title: Utility of lymph node aspiration in the diagnosis of visceral leishmaniasis in Sudan.
abstract: We evaluated lymph node aspiration (LNA) as a simple diagnostic procedure for visceral leishmaniasis (VL). Lymph node aspiration was compared with the direct agglutination test (DAT) using a diagnostic titer > or = 1:6,400 in 7,880 suspected VL patients in eastern Sudan. Compared with DAT, LNA had a sensitivity of 65.1% (95% confidence interval = 63.5-66.6%). Parasite density in LNA correlated strongly with DAT titers (P < 0.0001), and low parasite density accounted for 78.1% of positive LNA results with DAT titers < 1:6,400 (n = 782). Risk factors predictive of a positive LNA result were an age of 1-29 years, male sex, a hemoglobin level < 10.0 g/dL, a DAT titer > or = 1:800, and a location with a higher prevalence of VL. Lymph node and splenic aspirations were similarly accurate as tests of cure after treatment of 50 VL patients in southern Sudan. Pre-treatment LNA results were negative in 20 cases of severe post kala-azar dermal leishmaniasis.
authors.affiliation: Médecins Sans Frontières-Holland, Amsterdam, The Netherlands. zahir_babiker@yahoo.co.uk
authors.forename: Zahir O E
authors.initials: ZO
authors.lastname: Babiker
authors.forename: Robert
authors.initials: R
authors.lastname: Davidson
authors.forename: Charles
authors.initials: C
authors.lastname: Mazinda
authors.forename: Sammy
authors.initials: S
authors.lastname: Kipngetich
authors.forename: Koert
authors.initials: K
authors.lastname: Ritmeijer
mesh_terms: D000293:Adolescent; D000328:Adult; D000372:Agglutination Tests; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001707:Biopsy, Needle; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D008198:Lymph Nodes / Q000469:parasitology* / Q000473:pathology; D008297:Male; D012621:Seasons; D012680:Sensitivity and Specificity; D013397:Sudan / Q000453:epidemiology
chemical_list: D000981:Antiprotozoal Agents; D000967:Antimony Sodium Gluconate