title: Combining diagnostic procedures for the management of leishmaniasis in areas with high prevalence of Leishmania guyanensis.
abstract: BACKGROUND
  The Amazon region corresponds to approximately 40% of the cases of leishmaniasis in Brazil. We report a prospective study with 180 patients conducted in a health care unit that diagnoses 10% of the cases of leishmaniasis in the Brazilian Amazon. The study addresses how a combination of procedures improves diagnosis in areas with high prevalence of Leishmania guyanensis.
  
  
  OBJECTIVE
  to evaluate diagnostic methods in areas with high prevalence of Leishmania guyanensis.
  
  
  METHODS
  All subjects were amastigote-positive by direct microscopic examination of lesion scarifications. We conducted skin biopsy and histopathology, polymerase chain reaction and parasite cultivation.
  
  
  RESULTS
  Polymerase chain reaction detected almost ninety percent of infections when two amplification protocols were used (mini-exon and HSP-70). HSP-70 specific polymerase chain reaction matched the sensitivity of parasite cultivation plus histopathology.
  
  
  CONCLUSIONS
  The best combination was polymerase chain reaction plus histopathology, which increased diagnostic sensitivity to 94%. Species discrimination by polymerase chain reaction disclosed prevalence of human infections with Leishmania guyanensis of 94% and with Leishmania braziliensis of 6% for this region.
authors.affiliation: Tropical Medicine Foundation of Amazonas, Manaus, Brazil.
authors.forename: Ednelza de Almeida
authors.initials: Ede A
authors.lastname: Benicio
authors.forename: Ellen Pricilla Nunes
authors.initials: EP
authors.lastname: Gadelha
authors.forename: Anette
authors.initials: A
authors.lastname: Talhari
authors.forename: Roberto Moreira da
authors.initials: RM
authors.lastname: Silva
authors.forename: Luis Carlos
authors.initials: LC
authors.lastname: Ferreira
authors.forename: Mayara Cristina Cordeiro dos
authors.initials: MC
authors.lastname: Santos
authors.forename: Marcelo Távora
authors.initials: MT
authors.lastname: Mira
authors.forename: Cintia Mara Costa de
authors.initials: CM
authors.lastname: Oliveira
authors.forename: Carolina
authors.initials: C
authors.lastname: Talhari
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Machado
authors.forename: Albert
authors.initials: A
authors.lastname: Schriefer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007892:Leishmania braziliensis / Q000302:isolation & purification; D018334:Leishmania guyanensis / Q000302:isolation & purification*; D007897:Leishmaniasis, Mucocutaneous / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult