Combining diagnostic procedures for the management of leishmaniasis in areas with high prevalence of Leishmania guyanensis

An Bras Dermatol. 2011 Nov-Dec;86(6):1141-4. doi: 10.1590/s0365-05962011000600012.

Abstract

Background: The Amazon region corresponds to approximately 40% of the cases of leishmaniasis in Brazil. We report a prospective study with 180 patients conducted in a health care unit that diagnoses 10% of the cases of leishmaniasis in the Brazilian Amazon. The study addresses how a combination of procedures improves diagnosis in areas with high prevalence of Leishmania guyanensis.

Objectives: to evaluate diagnostic methods in areas with high prevalence of Leishmania guyanensis.

Methods: All subjects were amastigote-positive by direct microscopic examination of lesion scarifications. We conducted skin biopsy and histopathology, polymerase chain reaction and parasite cultivation.

Results: Polymerase chain reaction detected almost ninety percent of infections when two amplification protocols were used (mini-exon and HSP-70). HSP-70 specific polymerase chain reaction matched the sensitivity of parasite cultivation plus histopathology.

Conclusion: The best combination was polymerase chain reaction plus histopathology, which increased diagnostic sensitivity to 94%. Species discrimination by polymerase chain reaction disclosed prevalence of human infections with Leishmania guyanensis of 94% and with Leishmania braziliensis of 6% for this region.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Brazil
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Leishmania braziliensis / isolation & purification
  • Leishmania guyanensis / isolation & purification*
  • Leishmaniasis, Mucocutaneous / diagnosis*
  • Male
  • Middle Aged
  • Polymerase Chain Reaction
  • Prevalence
  • Prospective Studies
  • Sensitivity and Specificity
  • Young Adult