Diagnosis of symptomatic visceral leishmaniasis by use of the polymerase chain reaction on patient blood.
To diagnose symptomatic visceral leishmaniasis (kala-azar) using peripheral blood rather than tissue aspirates, a polymerase chain reaction (PCR) technique was developed for which the detection limit is 1 Leishmania-infected macrophage in 8 mL of blood. For Indian, Kenyan, or Brazilian patients with parasitologically confirmed kala-azar, 57 of 63 cases before treatment had blood that was PCR-positive (90% sensitivity). None of 40 clinically healthy persons had PCR-positive blood (100% specificity). Twelve (92%) of 13 clinically cured Indian patients had negative PCR reactions 1-6 months after treatment. This PCR procedure can provide a parasitologic diagnosis for the vast majority of kala-azar cases before therapy, may identify patients who have been successfully treated by chemotherapy, and should substantially reduce the need for invasive tests.
Nuzum
E
E
Division of Experimental Therapeutics, Walter Reed Army Institute of Research, Washington, DC 20307-5100.
White
F
F
Thakur
C
C
Dietze
R
R
Wages
J
J
Grogl
M
M
Berman
J
J
D001483:Base Sequence; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D008969:Molecular Sequence Data; D018512:Parasitemia / Q000175:diagnosis*; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity