[leish-l] Leishmania in Antigua? The final chapter?

[Davidson, Robert N]

Dear All,
Just to update you on this mystery case:
1. The lesions when swabbed grew Staph aureus, and as I thought
clinically that these were bacterial lesions (impetigo-like), not CL, I
recommended antibiotics/ topical antiseptics. The responsible clinician
(who was hundreds of miles away from me) was initially unconvinced by my
suggestion, but soon became convinced by the expert opinion of this
forum, that L mexicana was very very unlikely. They tried my treatment,
and the lesions have all gone. Let's hope they stay gone. So this is an
excellent example of how electronic comms can help a person none of us
have ever met.
2. The biopsy on which the reference lab in saw amastigotes has been
reviewed and the amastigotes have not been seen again. I have not been
shown the slides, but I just wonder whether they may have been looking
at Gram positive cocci. I can't explain the PCR being positive for L
mexicana complex, except by suggesting lab error. The lab had no other
cases of L mexicana around that time.
3. For interest, I attach some pictures of the skin lesions - I have
never seen the patient, these were emailed to me.
All the best, and many thanks for your assistance, I hope you had as
much fun as I did.
Rob 
Dr Robert N Davidson MD  FRCP DTM&H 
Dept Infection & Tropical Medicine
Lister Unit, Northwick Park Hospital, 
Harrow,  Middlesex HA1 3UJ
Phone 	(direct)	++ 44 208 869 2830
Mobile 07881955264 
Secretary	++ 44 208 869 2833
FAX   		++ 44 208 869 2836
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