1. Ankita Desai HUMAN AFRICAN TRYPANOSOMIASIS (SLEEPING SICKNESS)

2. Disease2007 US$2008 US$2008 Nominal US$2007%2008% 2007 Rank 2008 Rank HIV/AIDS1,083,018,1931,164,882,5511,215,841,70842.339.411 Malaria468,449,438541,746,356565,985,82718.3 22 Tuberculosis410,428,697445,927,582467,538,63516.015.133 Kinetoplastids125,122,839139,207,962145,676,5174.94.744

3. Kinetoplastids include Sleeping sickness. Approximately 400 million people are at risk of contracting a kinetoplastid disease.

4. Distribution of funds for sleeping sickness

5.  Human African Trypanosomiasis = “sleeping sickness”  Early stage vs. late stage WHAT IS HAT?

6.  Tsetse fly is a vector HOW DOES ONE CONTRACT HAT?

7.  Trypanosoma brucei gambiense – chronic  Trypanosoma brucei rhodesiense – acute; infects cattle and humans WHAT CAUSES DISEASE?

8.  Nucleus  Kinetoplast (circular DNA inside mitochondrion)  Flagella for movement STRUCTURE OF TRYPANOSOME

9. TRANSMISSION/THE PARASITE’S LIFE CYCLE

10.  36 African countries & ~ 60 million people at risk in 1996.  WHO estimate: b/w 50,000 and 70,000 people are infected. WHO DOES IT AFFECT?

11.  HAT mainly affects the most productive age group (15 to 45 years).  At risk if near/on:  forest trails  water collection points in forests  Riverbanks  forest edges surrounding plantations  Flies are attracted by large moving objects and by CO 2 which is why they often feed on animals and humans WHO IS MOST SUSCEPTIBLE?

12.  Look for inflammation of the brain and its covering, the meninges  Tests include the following:  Blood smear  Cerebrospinal fluid tests  Complete blood count (CBC)  Lymph node aspiration HOW TO DETECT HAT

13.  drug treatment  Melarsoprol  Eflornithine (T. gambiense only)  Nifurtimox (used with Eflornithine) HOW CAN WE CURE INFECTED PERSONS?

14. PROBLEM OF RELAPSE AND POTENTIAL DRUG RESISTANCE Year Total NorthernCentralSouthern No. treated No. (%) relapsed No. treated No. (%) relapsed No. treated No. (%) relapsed No. treated No. (%) relapsed 200170890 (12.7)1,154284 (24.6)50646 (9.1)2,368420 (17.7) 200257256 (9.8)799180 (22.5)13536 (26.7)1,506272 (18.1) 200336257 (15.7)570171 (30.0)11939 (32.8)1,051267 (25.4) Total1,642203 (12.4)2,523635 (25.2)760121 (15.9)4,925959 (19.5) Melarsoprol relapse rates in second-stage human African trypanosomiasis patients, Equateur Nord Province, 2001–2003

15.  WHO suggests supplying people with tsetse fly traps HOW CAN THE DISEASE BE PREVENTED?

16. QUESTIONS?