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<DIV><FONT face=Arial>Dear Rob,</FONT></DIV>
<DIV><FONT face=Arial>Thanks for the pictures; the lesions show none of
the features of CL. Little dark dots in histological sections are often
misinterpreted. </FONT></DIV>
<DIV><FONT face=Arial>I have learnt a lot about the distribution of leish in the
Caribbean.</FONT></DIV>
<DIV><FONT face=Arial>Best wishes</FONT></DIV>
<DIV><FONT face=Arial>Anthony</FONT></DIV>
<BLOCKQUOTE
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
<DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV
style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B>
<A title=r.n.davidson@imperial.ac.uk
href="mailto:r.n.davidson@imperial.ac.uk">Davidson, Robert N</A> </DIV>
<DIV style="FONT: 10pt arial"><B>To:</B> <A title=ateixeir@unb.br
href="mailto:ateixeir@unb.br">Antonio Teixeira</A> ; <A
title=ashford@liverpool.ac.uk href="mailto:ashford@liverpool.ac.uk">Richard
Ashford</A> ; <A title=Jorge.Arias@fairfaxcounty.gov
href="mailto:Jorge.Arias@fairfaxcounty.gov">Arias, Jorge Dr.</A> ; <A
title=leish-l@fat.org.br
href="mailto:leish-l@fat.org.br">leish-l@fat.org.br</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Thursday, September 22, 2005 8:21
AM</DIV>
<DIV style="FONT: 10pt arial"><B>Subject:</B> [leish-l] Leishmania in Antigua?
The final chapter?</DIV>
<DIV><BR></DIV>Dear All,<BR>Just to update you on this mystery case:<BR>1. The
lesions when swabbed grew Staph aureus, and as I thought<BR>clinically that
these were bacterial lesions (impetigo-like), not CL, I<BR>recommended
antibiotics/ topical antiseptics. The responsible clinician<BR>(who was
hundreds of miles away from me) was initially unconvinced by my<BR>suggestion,
but soon became convinced by the expert opinion of this<BR>forum, that L
mexicana was very very unlikely. They tried my treatment,<BR>and the lesions
have all gone. Let's hope they stay gone. So this is an<BR>excellent example
of how electronic comms can help a person none of us<BR>have ever met.<BR>2.
The biopsy on which the reference lab in saw amastigotes has been<BR>reviewed
and the amastigotes have not been seen again. I have not been<BR>shown the
slides, but I just wonder whether they may have been looking<BR>at Gram
positive cocci. I can't explain the PCR being positive for L<BR>mexicana
complex, except by suggesting lab error. The lab had no other<BR>cases of L
mexicana around that time.<BR>3. For interest, I attach some pictures of the
skin lesions - I have<BR>never seen the patient, these were emailed to
me.<BR>All the best, and many thanks for your assistance, I hope you had
as<BR>much fun as I did.<BR>Rob <BR>Dr Robert N Davidson MD FRCP
DTM&H <BR>Dept Infection & Tropical Medicine<BR>Lister Unit, Northwick
Park Hospital, <BR>Harrow, Middlesex HA1 3UJ<BR>Phone (direct) ++ 44 208
869 2830<BR>Mobile 07881955264 <BR>Secretary ++ 44 208 869
2833<BR>FAX ++ 44 208 869
2836<BR><BR>________________________________________________________________________<BR>Essential
facts about burns and blast injuries:<BR><A
href="http://www.doctors.net.uk/burnsandblasts">http://www.doctors.net.uk/burnsandblasts</A><BR>_______________________________________________________________________</BLOCKQUOTE></BODY></HTML>