Letter from Consultant

Confirmation of last week's news.

Dear Girish,

I apologise for the delay, but we've finally got some further results.

The further samples that went down to the Hospital for Tropical Diseases for PCR assay (looking for DNA) for leishmania have come back as being negative. The biopsies were sent down to Professor ________, the best infectious diseases pathologist in the country, based at St Thomas', and he commented that there was nothing specific that gave us a definite answer, that it could be consistent with ongoing healing leishmaniasis, but he could see no evidence of leishmania itself.

I think it would be good to chat through the options. There are perhaps one or two further blood tests that we can think about doing, looking for alternative causes. I'm not sure there's much use in repeating a further biopsy, as now two biopsies have failed to give us a definite answer.

Though it is not optimal, sometimes in this situation we do treat people for possible leishmania to try and prevent any long term recurrences if this was a possible diagnosis. This won't be an easy decision and I think we need to chat through it.

I've asked my secretary to send you a further appointment with this letter. If it is inconvenient ...

Yours sincerely



Dr _________
Consultant Physician in Infectious Diseases & Tropical Medicine