Immunohistochemistry and polymerase chain reaction on paraffin-embedded material improve the diagnosis of cutaneous leishmaniasis in the Amazon region.
BACKGROUND
Recently, there has been an increase in the incidence of cutaneous leishmaniasis (CL), which represents an important health problem. This increase may be related to the epidemiologic expansion of the infective agent and the increase in tourism in tropical areas. The difficulty in clinical diagnosis, mainly in areas in which CL is not the first consideration of local physicians, has intensified efforts to describe diagnostic tests, which should be specific, sensitive, and practical. Amongst the new tests described are those including nucleic acid amplification (polymerase chain reaction, PCR) and immunohistochemistry (IHC).


METHODS
In this study, we evaluated the sensitivity of a PCR based on small subunit (SSU) ribosomal DNA, in comparison with IHC using Leishmania spp. antibodies, in biopsies embedded in paraffin.


RESULTS
The results indicated a total sensitivity of 96% (90.9% with PCR and 68.8% with IHC), showing the possibility of using paraffin-embedded biopsies to diagnose CL.


CONCLUSIONS
We propose the use of the two tests together as a routine protocol for diagnosis. This would require the provision of local medical services to perform molecular biology techniques and adequate Leishmania antibodies.
Infectious and Parasitic Diseases Clinic, Parasitology (LIM 46), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Avenida Dr. Enéas de Carvalho, São Paulo, Brazil. valdirsa@netpoint.com.br
Valdir Sabbaga
VS
Amato
Felipe Francisco
FF
Tuon
Heitor Franco
HF
de Andrade
Helio
H
Bacha
Carla
C
Pagliari
Elaine Raniero
ER
Fernandes
Maria Irma Seixas
MI
Duarte
Vicente Amato
VA
Neto
Ricardo Andrade
RA
Zampieri
Lucile Maria
LM
Floeter-Winter
Beatriz J
BJ
Celeste
Juliane
J
Oliveira
Mariana Martinez
MM
Quiroga
Melissa
M
Mascheretti
Marcos
M
Boulos
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D006801:Humans; D007150:Immunohistochemistry; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis*; D008875:Middle Aged; D016612:Paraffin Embedding; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult