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Signs and symptoms of human African trypanosomiasis (HAT) according to stage, disease form, and affected population

Signs and symptoms of human African trypanosomiasis (HAT) according to stage, disease form, and affected population
Sign or symptom   Gambiense HAT Rhodesiense HAT
First-stage Second-stage First-stage Second-stage
Incubation period Natives 18 months[1] 18 months[1] 1 to 3 weeks A few weeks
Travelers 75% <1 month No data <3 weeks >4 weeks
Chancre Natives <5%[2-4] 0%[5,6] 5 to 26%[7-11] 0[7,12]
Travelers 55.6%[13] 33%[13] 87.9%[13] 75%[13]
Trypanosomal rash Natives 0[2-4] 0[5,6] 0[8,9,11] 0[7,10]
Travelers 22.2%[13] 50%[13] 24.4%[13] 41.7%[13]
Fever (≥37.5°C) Natives 10 to 20%[2-4] 10 to 40%[2-6,14-16] 28 to 90%[7,11] 18 to 37%[7,9,10,12]; 72%[8]
Travelers 88.9%; 55.6% >38.5°C[13] 100%; 50% >38.5°C[13] 100%; 72.7% >38.5°C[13] 91.7%; 50% >38.5°C[13]
Lymphadenopathy Natives 79 to 95%[2-4] 56 to 85%[2-6] 21%[7] 51 to 80%[7-10,12]
Travelers

Generalized 33.3%[13]

Satellite (to chancre) 22%[13]

Generalized 50%[13]

Satellite (to chancre) 50%[13]

Generalized 6.1%[13]

Satellite (to chancre) 30.3%[13]

Generalized 33.3%[13]

Satellite (to chancre) 16.7%[13]
Sleeping disorder Natives

Somnolence 18%

Insomnia 73%[3]

Somnolence 29 to 41%[5,6]

Insomnia 25 to 57%[3,5,17] 		Somnolence 25 to 33%[7,11]

Somnolence 54 to 66%

Insomnia 28 to 64%[7-10,12]
Travelers

Somnolence 0%[13]

Insomnia 28.6%[13]

Somnolence 0%[13]

Insomnia 16.7%[13]

Somnolence 0%[13]

Insomnia 6.7%[13]

Somnolence 16.7%[13]

Insomnia 8.3%[13]
Pruritus Natives 29 to 33%[2,3,18] 17 to 57%[2,3,5,6,18] 0%[7] 6 to 53%[8,10,12]
Travelers 22.2%[13] 16.7%[13] 3%[13] 8.3%[13]
Headache Natives 51 to 80%[2,18] 38 to 79%[2,3,5,6,18,19] 96%[11] 51 to 80%[7,12]
Travelers 55.5%[13] 50%[13] 42.4%[13] 66.7%[13]
Hepatomegaly Natives 1 to 20%[2,3,18] 7 to 17%[3,6] 0 to 40%[7] 6 to 30%[7,12]
Travelers 22.2%[13] 50%[13] 15.6%[13] 25%[13]
Splenomegaly Natives 9 to 27%[2,3,18] 5 to 19%[2,3,6] 0 to 36%[7] 16 to 58%[7,12]
Travelers 55.6%[13] 66.7%[13] 30.3%[13] 8.3%[13]
Tremor Natives 5%[4] 19 to 21%[9,20] 17 to 61%[7] 16 to 67%[7,12]
Travelers 14.3%[13] 0[13] 0[13] 16.7%[13]
Neurological disorder Natives <20%[2,3] 20 to 40%[3,5] <20%[7] 50 to 58%[7,12]
Travelers 25%[13] 33.3%[13] 0%[13] 8.3%[13]
Psychiatric disorder Natives <10% 25%[5] 17%[9] 15 to 22%[7,12]
Travelers 0%[13] 0%[13] 3.3%[13] 8.3%[13]
Kidney impairment Natives Rare[21] Rare[21,22] Unknown[7] Unknown
Travelers 0[13] 0[13] 85%[13] 77.7%[13]
References:
  1. Checchi F, Filipe J, Haydon DT, et al. Estimates of the duration of the early and late stage of gambiense sleeping sickness. BMC Infectious Diseases 2008; 8:16.
  2. Boa YF, Traore MA, Doua F, et al. Les différents tableaux cliniques actuels de la trypanosomiase humaine africaine à T. b. gambiense. Analyse de 300 dossiers du foyer de Daloa, Côte d'Ivoire. [Current clinical presentation of human African trypanosomiasis caused by T. b. gambiense. Analysis of 300 cases from the focus in Daloa, Côte d'Ivoire]. Bulletin de la Société de Pathologie Exotique et de ses Filiales 1988; 81:427.
  3. Bertrand E, et al. Symptomatologie générale de la trypanosomiase humaine africaine au moment du dépistage [General symptomatology of human African trypanosomiasis at the time of detection]. Médecine d'Afrique Noire 1973; 20:303.
  4. Le Bras J, et al. Symptomatology générale de la trypanosomiase humaine africaine de l'enfant [General symptomatology of human African trypanosomiasis in children]. Médecine Tropicale 1977; 37:51.
  5. Blum J, Schmid C, Burri C. Clinical aspects of 2541 patients with second stage human African trypanosomiasis. Acta Tropica 2006; 97:55.
  6. Blum J, Burri C. Treatment of late stage sleeping sickness caused by T. b. gambiense: a new approach to the use of an old drug. Swiss Medical Weekly 2002; 132:51.
  7. MacLean LM, Odiit M, Chisi JE, et al. Focus-specific clinical profiles in human African trypanosomiasis caused by Trypanosoma brucei rhodesiense. PLoS Neglected Tropical Diseases 2010, 4:e906.
  8. Boatin BA, Wyatt GB, Wurapa FK, Bulsara MK. Use of symptoms and signs for diagnosis of Trypanosoma brucei rhodesiense trypanosomiasis by rural health personnel. Bulletin of the World Health Organization 1986; 64:389.
  9. Buyst H. The epidemiology of sleeping sickness in the historical Luangwa valley. Annales de la Société Belge de Medécine Tropicale 1977, 57:349.
  10. Wellde BT, Chumo DA, Reardon MJ, et al. Presenting features of Rhodesian sleeping sickness patients in the Lambwe Valley, Kenya. Annals of Tropical Medicine and Parasitology 1989; 83(Suppl. 1):73.
  11. Mbulamberi DB. A clinical analysis of 3151 cases of Rhodesian sleeping sickness treated in the south eastern Uganda, during the year 1985. In: Proceedings of the 19th Meeting of the International Scientific Council for Trypanosomiasis Research and Control, Lomé, 30 March–3 April 1987. Nairobi, Organization of African Unity/International Scientific Council for Trypanosomiasis Research and Control (Publication No. 114) 1987:188.
  12. Kuepfer I, Hhary EP, Allan M, et al. Clinical Presentation of T. b. rhodesiense sleeping sickness in second stage patients from Tanzania and Uganda. PLoS Neglected Tropical Diseases 2011; 5:e968.
  13. Urech K, Neumayr A, Blum J. Sleeping sickness in travelers: do they really sleep? PLoS Neglected Tropical Diseases 2011; 5:e1358.
  14. Debroise A, Debroise-Ballereau C, Satge P, Rey M. La trypanosomiase africain chez le jeune enfant [African trypanosomiasis in young children]. Archives Français de Pediatrie 1968; 25:703.
  15. Ngandu-Kabeya G. Etude de la symptomatologie de la trypanosomiase africain chez l'enfant (à propos de 24 cas) [Study of the symptomatology of African trypanosomiasis in children (24 cases)]. Annales de la Société Belge de Medécine Tropicale 1976; 56:85.
  16. Edan G. Signes cliniques et biologiques des trypanosomiases à T. gambiense vues au stade d'atteinte méningo-encéphalitique. [Clinical and biological signs of T. gambiense trypanosomiasis at the stage of meningo-encephalitic involvement]. Médecine Tropicale 1979; 39:499.
  17. Ezzedine K, Darie H, Le Bras M, Malvy D. Skin features accompanying imported human African trypanosomiasis: hemolymphatic Trypanosoma gambiense infection among two French expatriates with dermatologic manifestations. Journal of Travel Medicine 2007; 14:192.
  18. Ginoux PY, Frezil JL, Alary JC. La trypanosomiase humaine au moment du dépistage en République Populaire du Congo. Distribution des signes cliniques. [Symptoms of human trypanosomiasis at the time of detection in the People's Republic of Congo]. Médecine Tropicale 1982; 42:281.
  19. Antoine P. Des études neurologiques et psychologiques des malades atteints de la maladie de sommeil et leur évolution [Neurological and psychological studies of patients with sleeping sickness and their course]. Annales de la Société Belge de Medécine Tropicale 1977; 57:227.
  20. Blum J, Nkunku S, Burri C. Clinical description of encephalopathic syndromes and risk factors for their occurrence and outcome during melarsoprol treatment of human African trypanosomiasis. Tropical Medicine and International Health 2001; 6:390.
  21. Bisser S, Bouteille B, Sarda J, et al. Apport des examens biochimiques dans le diagnostic de la phase nerveuse de la trypanosomose humaine africaine. [Contribution of biochemical tests in the diagnosis of the nervous phase of human African trypanosomiasis]. Bulletin de la Societé de Pathologie Exotique 1997; 90:321.
  22. Blum JA, Schmid C, Hatz C, et al. Sleeping glands? - The role of endocrine disorders in sleeping sickness (T.b. gambiense Human African Trypanosomiasis). Acta Trop 2007; 104:16.
Reproduced from: Control and surveillance of human African trypanosomiasis: report of a WHO expert committee, 2013 (WHO Technical Report Series 984), World Health Organization, Copyright © 2013. Available at: https://apps.who.int/iris/handle/10665/95732 (Accessed on July 24, 2020).
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