Visceral leishmaniasis laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Laboratory Findings
The gold standard for diagnosis is visualisation of the amastigotes in splenic aspirate or bone marrow aspirate. This is a technically challenging procedure that is frequently unavailable in areas of the world where visceral leishmaniasis is endemic.
Serological testing is much more frequently used in areas where leishmaniasis is endemic. The K39 dipstick test is easy to perform, and village health workers can be easily trained to use it. The kit may be stored at ambient temperature and no additional equipment needs to be carried to remote areas. The DAT anti-leishmania antigen test is standard within MSF is much more cumbersome to use and appears not to have any advantages over the K39 test.[1]
There are a number of problems with serological testing: in highly endemic areas, not everyone who becomes infected will actually develop clinical disease or require treatment. Indeed, up to 32% of the healthy population may test positive, but not require treatment.[2][3] Conversely, because serological tests look for an immune response and not for the organism itself, the test does not become negative after the patient is cured, it cannot be used as a check for cure, or to check for re-infection or relapse.[4] Likewise, patients with abnormal immune systems (e.g., HIV infection) will have false-negative tests.[5]
References
- ↑ CHappuis F, Rijal S, Soto A, Menten J, Boelaert M. "A meta-analysis of the diagnostic performance of the direct agglutination test and rK39 dipstick for cisceral leishmaniasis". Brit Med J. 333 (7571): 723&ndash, 6. doi:10.1136/bmj.38917.503056.7C.
- ↑ Sundar S, Singh RK, Maurya R; et al. "Serological diagnosis of Indian visceral leishmaniasis: dirrect agglutination test versus rK39 strip test". Trans R Soc Trop Med Hyg. 100: 533&ndash, 7.
- ↑ Sundar S, Maurya R, Singh RK; et al. (2006). "Rapid, noninvastive diagnosis of visceral leishmaniasis in INdia: comparison of two immunochromatographic strip tests for detection of anti-K39 antibody". J Clin Microbiol. 44: 251&ndash, 3.
- ↑ Lockwood DNJ, Sundar S. (2006). "Serological tests for visceral leishmaniasis". Brit Med J. 333: 711&ndash, 12.
- ↑ Pasquau F, Ena J, Sanchez R; et al. (2005). "Leishmaniasis as an oppotunistic infection in HIV-infected patients: determinants of relapse and mortality in a collaborative study of 228 episodes in a Mediterranean region". Eur J Clin Microbiol Infect Dis. 24: 411&ndash, 18.