Human African Trypanosomiasis

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General notes

Human African Trypanosomiasis (HAT) is caused by the protozoa of the genus trypanosoma that is transmitted by the bite of tsetse fly in sub­ Saharan Africa. The disease is also known as sleeping sickness and has been reported from remote areas, mainly from the game parks in Mashonaland Central, Mashonaland West and Matebeleland North.

There are two forms of HAT:

• Trypanosoma brucei rhodisiense - found in East and Southern Africa
• Trypanosoma brucei gambiense - found mainly in Central and West

Clinical Presentation has 2 phases

Acute haemolymphatic phase: presentation is with episodic bouts of fever, headache, joint pains, pruritis and anorexia. An eschar, "bite site" may be present together with local lymphadenopathy.

Delayed Neurological phase: when the parasite crosses the blood brain barrier it causes neurological signs and symptoms of sleep cycle disturbance, confusion, behavioural changes and poor coordination.

Refer all cases of Human African trypanosomiasis for specialist care. Acute haemolymphatic phase cases are to be referred to the two Provincial hospitals Chinhoyi and Bindura. All cases should be referred to Harare Central Hospital for further management.

Suramin is the medicine of choice for the acute haemolymphatic phase.

	Medicine	Adult Dose	Frequency	Duration
	suramin iv	4-5mg/kg	once	on day 1 as test dose
then		20mg/kg	on day 1,3,7,14,21

Melarsoprol is required if the patient progresses to the neurological phase.

Medicine	Adult Dose	Frequency	Duration
melarsoprol iv	2.16mg/kg/day for 10 consecutive days