Neglected tropical diseases: Can ‘sleeping sickness’ be eliminated by 2020?

Neglected tropical diseases (NTDs) are associated with the poorest populations and rarely affect those in developed countries [1]. They affect more than 1.4 billion people in 149 developing countries, where there is insufficient development into new diagnostic tools and drugs [2].

Human African Trypanosomiasis, or sleeping sickness, is a neglected parasitic disease transmitted through bites of male and female tsetse flies. The parasite Trypanosoma brucei gambiense causes 95% of reported cases of sleeping sickness and causes a chronic infection. There are two stages to the disease. In the first stage, the parasites multiply in tissue, blood and lymph causing fever, headaches and joint pains. This is followed by a second stage, which infects the central nervous system (CNS) causing poor coordination and confusion. This leads to disturbances in the sleep cycle. Without treatment, the disease is fatal.

Sleeping sickness threatens millions of people in Sub-Saharan Africa who have limited access to health services. Unfortunately, the devastating social and economical impact this neglected disease has is underestimated. The parasite mainly affects people aged 15-45: the most active age group who are more likely to come into contact with tsetse flies by fetching water or collecting firewood [3].

However, in the last ten years, 23 of the 36 endemic countries have had staff training on diagnosis and treatment, and access and availability of safe and simple treatment has been improved.

The World Health Organisation (WHO) plan to eliminate sleeping sickness as a public health problem by 2020 by continuous surveillance of at risk populations, reduction of animal reservoirs and tsetse fly control. However, treatment can be difficult. In the early stage of the disease, the drug is easy to administer and is of low toxicity. The later stage relies on drugs crossing the blood-brain barrier. These drugs can be very toxic and difficult to administer. Therefore, diagnosis should be made as early as possible before the parasite reaches the CNS.

References

[1] World Health Organisation (2015) Neglected Tropical Diseases. Available from: http://www.who.int/neglected_diseases/diseases/en/

[2] BRUN, R., BLUM, J., CHAPPUIS, F. & BURRI, C. (2010) Human African Trypanosomiasis. The Lancet. 375(9709):148-159

[3] World Health Organisation (2015) Human African Trypanosomiasis. Available from: http://www.who.int/trypanosomiasis_african/en/

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Madison Dunn

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