Tegumentary leishmaniasis diagnosis: what happened with MST (Montenegro Skin Test) in Brazil?

Braz, Lúcia Maria Almeida

doi:10.1590/s1678-9946201961017

Cited by 12 publications

(11 citation statements)

References 17 publications

(23 reference statements)

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“…The studies analyzed here were conducted from 1996 to 2019, however, almost 50% of them were conducted in the last five years, mostly in Brazil or another country in the Americas. The increase in the number of studies is coincident with the interruption of the production of MST antigen in Brazil in 2015, which extinguished the simple and rapid immunodiagnostic for TL [ 15 ]. This fact may have boosted research aimed at finding new diagnostic tools.…”

Section: Discussionmentioning

confidence: 99%

“…The anti- Leishmania delayed-type hypersensitivity reaction, known as the Montenegro skin test (MST), has been the most used immunological test for CL-diagnosis in Brazil, even though it presents significant limitations such as positive results associated with previous leishmaniasis or asymptomatic infections [ 13 , 14 ]. Nonetheless, the production of the MST antigen was discontinued in Brazil, hampering even more CL-diagnosis in the country [ 15 ]. Other immunological tests, mainly Enzyme-Linked Immunosorbent Assay (ELISA), have presenting promising results in the Americas and beyond [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review

et al. 2021

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Immunological tests may represent valuable tools for the diagnosis of human tegumentary leishmaniasis (TL) due to their simple execution, less invasive nature and potential use as a point-of-care test. Indeed, several antigenic targets have been used with the aim of improving the restricted scenario for TL-diagnosis. We performed a worldwide systematic review to identify antigenic targets that have been evaluated for the main clinical forms of TL, such as cutaneous (CL) and mucosal (ML) leishmaniasis. Included were original studies evaluating the sensitivity and specificity of immunological tests for human-TL, CL and/or ML diagnosis using purified or recombinant proteins, synthetic peptides or polyclonal or monoclonal antibodies to detect Leishmania-specific antibodies or antigens. The review methodology followed PRISMA guidelines and all selected studies were evaluated in accordance with QUADAS-2. Thirty-eight original studies from four databases fulfilled the selection criteria. A total of 79 antigens were evaluated for the detection of antibodies as a diagnostic for TL, CL and/or ML by ELISA. Furthermore, three antibodies were evaluated for the detection of antigen by immunochromatographic test (ICT) and immunohistochemistry (IHC) for CL-diagnosis. Several antigenic targets showed 100% of sensitivity and specificity, suggesting potential use for TL-diagnosis in its different clinical manifestations. However, a high number of proof-of-concept studies reinforce the need for further analysis aimed at verifying true diagnostic accuracy in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review

et al. 2021

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“…In New World, of healthy individuals without a history of CL living in endemic areas, 10–15% have a positive MST result [ 262 , 163 , 263 ]. Both LCL and MCL present positive response to MST, indicating a cell-mediated immunity against the parasite and MST is reported to be positive in more than 90% of American tegumentary leishmaniasis [ 264 , 265 ].…”

Section: Methodsmentioning

confidence: 99%

Potential biomarkers of immune protection in human leishmaniasis

Rostami

Khamesipour

2021

Med Microbiol Immunol

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Leishmaniasis is a vector-borne neglected tropical disease endemic in over 100 countries around the world. Available control measures are not always successful, therapeutic options are limited, and there is no vaccine available against human leishmaniasis, although several candidate antigens have been evaluated over the last decades. Plenty of studies have aimed to evaluate the immune response development and a diverse range of host immune factors have been described to be associated with protection or disease progression in leishmaniasis; however, to date, no comprehensive biomarker(s) have been identified as surrogate marker of protection or exacerbation, and lack of enough information remains a barrier for vaccine development. Most of the current understanding of the role of different markers of immune response in leishmaniasis has been collected from experimental animal models. Although the data generated from the animal models are crucial, it might not always be extrapolated to humans. Here, we briefly review the events during Leishmania invasion of host cells and the immune responses induced against Leishmania in animal models and humans and their potential role as a biomarker of protection against human leishmaniasis.

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“…The leishmanin from the Istituto Superiore de Sanità was produced until a study suggested that the sensitivity of the product declines over time [29]. The Centro de Produção e Pesquisa de Imunobiológicos (CPPI, Immunobiology Production and Research Center) was the last company producing the Brazilian leishmanin; production of the Brazilian leishmanin ended in 2017 when the Agência Nacional de Vigilância Sanitária (ANVISA, National Health Surveillance Agency), a regulatory agency belonging to the Brazilian Ministry of Health, redefined its requirements for the manufacturing of the reagent [32]. The Wellcome Trust also resumed its production of leishmanin for a time, but eventually stopped once again.…”

Section: Past Sources Of Leishmaninmentioning

confidence: 99%

A review of the leishmanin skin test: A neglected test for a neglected disease

et al. 2021

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The leishmanin skin test (LST) has been used for decades to detect exposure and immunity to the parasite Leishmania, the causative agent of the neglected tropical disease leishmaniasis. In the LST, Leishmania antigen (leishmanin) is intradermally injected into the forearm. In an individual who has been previously infected, a delayed-type hypersensitivity (DTH) reaction results in a measurable induration at the site of the injection, indicating that previous exposure to Leishmania has resulted in the development of cell-mediated immunity. LST positivity is associated with long-lasting protective immunity against reinfection, most notably as reported for visceral leishmaniasis (VL). Despite efforts over the past few decades, leishmanin antigen is no longer produced under good manufacturing practice (GMP) conditions anywhere in the world. Consequently, the use of the LST in epidemiological studies has declined in favor of serological and molecular tests. In this review, we provide a historical overview of the LST and justification for the reintroduction of leishmanin. A GMP-grade leishmanin can be used to detect immunity in vivo by the LST and can be investigated for use in an interferon-γ release assay (IGRA), which may serve as an in vitro version of the LST. The LST will be a valuable tool for surveillance and epidemiological studies in support of the VL elimination programs and as a surrogate marker of immunity in vaccine clinical trials. Methods A review of the literature was conducted using PubMed as the primary database, with MeSH terms “leishmanin skin test” OR “Montenegro test” OR “Montenegro skin test.” Articles written in English that describe the history or standardization of leishmanin, the use of leishmanin in an IGRA, or the use of the LST in epidemiological studies or vaccine trials were prioritized in our appraisal of the literature.

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Tegumentary leishmaniasis diagnosis: what happened with MST (Montenegro Skin Test) in Brazil?

Cited by 12 publications

References 17 publications

Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review

Potential antigenic targets used in immunological tests for diagnosis of tegumentary leishmaniasis: A systematic review

Potential biomarkers of immune protection in human leishmaniasis

A review of the leishmanin skin test: A neglected test for a neglected disease

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