Microbiology and Epidemiology: - Sleeping sickness (human African trypanosomiasis, HAT) is caused by parasites of the T. brucei complex and is transmitted via tsetse flies.

  • T. b. rhodesiense causes the East African form and T. b. gambiense the West African form; these two forms are epidemiologically and clinically distinct illnesses.
  • Humans are the only reservoir for T. b. gambiense; infection occurs primarily in rural populations and rarely develops in tourists. T. b. rhodesiense has reservoirs in antelope and cattle; tourists can be infected when visiting areas where infected game and vectors are present.
  • HAT was nearly eradicated in the mid-1960s but resurged in the 1990s.

There were an estimated 50,000–70,000 new cases in 2004.


A trypanosomal chancre develops ~1 week after the bite of an infected tsetse fly. A systemic febrile illness without involvement of the CNS (stage I disease) then evolves as the parasites disseminate through the bloodstream and lymphatics.

Bouts of high-grade fever lasting several days are separated by afebrile periods. Malaise, headache, arthralgias, hepatosplenomegaly, and other nonspecific manifestations can develop.

  • Lymphadenopathy with discrete, rubbery, nontender nodes is prominent in T. b. gambiense disease. Enlargement of nodes of the posterior cervical triangle (Winterbottom’s sign) is a classic manifestation.
  • With CNS invasion (stage II disease), pts develop progressive indifference and daytime somnolence, a state that sometimes alternates with restlessness and insomnia. Extrapyramidal signs may include choreiform movements, tremors, and fasciculations; ataxia is common.
  • Disease due to T. b. rhodesiense is more acute and, if untreated, can lead to death in weeks to months; in contrast, disease due to T. b. gambiense can smolder for months or years.


The medicines that can be thought of use are: -

  • Kali phos
  • Coffea cruda
  • Ignatia amara
  • Pulsatilla
  • Nux vomica.