Dermatology - Human African Trypanomiasis

Dermatology - Human African Trypanomiasis 
Ninety-five percent of reported cases of sleeping sickness in West Africa are caused by Trypanosoma brucei gambiense. East African sleeping sickness is caused by Trypanosoma brucei rhodesiense.
The tse-tse fly is the vector. The main source of West African sleeping disease is humans; antelopes and cattle are the principal carriers of East African sleeping sickness, which affects about 66 million people. Ivory Coast and Chad are in West Africa; laborers in wild regions, rural populations, and tourists are in Central African Republic; and tourism is prevalent in East Africa.

Trypanosomeal chancre at the injection site, painful; stage I illness. 3-5 cm indurated; ulcerate possible. Parasites in fluid expressed from lesion. Fever, lymphadenopathy, arthralgia, malaise, facial edema, and splenomegaly.
The East African variety has a faster course. Arrhythmias and congestive heart failure are also present.
Stage II disease: neurological symptoms.somnolence and  indifference.

Melarsoprol, eflorithine, and pentamidine. When treating advanced illness, difluoromethylornithine