Trypanosomiasis: Meningoencephalopathic stage

In the meningoencephalopathic stage there is a progression over 3-6 months, ending in death. Personality changes increase and the patient usually loses interest in his/her surroundings. Psychosis sometimes occurs. The patient develops tremor, paraesthesia, increased sensitivity to pain, gait disorders, speech­ difficulties and reversal of the diurnal wake/sleep rhythm. Ataxic dyskinesia is present in most patients. Basal ganlia involvement can produce clinical features which overlap with those of Parkinson's disease. Weight loss and endocrine abnormalities with e.g. impotence are common. Damage to the hypothalamus (paraventricular and supraoptic nuclei) may lead to disturbance of the normal sleep pattern. The patient progressively deteriorates and develops stupor (sleeping sickness!). The patient can still be woken up, but will quickly go “back to sleep” again. This is finally followed by coma and the patient dies of malnutrition, concomitant infections and destruction of the central nervous system. This disease is not to be confused with neurosyphilis, tuberculosis, AIDS with cerebral toxoplasmosis or cryptococcal meningitis, alcoholism or schizophrenia.

Histopathological changes include leukoencephalitis with demyelinisation and accentuation of the periventricular areas. There is a characteristic infiltration of lymphocytes and plasma cells around cerebral blood vessels (perivascular cuffing).

Category: Medicine Notes