title: Comparison of PCR with direct examination of bone marrow aspiration, myeloculture, and serology for diagnosis of visceral Leishmaniasis in immunocompromised patients.
abstract: A PCR assay amplifying a repeated sequence from the Leishmania infantum genome was compared with direct examination of bone marrow aspirate, myeloculture, and serology for the diagnosis of visceral leishmaniasis in immunocompromised patients. Of 73 patients living in an area endemic for leishmaniasis and where visceral leishmaniasis was suspected by physicians, only 10 had an indisputable diagnosis of visceral leishmaniasis. None of the diagnostic tests performed in the study achieved 100% sensitivity for diagnosing visceral leishmaniasis. PCR exhibited superior sensitivity (82%) in comparison with bone marrow aspirate examination (55%) and myeloculture (55%). Our PCR assay also showed good specificity (97%), negative predictive value (97%), and positive predictive value (82%) even when all unconfirmed PCR results were scored as false positives. Serology exhibited good sensitivity (80%) and excellent specificity (100%), negative predictive value (98%), and positive predictive value (100%) in diagnosing new cases of visceral leishmaniasis but failed to diagnose relapses. We also observed consistent negative serological results using several different immunological detection methods for 2 of the 10 patients with confirmed cases of visceral leishmaniasis. This lack of serological reactivity persisted throughout the course of their infections. These results demonstrate the importance of using PCR as an aid in the diagnosis of visceral leishmaniasis in immunocompromised patients.
authors.affiliation: Laboratoire de Parasitologie-Mycologie, Faculté de Médecine de la Timone, Marseille, France.
authors.forename: R
authors.initials: R
authors.lastname: Piarroux
authors.forename: F
authors.initials: F
authors.lastname: Gambarelli
authors.forename: H
authors.initials: H
authors.lastname: Dumon
authors.forename: M
authors.initials: M
authors.lastname: Fontes
authors.forename: S
authors.initials: S
authors.lastname: Dunan
authors.forename: C
authors.initials: C
authors.lastname: Mary
authors.forename: B
authors.initials: B
authors.lastname: Toga
authors.forename: M
authors.initials: M
authors.lastname: Quilici
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000913:Antibodies, Protozoan / Q000097:blood; D001483:Base Sequence; D001853:Bone Marrow / Q000469:parasitology; D017931:DNA Primers / Q000235:genetics; D016054:DNA, Protozoan / Q000235:genetics; D006801:Humans; D016867:Immunocompromised Host; D018314:Leishmania infantum / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis* / Q000276:immunology*; D008875:Middle Aged; D008969:Molecular Sequence Data; D010274:Parasitology / Q000379:methods / Q000706:statistics & numerical data; D016133:Polymerase Chain Reaction / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000706:statistics & numerical data
chemical_list: D000913:Antibodies, Protozoan; D017931:DNA Primers; D016054:DNA, Protozoan