS
Trypanosomiasis without CNS involvement:
Suramin IV 1g diluted with 8mls of water for
injection and given within 1 hour; given on
days 1,3 , 7, 14 and 21
TREATMENT OF
TRYPANOSOMIASIS
Trypanosomiasis with CNS involvement
Suramin IV 1g diluted with 8mls of water for
injection and given within 1 hour; given on
days 1,3 , 7, 14 and 21
Then start Mel B 3.6ml/kg body weight daily
in 3-4 doses
TREATMENT OF
TRYPANOSOMIASIS
Note: During Mel B treatment up to one
month after finishing the treatment course no
alcohol should be taken because it can cause
encephalopathy and death.
TREATMENT OF
TRYPANOSOMIASIS
Supportive treatment
Phenobarbitone (If patient is having
convulsion) 60-180mg 8 hourly or Nocte.
o In children 5.8mg/kg body weight daily.
Analgesics and antipyretics (For pain and
fever), like Paracetamol 10mg/kg 8 hourly for
3 days for 3/7
What are the complications of
Trypanosomiasis???
COMPLICATIONS OF
TRYPANOSOMIASIS
Lymphoedema arising from obstruction of
lymph drainage secondary to inflammation
Perinatal death which is associated with
congenital infection
Encephalitis resulting from cerebral
involvement by Trypanosomes which causes
cerebral inflammation
COMPLICATIONS OF
TRYPANOSOMIASIS
Anaemia due to increased haemolysis of
RBCs which is elicited by the infection
Stupor and coma arising from cerebral
involvement by Trypanosomes
Convulsion due to cerebral oedema (increased
Intracranial Pressure)
COMPLICATIONS OF
TRYPANOSOMIASIS
Multi-organ failure arising from infiltration of
the Trypanosomes in other body systems, like
kidneys, liver and Spleen
Embolitic stroke due to occlusion of the
cerebral blood flow by Trypanosomes
Renal failure due to destruction of renal cells
What is the prevention and control
of Trypanosomiasis???
PREVENTION AND CONTROL
OF TRYPANOSOMIASIS
Massive community sensitisation on disease
process, prevention and control
Wear of protective clothing to prevent bites
from Tse tse flies
Inspection of vehicles before entering,
because Tse tse flies are attracted to moving
PREVENTION & CONTROL OF
TRYPANOSOMIASIS
Avoid bush camping, especially in endemic
areas
Application of repellants to scare Tse tse flies
Avoid very bright and very dark coloured
clothing which attracts Tse tse flies
PREVENTION & CONTROL OF
TRYPANOSOMIASIS
Disease surveillance , especially in endemic
areas
Contact tracing of cases in the community
Adequate treatment of identified cases in the
community to cut on transmission cycle
Mass Drug Administration for population at
risk
THANK YOU FOR YOUR
ATTENTION!!!
ANY QUESTIONS!!!
