In the early stages, a painful chancre (rare in T b. gambiense infection), which originates as a papule and evolves into a nodule, may be found at the primary site of a tsetse fly bite. There may be fever, intense headache, insomnia, painless lymphadenopathy, anaemia, local oedema and rash. In the later stage there is cachexia, sleep disturbance and signs of central nervous system impairment. The disease may run a protracted course of several years in the case of T. b. gambiense. In the case of T. b. rhodesiense, the disease has a rapid and acute evolution. Both diseases are always fatal in the absence of treatment.
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