Clinical Review

Human African trypanosomiasis

BMJ 2002; 325 doi: (Published 27 July 2002) Cite this as: BMJ 2002;325:203
  1. August Stich, group leader, clinical tropical medicine (,
  2. Paulo M Abel, national coordinatorb,
  3. Sanjeev Krishna, professor of molecular parasitology and medicinec
  1. aMedical Mission Institute, Department of Tropical Medicine and Epidemic Control, D-97074 Würzburg, Germany
  2. bAngotrip Project, Caritas Luanda, Angola
  3. cDepartment of Infectious Diseases, St George's Hospital Medical School, London SW17 0RE
  1. Correspondence to: A Stich
  • Accepted 6 June 2002

The re-emergence of sleeping sickness presents a major public health problem

Human African trypanosomiasis or sleeping sickness is one of the most important but equally most neglected tropical infections. It is caused by a protozoan, Trypanosoma brucei,which is transmitted to humans through the bite of a tsetse fly (Glossinaspp).1 Patchy distribution of the various vector species confines the disease to some 200 microfoci in sub-Saharan Africa (fig 1). The disease had been successfully controlled by a combination of approaches, including treatment of patients, active case finding, and measures to deal with the vector.2 Since the 1970s, however, the disease has re-emerged as a new epidemic of immense proportions, which, until recently, received little attention from the international community (fig 2). According to the World Health Organization, about 500 000 people already carry trypanosomes and will die if left untreated.3

Summary points

Human African trypanosomiasis is a re-emerging public health problem of epidemic proportions in many parts of rural Africa

The disease is caused by subspecies of Trypanosoma brucei and is transmitted by tsetse flies

Treatment requires admission to hospital and is costly, potentially dangerous, and limited by the widespread appearance of drug resistances

Investment in clinical and pathophysiological research and a broad international commitment to fight trypanosomiasis in Africa are urgently needed

Fig 1

Distribution of human African trypanosomiasis in sub-Saharan Africa

Sources and methods

Extensive literature exists on human African trypanosomiasis and trypanosomes, but it is mostlyconfined to basic sciences and neglects clinical research and the impact of the disease on large parts of the population in rural Africa. One of the countries most affected is Angola. In the north, local health professionals are involved in a control programme implemented through the Catholic charity, Caritas. Some 14 000 patients have already been treated and more than 100 000 examined for the …

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