Hypersomnia associated with infectious disorders

Excessive sleepiness occurring during the acute phase of a bacterial or viral infection, without any other symptom of central nervous system involvement, is commonplace in medicine. Its mechanism may involve certain cytokines.

There are other conditions, also presenting with excessive sleepiness, which may be life threatening. The most frequent of these is African trypanosomiasis (sleeping sickness) caused by the haemoflagellate Trypanosoma brucei. The incubation period of the parasite lasts about 2 weeks. Systemic manifestations become apparent during the haematogenous dissemination of the trypanosome. They include an irregular fever and generalized lymphadenopathy, particularly of the posterior cerebral chain. The parasite enters the central nervous system after a delay of up to several years. Cerebral trypanosomiasis can be explosive, with seizures, coma, and eventually death, or more frequently it may be progressive with abnormal sleepiness, headaches, and tremor of the hands. Positive diagnosis is based on a history of a stay in an endemic zone, the presence of inflammatory signs, and finding the trypanosomes in the blood, aspirate of lymph nodes, or cerebrospinal fluid. Curative treatment consists of melarsoprol or pentamidine. Prophylaxis is the preferred treatment of the disease.

European tick-borne encephalitis occurs mainly in Eastern Europe. It is characterized by two stages, one viraemic and the second one referred to as nervous. Hypersomnia is common during the second stage.

Encephalitis lethargica first appeared in France and Vienna in 1917. It then spread rapidly through Western Europe and affected thousands of people. Two main varieties were encountered: the common somnolent form and the hyperkinetic form. Sporadic cases of encephalitis lethargica are sometimes encountered today. (27)

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