The tse tse fly, the insect behind the sleeping sickness

When you are relaxing, it can be quite annoying to see flies flying around you. Although it is not dangerous at first glance, it turns out that there are types of flies that can bite and carry infectious diseases. One of them is the Tse Tse fly, which is the cause of sleeping sickness or sleeping sickness.

What is a Tse Tse fly?

The tse tse fly is a type of fly that can transmit the sleeping sickness parasite sleeping sickness. These flies are found on the African continent, especially in sub-Saharan Africa.

The Tse Tse fly has a body characterized by yellow-brown color, and measures about 6-14 mm. The distinctive feature that distinguishes the Tse Tse fly from the common fly is that it has a needle-like muzzle on its head.

With this needle-shaped muzzle, the Tse Tse fly can bite other living things, including humans. From these fly bites, parasites that cause various diseases can be transmitted, such as sleeping sickness.

This fly likes places with lots of plants and trees. Usually, Tse Tse flies are found nesting in rainforests which flow by rivers.

How can the Tse Tse fly cause sleeping sickness?

Dangerous insect bites can indeed carry various diseases. Some of these include malaria and chikungunya, which are caused by mosquito bites.

However, not only mosquito bites can carry infectious diseases, but also bites from certain types of flies. The Tse Tse fly is the mastermind behind the transmission of sleeping sickness, or what has another name sleeping sickness and human African trypanosomiasis.

Actually, what is sleeping sickness? This disease is caused by a type of parasitic infection Trypanosoma, and can affect the human lymph nodes, nervous system, and even the brain.

This disease is mostly found on the African continent, where the Tse Tse fly originated. According to WHO, more than 60 million people living in the East, West and Central Africa region are at risk of developing sleeping sickness.

Fortunately, the number of new cases of this disease has decreased by 95% from 2000-2018. Therefore, WHO is working to eradicate this disease completely, until the incidence of cases is expected to reach 0 by 2030.

Sleeping sickness consists of 2 phases, namely:

• Hemolymphatic phase
  After the fly bites the human body, it parasites Trypanosoma will enter and multiply in the blood and lymph nodes. The incubation period required by parasites to cause symptoms usually varies, from a few days, months, to years.

• Meningoencephalitic phase
  Over time, these parasites can spread to the brain and attack the human central nervous system. This condition is quite dangerous and requires medical attention as soon as possible.

Types of sleeping sickness

Sleeping sickness itself can be divided into 2 types, depending on the type of parasite Trypanosoma which causes it, namely:

• Trypanosoma brucei gambiense
  Parasite types Trypanosoma brucei gambiense found in 24 countries in West and Central Africa. Parasite T. brucei gambiense is the cause of 98% of cases of sleeping sickness and can cause symptoms of chronic infection. A person infected with this type of parasite through the bite of a Tse Tse fly may not experience any symptoms for months, even years. If symptoms appear, it means that sleeping sickness is in a severe phase and affects the sufferer's central nervous system.
• Trypanosoma brucei rhodesiense
  This type of parasite is found in 13 countries in East and South Africa. Trypanosoma brucei rhodesiense is found in 2% of cases of sleeping sickness, and causes symptoms that are acute in nature. If a person is infected with this parasite, the signs and symptoms will appear within a few weeks or months. Disease progression is also much faster than T. brucei gambiense.

Apart from humans, parasites Trypanosoma also can infect wild and livestock through the bite of Tse Tse flies, especially the type T. brucei rhodesiense. In livestock, this infection is called Nagana.

Symptoms of sleeping sickness due to the Tse Tse fly

Even though the incidence of cases has decreased significantly, it is better if you are still aware of sleeping sickness and know what the symptoms are.

In the initial phase, the patient is stricken with parasitic infections Trypanosoma You may experience the following symptoms:

• Headache
• Fever that appears every few days or months
• Swollen lymph nodes in the back of the neck
• Malaise (not feeling well)
• The body feels tired
• Skin rash
• Joint pain
• Weight loss

If sleeping sickness has entered its second phase, the symptoms will get worse because the parasites have infected the brain and central nervous system. Here are the symptoms:

• Changing sleep times
• Insomnia
• Often sleepy for no reason
• Mental disorders (hallucinations, anxiety, difficulty focusing, emotional instability)
• Motor problems (difficulty speaking normally, tremors, difficulty walking, muscle weakness)
• Blurry vision
• Seizures
• Coma

Without proper treatment, infection caused by the Tse Tse fly bite can result in death within a few weeks to months.

If you start to feel unusual symptoms, especially after returning from Africa, you should immediately see a doctor to get the results of the appropriate diagnosis and treatment.

The reason is, the symptoms above are also often found in diseases or other health conditions, so you may not recognize them as symptoms of sleeping sickness.

How to treat this disease?

Before determining the appropriate treatment, the doctor needs to first diagnose what condition or disease you are suffering from.

In the process of diagnosis, the doctor will first ask about the symptoms you are experiencing, as well as your travel history. If you have just returned from Africa and your doctor suspects a parasitic infection Trypanosoma, You need to undergo additional tests.

Additional tests can consist of the following methods:

• Blood test
• Lumbar puncture or spinal tap
• Examination of fluid from the lymph nodes

After confirming that you are indeed suffering from sleeping sickness, the doctor will provide treatment that is tailored to the symptoms, age, and the type and severity of the disease.

The following is a selection of medications that are generally prescribed for patients with first-stage sleeping sickness:

• Pentamidine
  This medicine is usually given for parasitic infections from the Tse Tse fly manifold T. brucei gambiense. The side effects of pentamidine are generally mild and rare, making it safe for patients to consume.

• Suramin
  Suramin is the drug of choice for sleeping sickness caused by parasites Trypanosoma brucei rhodesiense. Side effects of this drug include urinary tract disorders as well as allergic reactions in some people.

Meanwhile, the drugs given to patients with second-stage sleeping sickness will be different. The following drugs are given:

• Melarsoprol
  This medicine can be used for both types of parasites Trypanosoma. This drug is a derivative of arsenic and has the risk of causing severe side effects. As many as 3-10% of patients receiving the drug melarsoprol experience encephalopathic syndrome or brain disorders.
• Eflornithine
  This drug is intended for patients with parasitic infections T. brucei gambiense, and do not cause side effects as severe as melarsoprol. Eflornithine can be given as the only treatment, or in combination with nifurtimox.

• Nifurtimox-eflornithine combination therapy (NECT)
  NECT is a therapeutic treatment consisting of a combination of eflornithine and nifurtimox. This medicine can help reduce the duration of a patient's hospitalization. However, further research is needed on the effect of this drug on infectious patients T. brucei rhodesiense.

How to prevent fly bites

Unfortunately, there is no vaccination or drug that can prevent infection Trypanosoma. The only way you can do this is to avoid the bite of the Tse Tse fly.

Take the steps below as a form of prevention, especially if you are traveling to the African continent:

• Wear clothes with long sleeves and trousers in neutral or environmental colors, such as brown. The Tse Tse fly is more attracted to light or too dark colors.
• Make sure the clothes you wear are thick enough, as fly bites can penetrate thin fabrics.
• Check your vehicle first before getting on it, especially if you are driving an open vehicle such as a car pick-up or jeep.
• Avoid walking or approaching shrubs during the day.
• Apply an insect repellent with permethrin.