Asymptomatic VL is a concern, considering the risk of transmission in highly
endemic areas due to human-to-human transmission. The aim of this study was to
report the sero-epidemiological prevalence in Bihar, India, a highly endemic
area of VL, using the leishmanin skin test (LST) and the direct agglutination
test (DAT). This was a cross-sectional study performed in Muzaffarpur, Bihar,
India. Relatives of patients with VL were tested by LST and DAT. Other
epidemiological data were evaluated and correlated with tests results. Forty
individuals (either previous or current patients), and 109 household contacts
were studied. There were 36% of male visceral leishmaniasis family members
versus 17.57% of females visceral leishmaniasis family members, thus showing
more males with symptomatic disease than females (p< 0.01). All visceral
leishmaniasis cases had positive DAT tests, but only 37% of past cases were
positive on the skin testing. Amongst healthy household contacts, 34% were
DAT-positive, whilst 21% were LST-positive. The overall positivity for both
assays combined was 44.8% and 23.8% were DAT-positive alone. The finding of high
infection prevalence amongst asymptomatic individuals, and the estimation of
those at greater risk for overt disease (DAT-positive alone) are important in
the development of future disease control policies.
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