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African trypanosomiasis (sleeping sickness)

Trypanosomiasis africana (morbus somnolentiae) · Africká trypanozomóza (spavá nemoc)

What it is

Trypanosomes spread by tsetse flies; the West African form smoulders for years, the East African for weeks, and both end in brain invasion, disturbed sleep and death if untreated. Reported cases have fallen below 1 000 a year since 2018.

Symptoms & signs

  • Chancre at the bite
  • bouts of fever, headache and itching
  • swollen nodes at the back of the neck
  • daytime sleepiness and wakeful nights
  • confusion, personality change, tremor
  • coma

🚩 Get help if…

  • call 112 / 911 now Confusion, fits or unable to stay awake
  • call 112 / 911 now Fever with breathlessness or swollen legs after an African safari
  • see a doctor soon Fever within weeks of a tsetse bite or a painful sore
  • see a doctor soon Swollen glands at the back of the neck with fever

Where it strikes

Medical treatment

  • Blood or node microscopy and card screening test
  • lumbar puncture to stage
  • Fexinidazole tablets for 10 days — West African form (positive EMA opinion 2018), East African form too since 2023; avoids lumbar puncture in most trials support
  • pentamidine (early) or nifurtimox–eflornithine (brain stage), West African form
  • suramin (early) or melarsoprol (brain stage), East African form when fexinidazole cannot be used — melarsoprol, an arsenical, kills about 1 in 20 through encephalopathy

Natural & lifestyle

  • Neutral-coloured long clothes
  • insect-repellent-treated traps and screens against tsetse

Emerging & experimental

  • Acoziborole — a single oral dose; high cure rates in trials early / small studies
  • screen-and-treat with one dose

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Plant extracts — active against trypanosomes in laboratory screens; no human trials early / small studies
  • Herbal fever remedies — traditional; delay the drugs in a disease fatal without them anecdotal / traditional

ICD codes