title: Role of PCR in diagnosis and prognosis of visceral leishmaniasis in patients coinfected with human immunodeficiency virus type 1.
abstract: A group of 76 consecutive human immunodeficiency virus (HIV)-positive patients with fever of unknown origin (n = 52) or fever associated with pulmonary diseases was evaluated in order to assess the usefulness of PCR with peripheral blood in the diagnosis and follow-up of visceral leishmaniasis. We identified 10 cases of visceral leishmaniasis among the 52 patients with fever of unknown origin. At the time of diagnosis, all were parasitemic by PCR with peripheral blood. During follow-up, a progressive decline in parasitemia was observed under therapy, and all patients became PCR negative after a median of 5 weeks (range, 6 to 21 weeks). However, in eight of nine patients monitored for a median period of 88 weeks (range, 33 to 110 weeks), visceral leishmaniasis relapsed, with positive results by PCR with peripheral blood reappearing 1 to 2 weeks before the clinical onset of disease. Eight Leishmania infantum and two Leishmania donovani infections were identified by PCR-restriction fragment length polymorphism analysis. PCR with peripheral blood is a reliable method for diagnosis of visceral leishmaniasis in HIV-infected patients. During follow-up, it substantially reduces the need for traditional invasive tests to assess parasitological response, while a positive PCR result is predictive of clinical relapse.
authors.affiliation: Institute of Infectious Diseases and Tropical Medicine, University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pizzuto
authors.forename: M
authors.initials: M
authors.lastname: Piazza
authors.forename: D
authors.initials: D
authors.lastname: Senese
authors.forename: C
authors.initials: C
authors.lastname: Scalamogna
authors.forename: S
authors.initials: S
authors.lastname: Calattini
authors.forename: L
authors.initials: L
authors.lastname: Corsico
authors.forename: T
authors.initials: T
authors.lastname: Persico
authors.forename: B
authors.initials: B
authors.lastname: Adriani
authors.forename: C
authors.initials: C
authors.lastname: Magni
authors.forename: G
authors.initials: G
authors.lastname: Guaraldi
authors.forename: G
authors.initials: G
authors.lastname: Gaiera
authors.forename: A
authors.initials: A
authors.lastname: Ludovisi
authors.forename: M
authors.initials: M
authors.lastname: Gramiccia
authors.forename: M
authors.initials: M
authors.lastname: Galli
authors.forename: M
authors.initials: M
authors.lastname: Moroni
authors.forename: M
authors.initials: M
authors.lastname: Corbellino
authors.forename: S
authors.initials: S
authors.lastname: Antinori
mesh_terms: D000328:Adult; D000818:Animals; D016054:DNA, Protozoan / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D007893:Leishmania donovani / Q000235:genetics / Q000302:isolation & purification; D018314:Leishmania infantum / Q000235:genetics / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis* / Q000469:parasitology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D012150:Polymorphism, Restriction Fragment Length; D011379:Prognosis
chemical_list: D016054:DNA, Protozoan