Transcript The Impact and Reduction of Trypanosomiasis Infection

The Impact and Reduction of Trypanosomiasis Infection
within
Sub-Saharan Africa
Rockefeller F. Cooper II, PhD. Student
Walden University
Ph 8165-1
Instructor: 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:
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.
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:
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.
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
Trypanosomiasis) control after 90 years since Carlos Chagas discovery.
Memorias do Instituto Oswaldo Cruz. 1, 103-121.
Grove, A.T. (1990). The Changing Geography of Africa. Oxford, 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:
Legros, D (2002).Treatment for human African Trypanosomiasis-present situation and needs for
research and development. The Lancelet Infectious Diseases. 2, 437-440.
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.
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:
Carlier, Yves (2004). Chagas Disease. Retrieved April 10, 2009, from the
chagaspace group Web site: http://chagaspace.org/eng/chagas/index.htm
Legros, D (2002).Treatment for human African Trypanosomiasis-present
situation and needs for research and development. The Lancelet Infectious
Diseases. 2, 437-440.
symptoms

Human African Trypanosomiasis:

African Animal
Trypanosomiasis:

Infertility

Abortion

Anemia

Weight loss

Intermittent fever
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.
Reference:
Grove, A.T. (1990). The Changing
Geography of Africa. Oxford,
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
the chagaspace group Web site:
http://chagaspace.org/eng/chagas/index.htm
Legros, D (2002).Treatment for human African Trypanosomiasispresent situation and needs for research and development. The
Lancelet Infectious Diseases. 2, 437-440.
Other Control & Methods
 Insecticide
 Traps and Screen
References:
(2004, Oct 19). Trypanosomiasis. Retrieved April 10, 2009, from Public
Health Agency of Canada Web site: http://wwwmicro.msb.le.ac.uk/224/Trypano.html
Moore, A (2004). Human African Trypanosomiasis: a reemerging
public health threat. Washington, D.C: ASM Press.
Treatment
Drugs
Species
Phase
Dosage
Route
Common side
effects
Pentamidine
isethionate
T. gambiense
acute
Suramin sodium
T. gambiense
acute
T. rhodisiense
7-10 doses of
4mg/kg per day
5mg/kg on the 1st day,
10 on the 3rd and 20 on
the 5th,11th, 23rd and
30th
IM
IV
Diarrhea
Dizziness
Headache
Upset stomach
Nausea
Renal failure
Anaphylactic shocks
Signs of neurotoxicity
Severe cutaneous
reactions
Melasoprol
T. gambiense
chronic
3-4 series of 3-4
injections per day
IV
syndrome
T. rhodisiense
Elfornithine
chronic
400mg/kg per day in 4
daily infusions for 1-2
wks.
IV
Diarrhea
Pancytopenia
Convulsion
Hallucination
chronic
400mg/kg per day in 4
daily infusions for 1-2
wks.
Oral
Anorexia
Neurological problems
T. gambiense
Nifurtimox
T. gambiense
T. cruzi
Reactive encephalopathic
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, 437440.
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_trypanosomia
sis.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_trypano
somiasis.htm

(2009). Trypanosomiasis, Africa. Retrieved May 2, 2009, from World Health
Organization Web site: http://www.who.int/topics/trypanosomiasis_african/en/
 Kioy, D., & Jannin , N (2004). Human African Trypanosomiasis. Nature
Reviews Microbiology. 2, 186-187.