Sleeping sickness

Sleeping sickness (human African trypanosomiasis) is a parasitic infection found in sub-Saharan Africa and is transmitted by the tsetse fly.

What is it?

Sleeping sickness or human African trypanosomiasis is transmitted by the bite of the tsetse fly. Over 90% of cases are caused by the parasite Trypanosoma brucei gambiense (Tbg), causing severe neurological disorders.

During the first phase of the disease, people have nonspecific symptoms such as fever and general weakness. At this stage, the disease is difficult to diagnose but relatively easy to treat. The second phase is reached when the parasite reaches the central nervous system. Infected people start to show psychiatric or neurological disorders, such as lack of coordination, confusion or convulsions. They may also have difficulty sleeping at night and beat them sleep during the day.

How is it diagnosed?

To detect trypanosomiasis is necessary to make a series of parasitological and serological tests in blood sometimes complemented with lymph node aspirates.

In some cases, you also need to do a lumbar puncture, cerebrospinal fluid extract and determine at what stage of the disease is to give the patient the best treatment. Diagnosis is complex, requires specific equipment and trained personnel.

How is it treated?

In phase one of the disease pentimidina is used, a drug that is administered intramuscularly for seven days and outpatient. The treatment is quite effective and low toxicity.

The best treatment for stage two is a combination therapy of oral nifurtimox and intravenous eflornithine, known as NEER. In 2009, the World Health Organization NEER included in the list of essential medicines. Before there was this new treatment option, most patients were treated with eflornithine monotherapy (to be administered four times a day intravenously for 14 days) or melarsoprol (a derivative of arsenic, very toxic and less effective) . The NEER is as effective as treatment with eflornithine monotherapy, with the advantage of requiring far fewer injections and shorter hospital stay (just seven days).

Currently, the NEER is used in most endemic countries to treat the disease stage two. In some countries such as Central African Republic, although treatment is used in the field, national protocols have not yet been adapted to this reality.

Why forgotten?

Historically sleeping sickness has beaten the poorest rural areas of Africa, where weak health systems and political instability have hindered the epidemiological control and treatment of the sick.

Although the disease is brought under control in the sixties, the late seventies, and largely due to conflicts in Africa expanded again.

MSF’s achievements

Since 1986, MSF has been a pioneer in the diagnosis and treatment of sleeping sickness, especially in war zones. Between 1986 and 2010, MSF has been tested for the disease to 2.8 million people and has treated 51,000 cases in seven countries (Uganda, South Sudan, Central African Republic, Congo, Democratic Republic of Congo, Chad and Angola ).

MSF currently runs projects for diagnosis and treatment of sleeping sickness in Central African Republic (bordering Chad), Democratic Republic of Congo, Uganda and South Sudan. In 2010, teams were testing to 123,000 people and 1,197 patients treated.

In 2011, MSF admitted 1,400 new patients for sleeping sickness treatment

New treatment

In 2009, a new treatment option called NECT (Nifurtimox-Eflornithine Combination Therapy) was added to the World Health Organization’s Essential Medicines List, based on the application submitted by the non-profit Drugs for Neglected Diseases initiative (DNDi) and supported by Epicentre and MSF.

Some studies have demonstrated that NECT, a co-administration schedule of oral nifurtimox and intravenous eflornithine, is a better treatment option for people with advanced-stage sleeping sickness, because it is safer than melarsoprol and easier to use than eflornithine.


Better diagnostic tests adapted to remote areas that are affordable and easy to use (ideally rapid tests) and better treatment options, as well as epidemiological surveillance systems.

“The NEER offers patients in stage two of sleeping sickness new improved treatment. However, it still is not ideal because it requires injections and qualified health personnel. DNDi remains committed to further research for innovations that meet the real needs of these neglected patients. ” Pécoul Bernard, executive director of DNDi (Drugs for Neglected Diseases initiative)

There are no reliable data on the number of people affected by sleeping sickness. If left untreated, is fatal.




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