A disease caused by trypanosomes (a protozoa) and transmitted to humans by several species of tsetse fly


  • Trypanosoma rhodesiense (mostly in the Central and Eastern regions of Uganda)
  • Trypanosoma gambiense (mostly in West Nile region)

Clinical features

  • May be history of tsetse fly bite and swelling at site of bite after 7-14 days (more often in T. rhodesiense, rarely in T. Gambiense)

T. Rhodesiense

  • Incubation is 2-3 weeks
  • Early stage (haemolymphatic stage): headache not responding to common analgesics, fever, generalised lymphadenopathy, joint pains
  • Late stage (meningoencephalitis stage): after some weeks, neurological and psychiatric symptoms like apathy, day sleepiness, paralysis, seizures
  • If not treated: cachexia, lethargy, coma and death within 3-6 months

T. gambiense

  • Similar to the rhodesiense but less acute and with slower progression
  • Incubation can last several years

Differential diagnosis

  • Malaria, meningitis


  • Blood: Slides for trypanosomes
  • CSF: For trypanosomes, lymphocyte count
  • Aspirate from chancre/lymph node: for trypanosomes


This is based on the findings of the CSF analysis, determining the stage of disease. To determine the medicine of choice, the disease is divided into two stages: early and late stage

Early (first)
  • CSF is normal
  • Lymphocytes <5 cells/mm3
  • Total protein <37 mg/dl (by dye-binding
    protein assay) or < 25 mg/dl (by Double
    Standard & Centrifuge Method)
    yy Absence of trypanosomes (by Double
    Standard and Centrifuge Method)
Late (second)
  • Lymphocytes > 5 cell/ mm3
  • Presence of trypanosomes

Patient with suspected or diagnosed sleeping sickness
should be managed at referral facilities.


Early (first) stage

T. rhodesiense sleeping sickness
For both children and adults

  • Suramin IV
    • A test dose of 5 mg/kg of body weight should first be administered to test for anaphylactic reaction
    • Followed by five injections of 20 mg/kg every 5 days interval
      1. Day 0: 5 mg/kg body weight
      2. Day 3: 20 mg/kg body weight
      3. Day 8: 20 mg/kg body weight
      4. Day 13: 20 mg/kg body weight
      5. Day 18: 20 mg/kg body weight
      6. Day 23: 20 mg/kg body weight

If anaphylaxis: do not administer

T. gambiense sleeping sickness

For both children and adults

  • Pentamidine IM 4 mg/kg daily for 7 days
    • Give food 1 hour before to prevent hypoglycaemia
    • The patient should be in a supine position during administration and 1 hour after to prevent hypotension

Late (second) stage

T. rhodesiense sleeping sickness
For both children and adults

  • IV Melarsoprol 2.2 mg/kg body weight daily for 10 days

T.gambiense sleeping sickness
Children ≤ 12 years and <35 kg

  • Eflornithine IV 150 mg/kg 6 hourly for 14 days (total dose of 600 mg/kg/day. Dilute 150 mg/kg dose of eflornithine into the 100 ml of distilled
    water. Administer the infusion over at least 2 hours

Children >12 years up to 15 years

  • Eflornithine IV 100 mg/kg 6 hourly for 14 days (total dose of 400 mg/kg per day). Dilute the eflornithine dose of 100 mg/kg into the 100 ml of
    distilled water. Administer the infusion over at least 2 hours (rate 20 drops/minute)

Adults >15 years

  • Nifurtimox/Elfornithine combination therapy (NECT)
  • Nifurtimox: 5 mg/kg every 8 hours orally for 10 days (15 mg/kg/day)
  • Plus Eflornithine 200 mg/kg 12 hourly for 7 days (400 mg/kg/day). Dilute Eflornithine dose of 200 mg/kg into 250 ml of distilled water and
    administer the infusion over at least 2 hours (50 drops/minute)
  • Infusions are given slowly to prevent convulsions
  • IV melarsoprol 2.2 mg/kg once daily for 10 days


  • Corticosteroids: Should be given to patients with late trypanosomiasis on melarsoprol who may have hypoadrenalism – the steroids may also reduce any drug reactions
  • Do not give hydrocortisone after day 24, even though the melarsoprol treatment is not yet complete If prednisolone is used instead of hydrocortisone, the anti-inflammatory action is similar but the correction of
    the hypoadrenalism will be much less marked
  •  Suramin: Do not use this medicine for early or late stage
    T. gambiense treatment in onchocerciasis-endemic areas as it may cause blindness in any onchocerciasis-infected patients by killing the filariae in the eye


  • Trapping of tsetse flies
  • Clearing of bushes around homes and paths
  • Early detection and treatment of cases