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Sleep Medicine pp 159–165Cite as

African Sleeping Sickness

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Abstract

Glossina, the tsetse fly, provokes human African trypanosomiasis (HAT) by injecting Trypanosoma brucei (T. b.) gambiense or rhodesiense. All aspects of HAT are exposed, emphasizing historical milestones and scientific background. Breaking-up with the unique clinical approach of the past centuries, the turn of the nineteenth century was a fecund period. A dramatic epidemic ravaged Central Africa and the colonial powers launched medical research teams. In 15 years, the agents, the trypanosomes, and their vectors were discovered. The two previously separated entities, recurrent Trypanosoma fever and sleeping sickness, merged in the clinical and biological continuum of HAT, becoming hemolymphatic stage 1 and meningoencephalitic stage 2. Even treatments were proposed. During World War I, specific services and mobile teams were created to track trypanosomes and treat patients, initiating modern epidemiology. In 1960, HAT was virtually eliminated from intertropical Africa. However, political and military unrest impeached surveillance and, in the 1990s, a new epidemic wave burst out. In recent years, new biological tests were designed to elaborate field-adapted diagnosis and staging tools. Nevertheless, diagnosis still relies on direct microscopic trypanosome detection or after concentration techniques. Staging is based on trypanosome detection in the cerebrospinal fluid (CSF) or CSF white blood cell (WBC) counts (stage 1, no trypanosome, WBC counts ≤ 5/µL; stage 2, trypanosomes, WBC counts ≥ 20/µL; T. b. gambiense HAT intermediate stage, between these thresholds and no trypanosome). Staging is vital: stage 1 treatment with pentamidine (T. b. gambiense) or suramine (T. b. rhodesiense) is well tolerated, but stage 2 requires toxic drugs (melarsoprol, especially for rhodesiense HAT; eflornithine or nifurtimox–eflornithine combination therapy, NECT, for gambiense HAT).

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Acknowledgments

Part of the work received support from the Technical Services Agreement # T7/83/2 of the World Health Organization (2005–2006), from the “Action de recherche en réseau: Le syndrome du cycle veille-sommeil dans la trypanosomiase humaine africaine: méthode noninvasive de diagnostic du stade de la maladie, de validation de tests biologiques et de suivi de traitement” of the Agence universitaire de la Francophonie (2005–2006), and mainly from the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) No A50468 “Polysomnography, electrochemistry, immunology & neuroanatomy to the diagnosis of Human African Trypanosomiasis” (2006–2009).

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Authors and Affiliations

  1. Polyclinic Marie-Louise Poto-Djembo, B.P. 49, Pointe-Noire, Congo

    Alain Buguet

  2. Centre de recherché en neuroscience de Lyon, University of Lyon, Lyon, France

    Raymond Cespuglio

  3. Laboratory of Parasitology, Dupuytren University Hospital of Limoges, Limoges, France

    Bernard Bouteille

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  1. Alain Buguet
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  2. Raymond Cespuglio
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  3. Bernard Bouteille
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Correspondence to Alain Buguet .

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Editors and Affiliations

  1. Department of Neurology, New Jersey Neuroscience Institute JFK Medical Center, Edison, New Jersey, USA

    Sudhansu Chokroverty

  2. Department of Neurology, Gui de Chauliac Hospital, Montpellier, France

    Michel Billiard

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Buguet, A., Cespuglio, R., Bouteille, B. (2015). African Sleeping Sickness. In: Chokroverty, S., Billiard, M. (eds) Sleep Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2089-1_21

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  • DOI: https://doi.org/10.1007/978-1-4939-2089-1_21

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