Problems of diagnosis of trypanosomiasis

Diagnostic problems in trypanosomiasis arise from the inadequacy of current diagnostic procedures. This inadequacy deprives the clinician of essential data, hinders individual therapy and therapeutic control programmes, and makes suspect many conclusions drawn from previous experimental work. In this paper the author examines alternative methods of diagnosis, emphasizing cultivation and immunological procedures. An independent standard for diagnostic evaluation is available with the culture method. Comparison indicates that conventional procedures are frequently in error and that the error is always an underestimation, which may reach 20%-25% or more. The culture method has proved to be sensitive, reliable, usable under African field and hospital conditions, and applicable to isolation of Trypanosoma gambiense and T. rhodesiense from both blood and spinal fluid. Complement-fixation is the most widely used of the immunological reactions available. Procedures and results are reviewed and possibilities both with this method and others are discussed. Continuing research on diagnostic methods is needed, and certain practical difficulties in such a continuing research programme are discussed.