The Impact and Reduction of Trypanosomiasis Infection within

Sub-Saharan Africa

Rockefeller F. Cooper II, PhD. StudentWalden University

Ph 8165-1Instructor: Dr. Shana Morrell

Spring, 2009

Stakeholders

The Government of Liberia:

Ministry of Health

Monrovia City Hall Corp

Learning Objectives What is trypanosomiasis?

What causes it and how is it transmitted?

Who is at risk?

What are the symptoms?

How do we prevent it?

How do we control it?

How do we treat it?

Understanding the etiology and geography.

Outline I

Introduction

African Trypanosomiasis

Etiology of African Trypanosomiasis

Geographical Distribution

Mode of Transmission

Symptoms Human African Trypanosomiasis African Animal Trypanosomiasis

Outline II

Prevention A-B-C Method

Control use of insecticide traps and screens

Treatment References

Introduction I

Trypanosomiasis is commonly known as “sleeping sickness”(Dias, 1999).

In cattle and other domestic animals, the disease is referred to as Nagana (Dias,1999).

Approximately, 66 million people are victims (Dias,1999).

Reference:Reference: Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis)

control after 90 years since Carlos Chagas discovery. control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Memorias do Instituto Oswaldo CruzCruz. . 11, 103-121., 103-121.

Introduction II

Acute and chronic phase.

Origin was unknown as caravanners noticed prevailing symptoms of the disease (Dias,1999).

The disease infiltrated the western, eastern and southern parts of Africa

Colonial masters organized campaigns to prevent and control trypanosomiasis.

This effort turned out to be successful due to the use pentamidine, and

agronol prevention (Dias,1999).

Reference:Reference: Dias, J.C.P (1999). The evolution of Chagas disease (American Dias, J.C.P (1999). The evolution of Chagas disease (American

Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo CruzMemorias do Instituto Oswaldo Cruz. . 11, 103-121., 103-121.

Introduction III

Trypanosomiasis was suppressed but reemerged after African countries started to obtain their independence. as they could not maintained the financial burden of suppressing the disease (Dias,1999).

Trypanosomiasis causes economical instability due to death infliction on cattle as a result of anemia, loss of condition and emaciation.

Disease is caused by: Trypanosoma congolense, Trypanosoma vivax and Trypanosoma brucei brucei.

(Grove, 1990).

References:

Dias, J.C.P (1999). The evolution of Chagas disease (American Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo CruzMemorias do Instituto Oswaldo Cruz. . 11, 103-121., 103-121.

Grove, A.T. (1990). Grove, A.T. (1990). The Changing Geography of AfricaThe Changing Geography of Africa. Oxford, . Oxford, England: Oxford University Press.England: Oxford University Press.

Etiology of African Trypanosomiasis

(2008,Dec 5). African Trypanosomiasis. Retrieved May 1, 2009, from CDC Web site: http://www.dpd.cdc.gov/dpdx/html/TrypanosomiasisAfrican.htm

Geographical Distribution

African Trypanosomiasis: Tsetse flies are between latitude 15 0 North and 20 0 South.

Central and West Africa serves as host to the Trypanosoma brucei gambiense, which is the most common causal agent of the disease.

In East and Southern Africa, there is the Trypanosoma brucei Rhodesiense.

Reference:Reference: Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for

research and development. research and development. The Lancelet Infectious DiseasesThe Lancelet Infectious Diseases. . 22, 437-440., 437-440.

Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) Dias, J.C.P (1999). The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery. control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Memorias do Instituto Oswaldo CruzCruz. . 11, 103-121., 103-121.

Mode of Transmission

Human African Trypanosomiasis: Glossina are the vectors

African Animal Trypanosomiasis: The vectors are Glossina palpalis, Glossina fusca and Glossina morsitans Other vectors are of the genus Tabanus, Haematopota, Chrysops, Liperosia and Stomoxys

References:References:

Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htmchagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm

Legros, D (2002).Treatment for human African Trypanosomiasis-present Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for research and development. situation and needs for research and development. The Lancelet Infectious The Lancelet Infectious DiseasesDiseases. . 22, 437-440., 437-440.

symptoms Human African Trypanosomiasis:

Chancre develops from bite.

Other manifestations are: fever rash severe headache severe fatigue painful muscles and joints Edema around eyes and hand Winterbottom’s sign weight loss

Reference: Moore, A (2004). Human African

Trypanosomiasis: a reemerging public health threat. Washington, D.C: ASM Press.

African Animal Trypanosomiasis:

Infertility

Abortion

Anemia

Weight loss

Intermittent fever

Reference: Grove, A.T. (1990). Grove, A.T. (1990). The Changing The Changing

Geography of AfricaGeography of Africa. Oxford, . Oxford, England: Oxford University Press.England: Oxford University Press.

Prevention

A-B-C Method: Awareness of Risk Bite Avoidance

Chemoprophylaxis

References: Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from

the chagaspace group Web site: the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htmhttp://chagaspace.org/eng/chagas/index.htm

Legros, D (2002).Treatment for human African Trypanosomiasis-Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for research and development. present situation and needs for research and development. The The Lancelet Infectious DiseasesLancelet Infectious Diseases. . 22, 437-440., 437-440.

Other Control & Methods

Insecticide

Traps and Screen

References:References:

(2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public (2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public Health Agency of Canada Web site: Health Agency of Canada Web site: http://www-micro.msb.le.ac.uk/224/Trypano.htmlhttp://www-micro.msb.le.ac.uk/224/Trypano.html

Moore, A (2004). Moore, A (2004). Human African Trypanosomiasis: a reemerging Human African Trypanosomiasis: a reemerging public health threatpublic health threat. Washington, D.C: ASM Press.. Washington, D.C: ASM Press.

Treatment

DrugsDrugs SpeciesSpecies PhasePhase DosageDosage RouteRoute Common side Common side

effectseffects Pentamidine Pentamidine isethionate isethionate T. gambienseT. gambiense acuteacute 7-10 doses of 7-10 doses of

4mg/kg per day4mg/kg per day IMIM DiarrheaDiarrhea

DizzinessDizziness

HeadacheHeadache

Upset stomachUpset stomach

NauseaNausea

Suramin sodium Suramin sodium T. gambienseT. gambiense

T. rhodisiense T. rhodisiense

acuteacute 5mg/kg on the 1st day, 5mg/kg on the 1st day, 10 on the 3rd and 20 on 10 on the 3rd and 20 on the 5th,11th, 23rd and the 5th,11th, 23rd and 30th 30th

IVIV Renal failureRenal failure

Anaphylactic shocksAnaphylactic shocks

Signs of neurotoxicitySigns of neurotoxicity

Severe cutaneous Severe cutaneous

reactionsreactions Melasoprol Melasoprol T. gambienseT. gambiense

T. rhodisienseT. rhodisiense chronicchronic 3-4 series of 3-4 3-4 series of 3-4

injections per day injections per day IVIV Reactive encephalopathic Reactive encephalopathic

syndromesyndrome

Elfornithine Elfornithine T. gambienseT. gambiense chronicchronic 400mg/kg per day in 4 400mg/kg per day in 4

daily infusions for 1-2 daily infusions for 1-2 wks. wks.

IVIV DiarrheaDiarrhea

PancytopeniaPancytopenia

ConvulsionConvulsion

HallucinationHallucination

Nifurtimox Nifurtimox T. gambienseT. gambiense

T. cruziT. cruzi chronicchronic 400mg/kg per day in 4 400mg/kg per day in 4

daily infusions for 1-2 daily infusions for 1-2 wks. wks.

OralOral AnorexiaAnorexia

Neurological problems Neurological problems

What have we learned ?

The nickname for trypanosomiasis is “sleeping sickness”.

It is an infectious disease that can be transmitted by the tsetse fly.

Two phases are involved.

Infection is specie specific with regards to the geography.

Transmission of the disease into humans and animals are not of the same species as symptoms vastly differs as well.

Prevention using the “ABC Method” as well as traps, screen and insecticide.

Different types of drugs.

References

"American Trypanosomiasis of Chagas Disease." Public Health Agency of Canada. 13 June 2001. Public Health Agency of Canada. Retrieved April 10, 2009, from

http://www.phac-aspc.gc.ca/tmp-pmv/info/am_trypan_e.html.

Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm

Dias, J.C.P (1999). The evolution of Chagas disease (American trypanosomiasis) control after 90 years since Carlos Chagas discovery. Memorias do Instituto Oswaldo Cruz. 1, 103-121.

Dias, J.C.P (1992). Epidemiology of Chagas disease. Retrieved October 5, 2006, from Foreign Animal Diseases Web site:

http://www.dbbm.fiocruz.br/tropical/chagas/chapter4.html

Grove, A.T. (1990). The Changing Geography of Africa. Oxford, England: Oxford University Press.

Legros, D (2002).Treatment for human African trypanosomiasis-present situation and

needs for research and development. The Lancelet Infectious Diseases. 2, 437-440.

References II

Mare, C.J. (1998). Foreign animal diseases. Retrieved April 10, 2009, from The Gray Book Web site: http://www.vet.uga.edu/VPP/gray_book/FAD/index.htm

Mare, C.J. (1998). In foreign animal diseases. Richmond, VA: United States Animal Health Association.

Moore, A (2004). Human African Trypanosomiasis: a reemerging public health threat. Washington, D.C: ASM Press.

Stich, A (2002).Human African Trypanosomiasis. BMJ. 325, 203-06.

Trail, J.C.M (1985). Productivity of Boran cattle maintained by chemoprophylaxis under Trypanosomiasis risk. Retrieved April 10, 2009, from Economic trade-offs between milk and meat production Web site: http://www.fao.org/wairdocs/ILRI/x5527E/x5527e00.HTM

(2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public Health Agency of Canada Web site: http://www-micro.msb.le.ac.uk/224/Trypano.html

(2006, Feb 8). West African Trypanosomiasis. Retrieved April 8, 2009, from Division of parasitic Diseases Web site: http://www.cdc.gov/NCIDOD/dpd/parasites/trypanosomiasis/factsht_ea_trypanosomiasis.htm

Bibliography for further reading

Cooper, Rockefeller (2007). Prevention and Control of Selective Tropical Diseases. Baltimore, MD: Publish America

(2008,June 8). West African Trypanosomiasis. Retrieved May 2, 2009, from CDC Web site: http://www.cdc.gov/ncidod/dpd/parasites/trypanosomiasis/factsht_wa_trypanosomiasis.htm

(2009). Trypanosomiasis, Africa. Retrieved May 2, 2009, from World Health (2009). Trypanosomiasis, Africa. Retrieved May 2, 2009, from World Health Organization Web site: http://www.who.int/topics/trypanosomiasis_african/en/ Organization Web site: http://www.who.int/topics/trypanosomiasis_african/en/

Kioy, D., & Jannin , N (2004). Human African Trypanosomiasis. Kioy, D., & Jannin , N (2004). Human African Trypanosomiasis. Nature Reviews MicrobiologyNature Reviews Microbiology. . 22, 186-187. , 186-187.