Noninvasive management of Indian visceral leishmaniasis: clinical application of diagnosis by K39 antigen strip testing at a kala-azar referral unit.
Firm diagnosis of visceral leishmaniasis (kala-azar) requires organ aspiration and microscopic examination of tissue specimens. To determine the usefulness of noninvasive diagnosis by strip test detection of anti-K39 immunoglobulin (Ig) G antibody in blood specimens obtained by fingerstick, 143 Indian patients with suspected kala-azar (fever, splenomegaly, anemia) were studied. Of 120 strip test-positive subjects (subjects with presumed kala-azar [group A]), amphotericin B treatment induced clinical cure in 119. Of 23 strip test-negative subjects (subjects presumed to have other diseases [group B]), 16 had other disorders diagnosed at entry, 4 responded to empiric antimalarial therapy, 2 were proven to have kala-azar, and 1 died elsewhere after undergoing splenic aspiration. Six months after treatment ended, all 120 patients in group A and the 18 assessable patients in group B were healthy. In a region in India where visceral infection is prevalent, strip test detection of anti-K39 IgG is a clinically promising diagnostic guide in persons with suspected kala-azar.
Sundar
S
S
Kala-Azar Medical Research Center, Department of Medicine, Banaras Hindu University, Institute of Medical Sciences, Varanasi, 211 005, India. shyam_vns@satyam.net.in
Sahu
M
M
Mehta
H
H
Gupta
A
A
Kohli
U
U
Rai
M
M
Berman
J D
JD
Murray
H W
HW
D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000032:analysis; D000953:Antigens, Protozoan; D015415:Biomarkers / Q000032:analysis; D019937:Diagnostic Techniques and Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D015800:Protozoan Proteins / Q000032:analysis*; D012106:Research; D016896:Treatment Outcome
D000906:Antibodies; D000953:Antigens, Protozoan; D015415:Biomarkers; D015800:Protozoan Proteins; C079253:K39 antigen, Leishmania