The characteristic symptoms of Chagas' disease are edema; hard, red nodular outbreaks of the skin; and damage to the heart muscle. There is no effective treatment. Symptoms of African sleeping sickness may appear at once, after several weeks, or even after years in the Gambian type. Early disturbances include inflammation at the site of the bite, intermittent fever, enlargement of the spleen; in the Gambian variety the lymph nodes are enlarged. Subsequent signs of heart damage, personality changes, and headache develop. The final stages are marked by tremor, disturbed speech and gait, emaciation, and a prolonged comatose state. African trypanosomiasis is treated with suramin sodium and other drugs, which are most effective when injected in early stages of the disease. Such drugs will also provide protection against infection for two months or more, but organ damage appears irreversible. Even with treatment, the disease is often fatal and the prognosis becomes grave after the nervous system is invaded. Prevention involves the use of insecticides and the clearing of vegetation that harbors the tsetse fly. Sleeping sickness also affects cattle, leading to enormous annual economic losses.