Prevention of human African trypanosomiasis is similar to measures that one will use for malaria and other insect-borne diseases. Specifically, people who reside in or visit areas where the disease occurs should wear long-sleeved shirts and long pants. The tsetse fly can bite through thin fabric, and the clothing should be durable enough to prevent that.
For African trypanosomiasis, it is best to wear clothing with neutral colors because dark or light materials may attract the insect vector. The tsetse fly also tends to follow moving vehicles, and one should inspect the car for the insects before entry. When the weather is very hot, these flies tend to rest in bushes; hence, the recommendation is to avoid them because the presence of a person near the bushes may agitate the insects.
Insect Repellents
The benefit of insect repellents for this disease is not clear, but there is definite advantage for their use with other insects. Therefore, one should employ the repellents whenever he or she is in a region where insect-borne diseases are present.
Medical Therapy
The drug management of African trypanosomiasis should lead to microbiologic cure. The medication that the physician chooses depends on the specific microorganism responsible for the disease as well as the stage of the infection. For stage one disease, pentamidine is beneficial for Trypanosoma brucei gambiense. Suramin, which has been available since 1921, is the first-line therapy for Trypanosoma brucei rhodesiense cases which have not progressed to the second stage.
There is benefit for the use of suramin for first-stage infection with Trypanosoma brucei gambiense; however, there may be a severe reaction to the drug in patients who also have Onchocerca volvulus infection. Hence, many physicians will not prescribe suramin for cases of Trypanosoma brucei gambiense disease (World Health Organization, 2012).
Second-stage cases of human African trypanosomiasis will benefit from melarsoprol, eflornithine, or combination therapy with eflornithine and nifurtimox. Melarsoprol is an organoarsenic compound which is effective against Trypanosoma brucei gambiense and Trypanosoma brucei rhodesiense. It may, nevertheless, result in an encephalopathic reaction in patients who have second stage infection.
To reduce the likelihood of these potentially fatal reactions, some physicians administer prednisolone therapy with melarsoprol.
Eflornithine is a less toxic agent than melarsoprol, and the physician can give it intravenously four times daily for 14 days for patients with Trypanosoma brucei gambiense. Eflornithine is not effective against Trypanosoma brucei rhodesiense. Another option for second stage Trypanosoma brucei gambiense is combination therapy with eflornithine and nifurtimox. This regimen appears to be as efficacious as eflornithine monotherapy for that microorganism.
Furthermore, combination therapy with eflornithine and nifurtimox, which has been in use since 2009, will lessen the need for so many intravenous infusions of eflornithine which are necessary when the physician utilizes monotherapy with that agent.
Sources
- Centers for Disease Control. (2010). Parasites—African trypanosomiasis (also known as sleeping sickness) Retrieved January 19, 2012.
- World Health Organization. (2012). African trypanosomiasis (sleeping sickness). Fact sheet. Retrieved January 19, 2012.
Disclaimer: The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.
Michael Koger - Dr. Koger obtained his medical education at Meharry Medical College and specialized in Internal Medicine.
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