Time To Put The African Sleeping Sickness To Bed

A huge collaborative effort of our University of Glasgow has enabled researchers to find that African Trypanosomiasis, more commonly known as African sleeping sickness, is also transmitted by the skin. At first glance this might seem like quite a trivial finding. However, the impacts these results have on diagnosis, treatment, and possible eradication of the sickness are huge.

Never heard of the sickness? That might not be so unusual, however, people have been trying for years to eradicate it and have thus far not managed. And it is highly dangerous – left untreated, it is fatal. Every year it kills thousands. It is a parasitic disease which affects 36 countries in Sub-Saharan Africa where there are tsetse flies that transmit the disease when taking a blood meal.

Usually, treatment is only given to people in whose blood the parasite can be found or who display symptoms. In the first phase, these include bouts of fever, headaches, joint pains, and itching. If that sounds all too familiar you might want to just check up on it, because you certainly don’t want to risk those of the second stage: the more obvious symptoms might disappear, but are replaced by changes of behaviour, sensory disturbance, confusion, messed-up sleeping cycle and bad coordination. And lastly: death.

So this really is something you want to eradicate and treat properly. These findings may help us do precisely that. Due to the toxicity of treatment the WHO policy was to only treat people presenting symptoms. This new research indicates that transmission via the skin may be possible and function as carriers, making it logical to also treat these cases. Not only does this affect who should be treated and how to achieve eradication, but also diagnosis. Clearly testing blood for parasites is not enough: the skin must also be analysed.

Although control efforts have effectively dropped the fatality rate below 10,000 by 2009 for the first time in 50 years, the disease still presented 3796 recorded cases in 2014. If the findings published online in eLife and funded by the Wellcome Trust and Institut Pasteur are used correctly, they may present the breakthrough to eradication.

[Kirsty Campbell]

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