🦟 Men's Health

African Sleeping Sickness (Trypanosomiasis)

Understanding sleeping sickness in endemic Nigerian communities

Human African Trypanosomiasis (HAT), caused by Trypanosoma brucei and transmitted by tsetse fly bites, is endemic in a number of Nigerian states, particularly in riverine and forested areas of the Middle Belt and South-South regions. While Nigeria is not among Africa's highest-burden countries for HAT, cases do occur and the disease is frequently misdiagnosed. HAT is uniformly fatal if untreated and progresses from a systemic febrile illness to a fatal neurological syndrome. The good news: significant progress has been made towards elimination.

Signs and Symptoms

✓ Stage 1 (haemolymphatic): fever, headaches, lymph node enlargement (Winterbottom's sign — posterior cervical lymphadenopathy), joint pain, itching, malaise

✓ Trypanosomal chancre: an indurated skin lesion at the tsetse bite site appearing days after the bite

✓ Stage 2 (meningoencephalitic): progressive neurological decline — behavioural changes, confusion, sleep disturbance (reversal of sleep-wake cycle — hence 'sleeping sickness'), involuntary movements, coma, and death

✓ The transition from stage 1 to stage 2 can occur weeks to months after infection

Risk Factors

Living or working in riverine, forested, or woodland areas where tsetse flies breed: Cross River, Benue, Kogi, Plateau, and other Middle Belt states
Fishing, farming, or hunting in tsetse fly habitats
Lack of protective clothing in endemic areas
Travel through national parks and game reserves with tsetse flies

When to Seek Help

InvestigateAny person from an endemic area with prolonged fever and lymphadenopathy not explained by malaria, typhoid, or other common infections — consider HAT; report to NCDC or state disease surveillance officer

Neurological symptomsAny person from an endemic area developing sleep disturbance, personality changes, or confusion — stage 2 HAT must be excluded as it requires different, more intensive treatment

Contact NCDCDiagnosis and treatment of HAT in Nigeria is managed through national disease control programmes with WHO support; contact ncdc.gov.ng for referral to specialist centres

Tests & Diagnosis

🧪 Blood thick and thin film

Identifies trypanosomes in blood — most reliable in stage 1 when parasitaemia is higher

🧪 Lymph node aspirate microscopy

Aspiration and microscopy of enlarged lymph nodes — particularly Winterbottom's sign nodes

🧪 Card Agglutination Test for Trypanosomiasis (CATT)

Rapid serological screening test — used in field conditions for mass screening

🧪 CSF examination

Critical for staging — LP shows trypanosomes and white cells in stage 2; WBC >5/mm3 or detectable trypanosomes in CSF = stage 2

🧪 PCR

Highly sensitive molecular test — available at NCDC reference lab

Treatment Options

Stage 1 — Pentamidine

For T. brucei gambiense (West African form): IM pentamidine 4mg/kg daily for 7 days; does not cross the blood-brain barrier so only effective in stage 1

Stage 1 or 2 — Fexinidazole (oral, new treatment)

First fully oral treatment for T. brucei gambiense; effective for both stages; 10-day course; major advance in HAT treatment; being rolled out in endemic countries with WHO support

Stage 2 — Nifurtimox-eflornithine combination therapy (NECT)

Standard treatment for stage 2 T. brucei gambiense; eflornithine IV + nifurtimox oral for 10 days; requires hospital admission

Stage 2 — Melarsoprol (for T. brucei rhodesiense)

East African form; arsenic-based drug; encephalopathic reaction in up to 10% of patients; still used where better alternatives are not available

Prevention

Tsetse fly control (insecticide-treated traps, cattle dipping); protective clothing (long sleeves, trousers) in endemic areas; insect repellents; mass screening in endemic communities

Frequently Asked Questions

How common is sleeping sickness in Nigeria?

Nigeria is not among Africa's highest-burden HAT countries, but sporadic cases occur in the Middle Belt and southern states where tsetse flies are present. The true burden is likely underestimated due to limited diagnostic capacity and case reporting.

Is HAT the same as malaria?

No — HAT (sleeping sickness) and malaria are completely different diseases caused by different parasites and different mosquito and fly vectors. Both cause fever, but HAT's lymphadenopathy (swollen neck glands) and progressive neurological decline distinguish it.

Can sleeping sickness be cured?

Yes — if detected in stage 1, treatment success approaches 100%. Stage 2 is harder to treat but new drugs (fexinidazole) have significantly improved outcomes. Untreated HAT is invariably fatal.

Where can sleeping sickness be diagnosed and treated in Nigeria?

Diagnosis and treatment are managed through NCDC and state disease surveillance systems with WHO support. The Federal Medical Centre, Makurdi (Benue State) and other tertiary hospitals in endemic states have diagnostic capability. Contact NCDC for specialist referral.

Is there a vaccine against HAT?

No vaccine is currently available for HAT. Prevention focuses on vector control and early detection through community screening programmes.