Solving a Medical Mystery Via E-Mail in Kiev

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Dr. Sergei Krivopustov, a pediatric cardiologist at Children's Hospital No. 2 in Kiev, Ukraine was having a difficult time assessing a 12-year-old patient. The boy had a high fever, an enlarged spleen and was very weak and pale. After a battery of tests and a course of antibiotics, the boy remained ill and undiagnosed. Baffled, Krivopustov and a colleague turned to their partners at Children's Hospital in Philadelphia, Pennsylvania, engaging in a series of e-mail consultations.

"During this time we were sending e-mail to Philadelphia four or five times a week....They were very helpful in pointing out tests and possible diagnoses," Krivopustov said.

After several months, doctors in Kiev began testing for the parasitic disease leishmaniasis, which is transmitted by sand flies. Although the disease had never before been seen in a child in Kiev, doctors felt many of the boy's symptoms matched that of the disease. A bone marrow test for the parasite turned up positive, and the boy was at last treated with the proper medication.

Doctors speculated that the boy picked up the disease while on a summer vacation, and its long incubation period meant that the patient did not become acutely ill until months after returning to Kiev.

"What was so nice was that we all learned from this experience," said William Schwartz, MD, a professor of pediatrics at Children's Hospital. "We can't always provide all the answers, but through e-mail, our partners in Kiev taught us something."

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