title: A nested polymerase chain reaction (Ln-PCR) for diagnosing and monitoring Leishmania infantum infection in patients co-infected with human immunodeficiency virus.
abstract: We investigated a Leishmania-specific nested polymerase chain reaction (Ln-PCR) for the diagnosis and treatment monitoring of L. infantum infections in patients co-infected with human immunodeficiency virus (HIV). Peripheral blood and bone marrow samples from 89 HIV patients in Spain suspected of having leishmaniasis were examined by different diagnostic techniques (Ln-PCR, microscopy, NNN culture and indirect fluorescent antibody test). The sensitivity of Ln-PCR compared with microscopy and culture of bone marrow was 95.45% using blood and 100% when using bone marrow. 38 of these patients with confirmed leishmaniasis were entered in a chemotherapy trial (reported elsewhere), and samples from them were collected before treatment, one month after treatment ended and during follow-up (1-20 months), and examined similarly. Ln-PCR was shown to be a good method for testing efficacy of treatment and for predicting relapses after treatment (relapses were predicted on average 5 months earlier than when using classical diagnostic techniques). We suggest that Ln-PCR (especially using peripheral blood) should be the technique of choice for diagnosis, monitoring the success of treatment, and predicting relapses in patients with HIV and suspected or confirmed L. infantum infection.
authors.affiliation: WHO Collaborating Centre for Leishmaniasis, Servicio de Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Cruz
authors.forename: C
authors.initials: C
authors.lastname: Cañavate
authors.forename: J M
authors.initials: JM
authors.lastname: Rubio
authors.forename: M A
authors.initials: MA
authors.lastname: Morales
authors.forename: C
authors.initials: C
authors.lastname: Chicharro
authors.forename: F
authors.initials: F
authors.lastname: Laguna
authors.forename: M
authors.initials: M
authors.lastname: Jiménez-Mejías
authors.forename: G
authors.initials: G
authors.lastname: Sirera
authors.forename: S
authors.initials: S
authors.lastname: Videla
authors.forename: J
authors.initials: J
authors.lastname: Alvar
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000818:Animals; D016054:DNA, Protozoan / Q000032:analysis; D005500:Follow-Up Studies; D015497:HIV-1; D006801:Humans; D018314:Leishmania infantum / Q000235:genetics / Q000302:isolation & purification; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy; D018512:Parasitemia / Q000175:diagnosis / Q000188:drug therapy; D016133:Polymerase Chain Reaction / Q000379:methods*; D012008:Recurrence; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D016054:DNA, Protozoan