The Sting of Sleep: Human African Trypanosomiasis

Parul Budhraja Khanna

Most of us get elated at the thought of sleep. Few of us even fantasize about it! Then there are some of us, who loathe the need to sleep and think it abstains us from vitality. Nonetheless, it is a phenomenon that liberates us from the world for few hours. It gives us comfort, peace and supports our organs to invigorate simultaneously. Thomas Dekker said, “Sleep is the golden chain that binds health and our bodies together”. While Dalai Lama said, “Sleep is the best meditation”. Although, imagine if this natural process was enforced unnaturally! Not with the pills but with a bite of an insect. Yes, the malicious winged creatures that have been known to cause enough harm to humankind, by inflicting us with fatal infections like dengue, malaria etc. To our bewilderment, they cause sleeping sickness as well. Perhaps, the insomniacs amongst us might have raised their eyebrows instead of frowning them in displeasure and their eyes must be gleaming with joy! But behold, before you wish for this insect to bite you and send you to the pleasant escape. The insect responsible is a; tsetse fly, size of a honeybee, grey-brown in color, designed to pierce through and suck onto our blood.

Reach of a tsetse fly

The disease that tsetse flies are culpable for, is referred to as African sleeping sickness or human African trypanosomiasis. The latter part of the name infallibly makes up for a good tongue-twister! Tsetse flies carry microscopic parasites of the species Trypanosoma brucei. Depending on the parasite tsetse fly is armed with the human African typanosomiasis, exists in two forms. One that is found in 24 countries in west and central Africa, responsible for chronic infection and accountable for 98% of cases of sleeping sickness. The infection dawdles for a prolonged period in the body, before it is diagnosed. And the other one, found in 13 countries in eastern and southern Africa, form 2% of reported cases of acute infection. With this form of infection, an individual is infected speedily with parasite breaching the blood-brain barrier and attacking the central nervous system, causing encephalitis and meningitis. Uganda is the only country, down on luck, which has shown both forms of the disease. Trypanosomiasis is not only limited to Africa but it also encumbers Latin America. There it is known as American trypanosomiasis or Chagas disease. The torment of trypanosomiasis does not culminate there, it strikes animals as well, wild and domestic. Predominantly, it craves for cattle in animals, where the disease is called Nagana. For its affliction to cattle, the rural areas suffer harshly with their commercial growth. Sleeping sickness terrorizes 36 countries in sub-Saharan Africa. It specifically has leverage over the rural areas which are deprived of adequate health services, besides, getting delayed diagnosis and treatment. Currently, Democratic Republic of Congo is the only country, notifying 1000 cases of sleeping sickness annually. Whereas, Central African Republic, affirmed 100-200 fresh cases in 2014.

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Transmission and warning signs of the parasite

Apart from tsetse flies savoring a scrumptious blood meal on the mammalian host and infecting it with the disease, there are additional means by which this insect can agonize a soul. The nefarious parasite that causes African trypanosomiasis, can cunningly make its way, through a mother’s placenta in the blood and infect the baby while it is still in the womb. Due to the parasite’s devious methods, sleeping sickness has been affirmed to be transferred sexually as well. A rare way of getting infected is by accident, in the laboratory, by getting pierced with a contaminated needle. This bloodcurdling puncturing tool i.e. needle, definitely needs to be used with caution! Human African trypanosomiasis comprises of two stages. The first stage unveils when the tsetse fly, secretes its parasite-filled saliva into the skin of the host and multiplies in the skin. Followed by inflammation of skin and swelling of lymph nodes in the neck. This invasion results in an immune response creating symptoms like that of fever, headaches, joint pains and itching. The second stage is detectible when the parasite crosses the blood-brain barrier and infects the central nervous system. This affects the working of brain, leading to; alterations in behavior, confusion, poor cognitive functions, trouble in speech delivery, disruption of biological clock due to upheaval in the sleep-cycle, hence the name, ‘sleeping sickness’. Even though sleeping sickness is considered fatal, yet reportedly, there have been healthy carriers of this condition too.

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Prevention and cure of the “sleeping sickness”

The prime approach to prevent this lethal disease is by early detection. Especially before it clings onto our brain, as there is no vaccine available to avoid it. For this reason, an exhaustive, active screening of the population is recommended by the WHO. Saving those innocent lives, calls for an extensive financing in human and material resources. More so, because the remote rural areas, face scarcity of such resources. According to WHO, drugs prescribed at first stage of the disease are pentamidine and suramin. These are safer and can be effortlessly managed than the drugs used for second stage of human African trypanosomiasis. Drugs used in the second stage, can be harmful and challenging to administer, which are; melarsoprol, eflornithine and nifurtimox. Before the prescription of these not so palatable drugs, certain tests are done for confirmation of Sleeping sickness. These tests entail; blood smears for signs of parasite, antibody-specific tests, and examination of cerebrospinal fluid obtained by lumbar puncture, because these parasites can remain in hiding and stay viable for extended time periods as well as start reproduction of the disease months after treatment. Additional measures that we can undertake, to defend ourselves from the attack of the causative agents of sleeping sickness involve; wearing long-sleeved shirts and full-length trousers to limit the amount of exposed skin that tsetse fly can perforate, wearing clothes in neutral colors as tsetse flies are drawn to bright colors much like butterflies. However, the difference being, one is an obnoxious bugger, guilty of a deadly disease, while other is a stunning creature that helps with pollination! We should also avoid bushy areas where tsetse fly relaxes during the day, also make use of the effective insect repellants.

It is rather startling; how such tiny beings can be a source of such spine-chilling ailments. Nonetheless, one must be fearless and hopeful, then at the same time vigilant of the surroundings too. A great writer and leadership speaker, Robin Sharma says, “fear only becomes powerful when you give it your power”.

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