Types of sleeping sickness:
(1) T. brucei gambiense (West and Central African) = chronic course (progression over years)
(2) T. brucei rhodesiense (East and Southern African) = rapid course (progression over months)
Clinical findings prior to CNS involvement (Stage I):
(1) nodule or chancre at the site of a tsetse fly bite, with localized inflammation
(2) irregular, periodic fevers with night sweats
(3) headache, malaise and anorexia during febrile episodes
(3) lymphadenopathy
(3a) posterior cervical lymph nodes (Winterbottom's sign)
(3b) near chancre
(4) hyperesthesia (Kerandel's sign) with excessive pain to a stimulus
(5) erythematous skin rash
(6) pruritis
(7) joint pains
(8) muscle aches
(9) unintended weight loss
(10) edema in face, hands, feet, lower eyelids, and periarticular areas
(11) carditis with congestive heart failure, pulmonary edema and ascites
(12) amenorrhea or abortion in women; impotence in males
(13) moderate hepatosplenomegaly
(14) diarrhea
(15) interstitial keratitis or conjunctivitis
(16) increased risk for bacterial infection
Clinical findings with CNS involvement (Stage II)
(1) mental status changes, with confusion and somnolence progressing to coma
(2) behavioral or personality change, with apathy, mania, delirium, paranoia, or other psychiatric disorders
(3) meningoencephalitis
(4) excessive fatigue
(5) loss of coordination and ataxia
(6) slurred speech
(7) pareses or paralysis
(8) altered reflexes
(9) seizures
(10) dyskinesias and/or choreoathetosis
(11) insomnia
(12) physical emaciation
Laboratory findings:
(1) pancytopenia
(2) elevated ESR
(3) elevated serum IgM levels
(4) autoantibodies and rheumatoid factor
Changes in CSF:
(1) increased protein
(2) elevated IgM levels
(3) lymphocytosis
(4) Morular cells (plasma cells)
Diagnosis depends on demonstrating the organism:
(1) direct visualization of trypanosomes in chancre fluid, blood, CSF, lymph node aspirate, bone marrow
(2) ELISA
(3) antigen detection
(4) PCR or branched chain amplification
