Editing African trypanosomiasis (section)

=== Hemolymphatic Phase ===
The incubation period is 1–3 weeks for ''T. b. rhodesiense,'' and longer (but less precisely characterised) in ''T. b. gambiense'' infection. The first/initial stage, known as the hemolymphatic phase, is characterized by non-specific, generalised symptoms<ref name="www.cdc.gov_2020" /> like: [[Intermittent fever|fever (intermittent)]], headaches (severe),<ref name="www.cdc.gov_2019">{{cite web|date=2019-04-22|title=CDC – African Trypanosomiasis – General Information – East African Trypanosomiasis FAQs|url=https://www.cdc.gov/parasites/sleepingsickness/gen_info/faqs-east.html|access-date=2020-08-11|publisher=Centers for Disease Control and Prevention}}</ref> [[Arthralgia|joint pains]], [[itch]]ing,<ref name="pmid15304634" /><ref name="www.cdc.gov_2020" /> weakness, malaise, fatigue, weight loss, lymphadenopathy, and [[hepatosplenomegaly]].<ref name="www.cdc.gov_2020" />

Diagnosis may be delayed due to the vagueness of initial symptoms. The disease may also be mistaken for [[malaria]] (which may occur as a co-infection).<ref name="Kennedy_2019" />

==== Intermittent Fever ====

Fever is intermittent, with attacks lasting from a day to a week, separated by intervals of a few days to a month or longer.<ref name="pmid15304634" /><ref name="www.cdc.gov_2020" /> Episodes of fever become less frequent throughout the disease.<ref name="www.cdc.gov_2020" />

==== Lymphadenopathy ====

Invasion of the circulatory and lymphatic systems by the parasite is associated with severe [[Lymphadenopathy|swelling of lymph nodes]], often to tremendous sizes.<ref name="pmid15304634" /> Posterior cervical lymph nodes are most commonly affected, however, axillary, inguinal, and epitrochlear lymph node involvement may also occur.<ref name="www.cdc.gov_2020" /> [[Winterbottom's sign]], is a clinical finding involving swollen lymph nodes at the base of the skull or along the back of the neck, particularly characteristic of T. b. gambiense infections.<ref name="pmid15304634">{{cite journal | vauthors = Lundkvist GB, Kristensson K, Bentivoglio M | title = Why trypanosomes cause sleeping sickness | journal = Physiology | volume = 19 | issue = 4 | pages = 198–206 | date = August 2004 | pmid = 15304634 | doi = 10.1152/physiol.00006.2004 | s2cid = 17844506 }}</ref><ref name="www.cdc.gov_2020" />

==== Other Features ====

Those affected may additionally present with: skin rash,<ref name="www.cdc.gov_2019" /> haemolytic anaemia, hepatomegaly and abnormal liver function, splenomegaly, endocrine disturbance, cardiac involvement (e.g. pericarditis, and congestive heart failure), and ophthalmic involvement.<ref name="Kennedy_2019" />

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File:PMC5373517 pntd.0005324.g001.png|Ulcer of human African trypanosomiasis<ref name=":0">{{cite journal | vauthors = Gómez-Junyent J, Pinazo MJ, Castro P, Fernández S, Mas J, Chaguaceda C, Pellicé M, Gascón J, Muñoz J | display-authors = 6 | title = Human African Trypanosomiasis in a Spanish traveler returning from Tanzania | journal = PLOS Neglected Tropical Diseases | volume = 11 | issue = 3 | pages = e0005324 | date = March 2017 | pmid = 28358876 | pmc = 5373517 | doi = 10.1371/journal.pntd.0005324 | doi-access = free }}</ref>
File:AcuteSleepingSickness.jpg|Typical fine-spotted pink rash of acute African trypanosomiasis on the skin of the abdomen ("trypanid rash")<ref name=Paul2014>{{cite journal | vauthors = Paul M, Stefaniak J, Smuszkiewicz P, Van Esbroeck M, Geysen D, Clerinx J | title = Outcome of acute East African trypanosomiasis in a Polish traveller treated with pentamidine | journal = BMC Infectious Diseases | volume = 14 | page = 111 | date = February 2014 | pmid = 24571399 | pmc = 3941560 | doi = 10.1186/1471-2334-14-111 | doi-access = free }}</ref>
File:SSHemorragicRash.jpg|Numerous [[ecchymoses|spots of bleeding into the skin]] of the leg in a person infected with ''T. b. rhodesiense''<ref name=Paul2014/>
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