In vitro antiplasmodial, antitrypanosomal and antileishmanial activities of selected medicinal plants from Ugandan flora: Refocusing into multi-component potentials

A comprehensive review of antimalarial medicinal plants used by Tanzanians

CONTEXT

Tanzania has rich medicinal plant (MP) resources, and most rural inhabitants rely on traditional healing practices for their primary healthcare needs. However, available research evidence on antimalarial MPs is highly fragmented in the country.

OBJECTIVE

This systematic review compiles ethnomedicinal research evidence on MPs used by Tanzanians as antimalarials.

MATERIALS AND METHODS

A systematic web search was conducted using various electronic databases and grey materials to gather relevant information on antimalarial MPs utilized by Tanzanians. The review was per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The data were collected from 25 articles, and MS Excel software was used to analyse relevant ethnobotanical information using descriptive statistics.

RESULTS

A total of 227 MPs belonging to 67 botanical families and 180 genera were identified. Fabaceae (15.9%) is the most frequently utilized family. The ethnobotanical recipes analysis indicated leaves (40%) and trees (44%) are the preferred MPs part and life form, respectively. Decoctions (67%) are the dominant preparation method of remedies. Of the recorded MPs, 25.9% have been scientifically investigated for antimalarial activities with positive results. However, 74.1% of MPs have no scientific records on antimalarial activities, but they could be potential sources of remedies.

CONCLUSIONS

The study discloses a wealth of antimalarial MPs possessed by Tanzanians and suggests a need for research to authenticate the healing potential of antimalarial compounds from the unstudied MPs. Additionally, it indicates that some of the presented MPs are potential sources for developing safe, effective and affordable antimalarial drugs.

The Potentials of Ageratum conyzoides and Other Plants from Asteraceae as an Antiplasmodial and Insecticidal for Malaria Vector: An Article Review

Background

Malaria is a life-threatening disease prevalent in tropical and subtropical regions. Artemisinin combination therapy (ACT) used as an antimalarial treatment has reduced efficacy due to resistance, not only to the parasite but also to the vector. Therefore, it is important to find alternatives to overcome malaria cases through medicinal plants such as Ageratum conyzoides and other related plants within Asteraceae family.

Purpose

This review summarizes the antimalarial and insecticidal activities of A. conyzoides and other plants belonging to Asteraceae family.

Data Source

Google Scholar, PubMed, Science Direct, and Springer link.

Study Selection

Online databases were used to retrieve journals using specific keywords combined with Boolean operators. The inclusion criteria were articles with experimental studies either in vivo or in vitro, in English or Indonesian, published after 1st January 2000, and full text available for inclusion in this review.

Data Extraction

The antimalarial activity, insecticidal activity, and structure of the isolated compounds were retrieved from the selected studies.

Data Synthesis

Antimalarial in vitro study showed that the dichloromethane extract was the most widely studied with an IC50 value <10 μg/mL. Among 84 isolated active compounds, 2-hydroxymethyl-non-3-ynoic acid 2-[2,2']-bithiophenyl-5- ethyl ester, a bithienyl compound from the Tagetes erecta plant show the smallest IC50 with value 0.01 and 0.02 µg/mL in Plasmodium falciparum MRC-pf-2 and MRC-pf-56, respectively. In vivo studies showed that the aqueous extract of A. conyzoides showed the best activity, with a 98.8% inhibition percentage using a 100 mg/kg dose of Plasmodium berghei (NK65 Strain). (Z)- γ-Bisabolene from Galinsoga parviflora showed very good insecticidal activity against Anopheles stephensi and Anopheles subpictus with LC50 values of 2.04 μg/mL and 4.05 μg/mL.

Conclusion

A. conyzoides and other plants of Asteraceae family are promising reservoirs of natural compounds that exert antimalarial or insecticidal activity.

Antibacterial activity of medicinal plants on the management of mastitis in dairy cows: A systematic review

BACKGROUND

Mastitis is a disease of economic importance in dairy production systems. The common management regime for mastitis is the use of synthetic antibiotics, giving a new problem of antibiotic resistance. There is, therefore, a need to prospect for alternatives to conventional antibiotics from herbal plants.

OBJECTIVES

This systematic review evaluates the use of plants as alternatives for the control of mastitis in dairy cattle, focussing on the effectiveness of studied plants and plant-based products and possible implications on the use of these products in livestock health.

METHODOLOGY

The PRISMA model was implemented with searches done in five electronic databases: Scopus, ScienceDirect, PubMed, Ovid and Research4Life. Data were extracted from 45 studies with 112 plant species from plant species belonging to 42 different families. The specific keywords were 'mastitis', 'dairy cows' and 'medicinal plants'.

RESULTS

The most cited plant species included Allium sativum L., Azadirachta indica and Eucalyptus globulus Labill with the latter further exploring its components. Microbial species causing mastitis mainly were Staphylococcus aureus and Escherichia coli. The extraction methods used included maceration approach using ethanol, methanol and water as solvents for phytochemicals and chromatographic techniques for essential oils. A few studies explored the mode of action, and toxicities of the herbal extracts as well as evaluating their efficacy in clinical trials using animal models.

CONCLUSION

Plants with defined levels of phytochemicals were essential sources of antibacterials. Standardisation of analytical methods is required.

Potential of medicinal plants as antimalarial agents: a review of work done at Kenya Medical Research Institute

Background: Medicinal plants have traditionally been used as remedies against malaria. The present review attempted to compile data on scientific research evidence on antimalarial medicinal plants screened at Kenya Medical Research Institute (KEMRI), Center for Traditional Medicine and Drug (CTMDR) Research from January 2003 to December 2021. Methods: A systematic review was conducted using a predefined protocol based on PRISMA. Search was performed in Google Scholar and PubMed. One hundred and eight journal articles were identified 37 of which published on antimalarial/antiplasmodial work. Thirty journal articles with at least one author from KEMRI-CTMDR and accessible in full were selected for analysis. Relevant data was captured in MS Excel format and descriptive statistics, percentages and tables used to summarize the findings. Results: Assessment of individual plant species was considered as an independent study resulting in 1170 antiplasmodial/antimalarial tests done from 197 plant species. One hundred and fifty plant species were screened in vitro, one in vivo and 46 were both in vivo and in vitro. Three hundred and forty-four of tests reported good activity (IC50 < 10 μg/mL or parasite suppression rate of ≥50%), 414 moderate activity (IC50 values of 10-49 μg/mL or parasite suppression rate of 30%-49%) and 412 were reports of inactivity (IC50 ˃ 50 μg/mL or parasite suppression rate of <30%). Fuerstia africana and Ludwigia erecta were reported to have the highest activities, with IC50 < 1 μg/mL against Plasmodium falciparum D6 strain and chemosuppression in mice at an oral dose of 100 mg/kg, was reported as 61.9% and 65.3% respectively. Fifty five antimalarial/antiplasmodial active compounds isolated from eight plant species were reported with resinone (39) having the best activity (IC50 < 1 μg/mL). Conclusion: Though 344 of tests reported promising antimalarial activity, it was noted that there was limited evaluation of these plants in animal models, with only 9.0% (105/1170) studies and no clinical trials. This highlights an important research gap emphasizing the need for drug development studies that aim to progress study findings from preclinical to clinical studies. There is still need for extensive research on promising plant species aimed at developing new plant based antimalarial drugs.

Ethnomedicinal plants used for malaria treatment in Rukungiri District, Western Uganda

BACKGROUND

Malaria remains a major global health challenge and a serious cause of morbidity and mortality in sub-Saharan Africa. In Uganda, limited access to medical facilities has perpetuated the reliance of indigenous communities on herbal medicine for the prevention and management of malaria. This study was undertaken to document ethnobotanical knowledge on medicinal plants prescribed for managing malaria in Rukungiri District, a meso-endemic malaria region of Western Uganda.

METHODS

An ethnobotanical survey was carried out between May 2022 and December 2022 in Bwambara Sub-County, Rukungiri District, Western Uganda using semi-structured questionnaire. A total of 125 respondents (81 females and 44 males) were randomly selected and seven (7) key informants were engaged in open interviews. In all cases, awareness of herbalists on malaria, treatment-seeking behaviour and herbal treatment practices were obtained. The ethnobotanical data were analyzed using descriptive statistics, informant consensus factor and preference ranking.

RESULTS

The study identified 48 medicinal plants belonging to 47 genera and 23 families used in the treatment of malaria and its symptoms in the study area. The most frequently cited species were Vernonia amygdalina, Aloe vera and Azadirachta indica. Leaves (74%) was the most used plant organ, mostly for preparation of decoctions (41.8%) and infusions (23.6%) which are administered orally (89.6%) or used for bathing (10.4%).

CONCLUSIONS

Indigenous knowledge of medicinal plants used as prophylaxis and for treatment of malaria still exist among the local communities of Bwambara Sub-County. However, there is a need to investigate the antimalarial efficacy, phytochemical composition and safety of species (such as Digitaria abyssinica and Berkheya barbata) with high percentage use values to validate their use.

Medicinal plants used for treatment of malaria by indigenous communities of Tororo District, Eastern Uganda

BACKGROUND

Malaria remains the leading cause of death in sub-Saharan Africa. Although recent developments such as malaria vaccine trials inspire optimism, the search for novel antimalarial drugs is urgently needed to control the mounting resistance of Plasmodium species to the available therapies. The present study was conducted to document ethnobotanical knowledge on the plants used to treat symptoms of malaria in Tororo district, a malaria-endemic region of Eastern Uganda.

METHODS

An ethnobotanical study was carried out between February 2020 and September 2020 in 12 randomly selected villages of Tororo district. In total, 151 respondents (21 herbalists and 130 non-herbalists) were selected using multistage random sampling method. Their awareness of malaria, treatment-seeking behaviour and herbal treatment practices were obtained using semi-structured questionnaires and focus group discussions. Data were analysed using descriptive statistics, paired comparison, preference ranking and informant consensus factor.

RESULTS

A total of 45 plant species belonging to 26 families and 44 genera were used in the preparation of herbal medicines for management of malaria and its symptoms. The most frequently mentioned plant species were Vernonia amygdalina, Chamaecrista nigricans, Aloe nobilis, Warburgia ugandensis, Abrus precatorius, Kedrostis foetidissima, Senna occidentalis, Azadirachta indica and Mangifera indica. Leaves (67.3%) were the most used plant part while maceration (56%) was the major method of herbal remedy preparation. Oral route was the predominant mode of administration with inconsistencies in the posology prescribed.

CONCLUSION

This study showed that the identified medicinal plants in Tororo district, Uganda, are potential sources of new antimalarial drugs. This provides a basis for investigating the antimalarial efficacy, phytochemistry and toxicity of the unstudied species with high percentage use values to validate their use in the management of malaria.

A review of efficacy and safety of Ugandan anti-malarial plants with application of RITAM score

BACKGROUND

Malaria, a treatable disease mainly caused by Plasmodium falciparum has remained a health challenge in Africa, a continent that accounted for 96% of total global cases and deaths in 2021. Uganda, a malaria endemic country is experiencing malaria parasite resistance to some of the drugs used in the artemisinin-based combination therapy (ACT). In an effort to prioritize herbal medicines for new product development, this review synthesized the available safety and efficacy literature on the Ugandan anti-malarial plants to suggest most effective herbal plants.

METHODS

Literature was exhaustively searched using engines and databases, such as Google scholar, Pubmed, and Scopus-indexed journals during the period of June 2020-December 2021. In the first phase, information on ethnobotanical uses of anti-malarial plants in Uganda was gathered and synthetized to generate a list of plants, followed by data on anti-malarial efficacy (both in vitro and in vivo) on each listed plant. Minimum inhibitory concentrations (µg/ml), and % parasite suppression for every plant were scored using The Research Initiative on Traditional and Antimalarial Methods (RITAM) scoring system. The best twenty (20) plants were evaluated for acute safety (LD₅₀) data in rat model, plant parts used, ease of cultivation, presence of clinical studies and other relevant factors for suggesting the best three (3) plants for future anti-malarial product development.

RESULTS

Over one hundred twenty-six (126) plant species are used in Uganda for treatment of malaria in local communities. Out of these, about 33% (41) have been studied for efficacy and safety, with Artemisia annua and Vernonia amygdalina being the most extensively studied and among the best twenty (20) anti-malarial plants in Uganda. Both are limited by parasite recrudescence in clinical studies. Microglossa pyrifolia, a very potent plant (IC50 = 0.03 - 0.05 µg/ml has potential to penetrate the liver and could ameliorate the challenge of recrudescence if combined with A. annua and V. amygdalina in a polyherbal formulation.

CONCLUSION

There are many plants with promising potential for malaria treatment in Uganda and a herbal combination of A. annua, V. amydalina and M. pyrifolia could offer the next herbal ACT if carefully studied and developed.

A terpenoid-rich extract from Clethra fimbriata exhibits anti-Trypanosoma cru zi activity and induces T cell cytokine production

Chagas disease, a worldwide public health concern, is a chronic infection caused by Trypanosoma cruzi. Considering T. cruzi chronic persistence correlates with CD4+ and CD8+ T cell dysfunction and the safety and efficacy profiles of Benznidazol and Nifurtimox, the two drugs currently used for its etiological treatment, are far from ideal, the search of new trypanocidal treatment options is a highly relevant issue. Therefore, the objective of this work was to evaluate the trypanocidal effect and cytokine production induction of three extracts (hexane, dichloromethane and hydroalcoholic) obtained from Clethra fimbriata, a plant traditionally used as a febrifuge in Colombia. Additionally, the extracts' major components with the highest trypanocidal activity were determined. It was evidenced C. fimbriata hexane extract exhibited the highest activity capable of inhibiting the three parasite developmental stages with an IC50/EC50 of 153.9 ± 29.5 (epimastigotes), 39.3 ± 7.2 (trypomastigotes), and 45.6 ± 10.5 (amastigotes) μg/mL, presenting a low cytotoxicity in VERO cells with a selectivity index ranging from 6.49 to 25.4. Moreover, this extract induced trypomastigote apoptotic death and inhibited parasite cell infection. The extract also induced IFN-γ and TNF production in CD4+ and CD8+ T cells, as well as de novo production of the cytotoxic molecules granzyme B and perforin in CD8+ T cells from healthy donors. Fatty acids and terpenes represented C. fimbriata key compounds. Thus, the trypanocidal activity and cytokine production induction of the hexane extract may be associated with terpene presence, particularly, triterpenes.

The anti-nociceptive effects of ethanol extract of aerial parts of Schkuhria pinnata in mice

ETHNOPHARMACOLOGICAL RELEVANCE

The growing challenge to access conventional analgesics, contraindications, and adverse effects could have led individuals to use Schkuhria pinnata (Lam.) Kuntze ex Thell. (Compositae), as an alternative traditional therapeutic strategy for pain. However, evidence of its safety and efficacy is scarce.

AIM OF THE STUDY

This study evaluated the anti-nociceptive effect of the ethanol extract of the aerial parts of S. pinnata in mice.

METHODS

The mice were randomly assigned to nine groups: (1) vehicle; (2) acetylsalicylic acid (intraperitoneally 150 mg/kg); (3) pentazocine (intramuscularly 1.0 mg/kg); (4 a & b) orally 100 mg/kg extract; (5 a & b) orally 200 mg/kg extract; (6 a & b) orally 400 mg/kg extract. We used an acetic acid-induced writhing model and a tail-flick test. The number of writhes and time taken for the tail to flick was recorded. A one-way analysis of variance followed by Tamhane T2 post hoc was used for multiple comparisons.

RESULTS

Compared to a vehicle (59.0 ± 2.68), S. pinnata ethanol extract at a dose of 200 and 400 mg/kg, p.o reduced writhes to 42.5 ± 1.12 and 27.0 ± 2.62, (p < 0.05) respectively. Similarly, the pain threshold of mice increased dose-dependently; doses of 200 and 400 mg/kg, increased time to 5.33 ± 0.42 and 8.67 ± 0.21 min, (p < 0.05) respectively. The extract had an EC50 of 348.8 mg/kg and acute toxicity established an LD50 of 1224.8 (95% CI: 952.2-1575.3).

CONCLUSION

S. pinnata ethanol extract had anti-nociceptive activity by central and peripheral mechanisms that could justify its traditional use in pain management. Further studies could now focus on identifying active fractions and pure isolated compounds responsible for anti-nociceptive activity.

Biological activities of limonoids in the Genus Khaya (Meliaceae): a review

Background

Limonoids are a class of highly oxygenated modified triterpenoids with a diverse range of biological activities. Although with restricted occurrence in the plant kingdom, these compounds are found extensively in the Meliaceae and Rutaceae families. Limonoids are of great interest in science given that the small number of plant families where they occur exhibit a broad range of medicinal properties that promote health and prevent disease.

Main text

The Meliaceae family includes the genus Khaya and comprises tree species that have been used in traditional medicine to treat several ailments. In recent years, the genus Khaya has attracted much research interest owing to the presence of limonoids in different plant parts of a few species that can serve as therapeutic molecules in the pharmaceutical industry. In this study, a literature search over the past two decades (2000–2020) was conducted on the biological activities of limonoids in the genus Khaya using different databases such as Google Scholar, PubMed, Scopus and ISI Web of Science. The taxonomy, geographical distribution and the various traditional uses of the genus are presented in detail. This study reveals that the currently documented biological activities of limonoids both in vivo and in vitro are limited to four species (K. anthotheca, K. grandifoliola, K. ivorensis and K. senegalensis) in the genus Khaya, and include anticancer, antimalarial, hepatoprotection, anti-inflammatory, neuroprotection, antimicrobial, antifungal and antifeedant. The most well-researched species, K. senegalensis, has the most notable biological activities and traditional uses in the genus Khaya.

Conclusion

The present detailed and up-to-date review of recent literature on the biological activities in the genus Khaya reveals the potentials of limonoids for drug development in managing several ailments.

Antimalarial Plants Used across Kenyan Communities

Malaria is one of the serious health problems in Africa, Asia, and Latin America. Its treatment has been met with chronic failure due to pathogenic resistance to the currently available drugs. This review attempts to compile phytotherapeutical information on antimalarial plants in Kenya based on electronic data. A comprehensive web search was conducted in multidisciplinary databases, and a total of 286 plant species from 75 families, distributed among 192 genera, were retrieved. Globally, about 139 (48.6%) of the species have been investigated for antiplasmodial (18%) or antimalarial activities (97.1%) with promising results. However, there is no record on the antimalarial activity of about 51.4% of the species used although they could be potential sources of antimalarial remedies. Analysis of ethnomedicinal recipes indicated that mainly leaves (27.7%) and roots (19.4%) of shrubs (33.2%), trees (30.1%), and herbs (29.7%) are used for preparation of antimalarial decoctions (70.5%) and infusions (5.4%) in Kenya. The study highlighted a rich diversity of indigenous antimalarial plants with equally divergent herbal remedy preparation and use pattern. Further research is required to validate the therapeutic potential of antimalarial compounds from the unstudied claimed species. Although some species were investigated for their antimalarial efficacies, their toxicity and safety aspects need to be further investigated.

Microalgae extracts: Potential anti-Trypanosoma cruzi agents?

INTRODUCTION

Chagas disease, caused by the protozoan parasiteTrypanosoma cruzi, has no effective treatment available. On the other hand, microalgae are aquatic organisms that constitute an interesting reservoir of biologically active metabolites. Moreover, some species of green and red algae present anti-protozoan activity. Our aim was to study the antiparasitic effects of aqueous, methanolic and ethanolic extracts from different microalgae.

METHODS AND RESULTS

Our results show that the methanolic extracts of S. obliquus and T. suecica as well as the ethanolic extracts of C. reinhardtii and T. suecica present trypanocidal activity on the infective extracellular trypomastigotes and intracellular amastigotes. In addition, the ethanolic extract of C. reinhardtii potentiates the activity of the conventional antichagasic drug nifurtimox. In order to identify some potential compounds with trypanocidal activity, we performed a phytochemical screening analyzing the presence of phenolic compounds, pigments and terpenoids.

CONCLUSION

The different microalgae extracts, particularly the ethanolic extract ofC. reinhardtii, are promising potential candidates for the development of future natural antichagasic drugs.

Exploring Antimalarial Herbal Plants across Communities in Uganda Based on Electronic Data

Malaria is one of the most rampant diseases today not only in Uganda but also throughout Africa. Hence, it needs very close attention as it can be severe, causing many deaths, especially due to the rising prevalence of pathogenic resistance to current antimalarial drugs. The majority of the Ugandan population relies on traditional herbal medicines for various health issues. Thus, herein, we review various plant resources used to treat malaria across communities in Uganda so as to provide comprehensive and valuable ethnobotanical data about these plants. Approximately 182 plant species from 63 different plant families are used for malaria treatment across several communities in Uganda, of which 112 plant species have been investigated for antimalarial activities and 96% of the plant species showing positive results. Some plants showed very strong antimalarial activities and could be investigated further for the identification and validation of potentially therapeutic antimalarial compounds. There is no record of an investigation of antimalarial activity for approximately 39% of the plant species used for malaria treatment, yet these plants could be potential sources for potent antimalarial remedies. Thus, the review provides guidance for areas of further research on potential plant resources that could be sources of compounds with therapeutic properties for the treatment of malaria. Some of the plants were investigated for antimalarial activities, and their efficacy, toxicity, and safety aspects still need to be studied.

A chloroquinoline derivate presents effective in vitro and in vivo antileishmanial activity against Leishmania species that cause tegumentary and visceral leishmaniasis

The identification of new therapeutics to treat leishmaniasis is desirable, since available drugs are toxic and present high cost and/or poor availability. Therefore, the discovery of safer, more effective and selective pharmaceutical options is of utmost importance. Efforts towards the development of new candidates based on molecule analogs with known biological functions have been an interesting and cost-effective strategy. In this context, quinoline derivatives have proven to be effective biological activities against distinct diseases. In the present study, a new chloroquinoline derivate, AM1009, was in vitro tested against two Leishmania species that cause leishmaniasis. The present study analyzed the necessary inhibitory concentration to preclude 50% of the Leishmania promastigotes and axenic amastigotes (EC₅₀ value), as well as the inhibitory concentrations to preclude 50% of the murine macrophages and human red blood cells (CC₅₀ and RBC₅₀ values, respectively). In addition, the treatment of infected macrophages and the inhibition of infection using pre-treated parasites were also investigated, as was the mechanism of action of the molecule in L. amazonensis. To investigate the in vivo therapeutic effect, BALB/c mice were infected with L. amazonensis and later treated with AM1009. Parasitological and immunological parameters were also evaluated. Clioquinol, a known antileishmanial quinoline derivate, and amphotericin B (AmpB), were used as molecule and drug controls, respectively. Results in both in vitro and in vivo experiments showed a better and more selective action of AM1009 to kill the in vitro parasites, as well as in treating infected mice, when compared to results obtained using clioquinol or AmpB. AM1009-treated animals presented significantly lower average lesion diameter and parasite burden in the infected tissue and organs evaluated in this study, as well as a more polarized antileishmanial Th1 immune response and low renal and hepatic toxicity. This result suggests that AM1009 should be considered a possible therapeutic target to be evaluated in future studies for treatment against leishmaniasis.

Antiprotozoal dimeric naphthylisoquinolines, mbandakamines B3 and B4, and related 5,8'-coupled monomeric alkaloids, ikelacongolines A-D, from a Congolese Ancistrocladus liana

From the leaves of a botanically and phytochemically as yet unexplored Ancistrocladus liana discovered in the rainforests of the Central region of the Democratic Republic of the Congo in the vicinity of the town of Ikela, six new naphthylisoquinoline alkaloids were isolated, viz., two constitutionally unsymmetric dimers, the mbandakamines B3 (3) and B4 (4), and four related 5,8'-linked monomeric alkaloids, named ikelacongolines A-D (5a, 5b, 6, and 7). The dimers 3 and 4 are structurally unusual quateraryls comprising two 5,8'-coupled monomers linked via a sterically strongly constrained 6',1''-connection between their naphthalene units. These compounds contain seven elements of chirality, four stereogenic centers and three consecutive chiral axes. They were identified along with two known related compounds, the mbandakamines A (1) and B2 (2), which had so far only been detected in two Ancistrocladus species indigenous to the Northwestern Congo Basin. In addition, five known monomeric alkaloids, previously found in related Central African Ancistrocladus species, were isolated from the here investigated Congolese liana, three of them belonging to the subclass of 5,8'-coupled naphthylisoquinoline alkaloids, whereas two compounds exhibited a less frequently occurring 7,8'-biaryl linkage. The stereostructures of the new alkaloids were established by spectroscopic (in particular HRESIMS, 1D and 2D NMR), chemical (oxidative degradation), and chiroptical (electronic circular dichroism) methods. The mbandakamines B3 (3) and B4 (4) displayed pronounced activities in vitro against the malaria parasite Plasmodium falciparum and the pathogen of African sleeping sickness, Trypanosoma brucei rhodesiense.