Specific K39 antibody response and its persistence after treatment in patients with imported leishmaniasis.
The sensitivity of a K39 ELISA (Leishmania IgG, Virion/Serion) for the detection of antibodies in patients with imported leishmaniasis was compared with an immunofluorescence assay (IFA), which was applied as "golden standard". The retrospective study comprised 93 IFA-positive or borderline sera from 42 patients with visceral (n = 16) or cutaneous (n = 26) leishmaniasis. Patients had acquired infection predominately in the Mediterranean area or the Middle East. The Leishmania species (Leishmania donovani/infantum, Leishmania tropica, Leishmania major) were identified by real-time PCR. The majority (94%) of first samples from patients with visceral leishmaniasis (VL) tested positive by K39 ELISA. Antibody levels ranged from low to very high (33.19-1990.00 U/ml; median 596.66 U/ml) but did not correlate with the respective IFA titers. High K39 ELISA values correlated with acute infection in immunocompetent individuals. K39 antibodies declined in all individuals after clinically successful therapy, but time to seronegativity varied considerably (51 weeks to >6 years). In patients with cutaneous leishmaniasis (CL), the sensitivity of the K39 ELISA was low (23%) compared to IFA (92% positive). Antibody levels ranged from low to medium (10.85-524.77 U/ml; median 19.77 U/ml). The highest antibody concentrations were seen in L. infantum-infected individuals. Summarizing, a high K39 ELISA value indicates active VL. The assay is, like IFA, not a measure for effective therapy but may support post-treatment monitoring. Low level positivity can indicate subclinical, previous or clinically cured VL or even CL. The K39 ELISA can supplement highly sensitive screening tests in the diagnosis and follow-up of imported leishmaniasis.
Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum, Bonn, Germany. reiter-owona@microbiology-bonn.de.
Ingrid
I
Reiter-Owona
Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Sigmund-Freud Str.25, 53105, Bonn, Germany.
Claudia
C
Rehkaemper-Schaefer
Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum, Bonn, Germany.
Sandra
S
Arriens
Institut Virion/Serion GmbH, 97076, Würzburg, Germany.
Philip
P
Rosenstock
Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum, Bonn, Germany.
Kenneth
K
Pfarr
Institut für Medizinische Mikrobiologie, Immunologie und Parasitologie, Universitätsklinikum, Bonn, Germany.
Achim
A
Hoerauf
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000913:Antibodies, Protozoan / Q000096:biosynthesis* / Q000097:blood; D000953:Antigens, Protozoan / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D006224:Cricetinae; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005455:Fluorescent Antibody Technique; D005858:Germany; D006801:Humans; D007121:Immunocompetence; D007074:Immunoglobulin G / Q000096:biosynthesis / Q000097:blood; D018314:Leishmania infantum / Q000235:genetics / Q000276:immunology; D018320:Leishmania major / Q000235:genetics / Q000276:immunology; D007895:Leishmania tropica / Q000235:genetics / Q000276:immunology; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000276:immunology; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D008647:Mesocricetus; D008875:Middle Aged; D008877:Middle East; D015800:Protozoan Proteins / Q000276:immunology*; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
D000913:Antibodies, Protozoan; D000953:Antigens, Protozoan; D007074:Immunoglobulin G; D015800:Protozoan Proteins; C079253:K39 antigen, Leishmania
Diagnosis; IFA; Imported leishmaniasis; K39 ELISA; Leishmaniasis; Treatment