Serum Creatine Kinase and Exercise

Trypanosomiasis in Britain SIR,-Two cases have recently come to my notice of failure to diagnose trypano- somiasis in an African in this country.In one, with the lapse of nearly three years since the patient was last in Africa, the possibility of a tropical cause of the illness may have been dismissed.In the other the presenting symptoms were personality changes, and trypanosomiasis was apparently never con- sidered as a possible cause.The chronic, Gambian form of trypano- somiasis may continue with virtually no symptoms for three, or even more, years before involvement of the central nervous system affects the patient noticeably.It may then present with complaint of persistent headache, with other meningeal symptoms, or with more apparently psychological signs such as increasing depression or with marked personality change, not infrequently with impaired responsibility.I wish to make an urgent plea for the consideration of a diagnosis of trypano- somiasis in any person from Africa, whether African or not, now under medical care, per- haps even in a mental hospital, in this country with undiagnosed symptoms which could be due to trypanosomiasis.The finding of a C.S.F. protein of under 30 mg./100 ml. and a normal cell count would be strong evidence against the diagnosis of trypanosomiasis, but if the C.S.F. protein is near or above 40 mg./ 100 ml., or if an abnormal cell count, particularly a lymphocytosis, in the C.S.F. is found, the possibility of trypanosomiasis should not be discarded until some other un- questionable cause has been found.If further opinion or advice is needed there are schools of tropical medicine with associated hospitals at London,