Trypanosomiasis is a, is a big problem in, among African. We know, we know that we have trypanosome which is rhodensiensae. We have also the gambianse and, in here, the transmission is by tsetse fly. I think this problem is only found in, in rural areas. We only found this in rural areas. But around the, it's very common in the, in the bush. Where we have, we have cattles, and have, have animals, because these are the river reservoirs. But also, men. Do work in rural areas. So, they interact and they are always, they can be bitten by the tsetse flies. Okay, the presentation has two phases. Phase one, is that it has a phase one which is. Which is a, presents like a malaria case. You can present like malaria case. Fever, general body malaise, okay? And you, of course, itchy. Itching is a problem. And a chancre, which has been there. That can be the only firstly present issue. So if you need to diagnose this, I think you need to. You need to get a very good history, about the contact of the, of the, of the peep, of people with with animals and tsetse tsetse flies. And the, the second phase, is the phase which has evolved the central nervous system. And that is the phase when they change their behavior. And they, when they change their behavior, they, they actually change their sleeping pattern. And they, they are always, and they are drowsy in the, in the, in the day, and during the night they are awake, okay? And not uncommon from that state, they can end up into, into, into cerebral, severe cerebral mal, mal, Which is confusion, okay. And eventually maybe they can die, because of multiple problems. Renal problems, or cardiac problems, or cerebral problems then they can die out of that. Well I would say that for the past five years, or so I have not seen a case. With trypanosomiasis. But, about six years ago, we had a case which she presented very, very funny. And most of the people missed it. And we go to the trypanosomes in the CSF. We took the lumbar puncture, and we got the trypanosomes into the, in that CSF. And the treatment of that patient was not very easy, and he eventually, of course we used, of course we used the suramin and then we combined it with the melarsoprol. Unfortunately this patient didn't make it, and this patient died. I remember one episode of a foreign student, who came here. And she was a foreigner, and she visited Arusha somewhere. As the, as a, as a visitor, a tourist. And she was she was bitten by, by tsetse flies. And this was a typical patient who came to us, presenting with a chancre, and winterbottom's sign. So, because of some logistics. We had to, we had to transfer this patient to Germany. And the patient was taken care of very well, and he recovered. This is the case which we also have some video, pictures you need. But, this was the first case I saw typical for trypanosomiasis. So the treatment is not so easy, but we only have two options. Either suramin or melarsoprol that's, these are the two options which we, we have. So, I think that is what I can say. But if you talk of a, of diagnosis, it remains, it remains blood slides to see the It also remains, it also remains you can also take the fluids, if not cns, or fluid from the chancre. And you can stain them. That is the, is the, is the, is the mainstay here. Okay? If you take this seriously for the central system involvement, you may also see the trypanosomes, okay? So that is it. So to the, exactly that we have not seen a case, for the past five years or six or in my experience. We have not seen a case, but we saw some of them.
