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The Year in Science: Medicine 1997

Perchance to Die

By Patricia GadsbyJanuary 1, 1998 6:00 AM


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The last thing Africa needs is another deadly epidemic. Yet alarming reports of sleeping sickness in equatorial Africa reached the Western world this summer. Whole villages will die, predicts Anne Moore, an investigator for the Centers for Disease Control who visited the current hot spot in southern Sudan. In a preliminary study her team found that close to 20 percent of those tested in the region of Tambura had the lethal parasite Trypanosoma brucei gambiense in their blood. In Ezo, a town of 6,000, some 45 percent of those screened tested positive. In a village near Ezo everyone has apparently died except the few that fled, says Moore.

Sleeping sickness, officially called African trypanosomiasis, was once Africa’s biggest public health scourge. It begins with a bite from a tsetse, a fly with a nasty taste for blood. If your fly is carrying the trypanosome pathogen, that bite can transmit the disease. A lousy flulike feeling sets in as you fight a foe that multiplies and fakes out your immune system by changing its outer coat. Sooner or later, parasites inflame your brain, causing weird changes in behavior, personality, and sleep. You sink into zombielike apathy, and eventually lapse into a coma that ends in death. A turn-of-the-century epidemic in the Belgian Congo killed half a million people.

Today, with prompt treatment, the disease is curable. In fact, until recently it was well controlled. So what went wrong? Regional civil war is one problem: people fled into the bush and ran into flies. More important, war chased out Belgian doctors in the late 1980s, and relief organizations like care and the International Medical Corps only recently returned.

And then there are problems with the treatments themselves. Melarsoprol attacks the parasite’s ability to fend off the body’s defenses, but it’s toxic and costs roughly $150 for a weeklong course of treatment. A less toxic drug, dfmo (difluoromethylornithine), works by preventing the parasite from multiplying, but its $400 price tag is far too high for countries poor in medical resources. That’s one reason doctors in Sudan called the cdc: they needed to document the epidemic to raise cash.

But the outbreak in Sudan is only the tip of the iceberg. Tens of thousands are said to be dying each year in the Democratic Republic of the Congo (formerly Zaire). And there’s word of flare-ups elsewhere in the tsetse belt.

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