Complementary exams in the diagnosis of american tegumentary leishmaniasis

Abstract

The diagnosis of American Tegumentary Leishmaniasis is a difficult but essential task when considering the high toxicity profile of the drugs available. Since the discovery of its etiologic agent, numerous diagnostic tests have been developed. None of the tests available today can be considered as the gold standard, since they do not add enough accuracy for the disease detection. Good epidemiological and clinical knowledge of the disease are fundamental precepts of the dermatology practice and precede the rational use of existing diagnostic tests. In this article we aim, through extensive literature review, to recall fundamental concepts of any diagnostic test. Subsequently, based on this information, we will weave important comments about the characteristics of existing diagnostic tests, including immunological tests such as Montenegro's skin test, serology and detection of parasites by direct examination, culture or histopathology. Finally we will discuss the new technologies and options for the diagnosis of Cutaneous Leishmaniasis. The molecular biology technique is considered a promising tool, promoting the rapid identification of the species involved. We also aim to educate dermatologists about a disease with high morbidity and assist in its difficult recognition.

Field Validation of SYBR Green- and TaqMan-Based Real-Time PCR Using Biopsy and Swab Samples To Diagnose American Tegumentary Leishmaniasis in an Area Where Leishmania (Viannia) braziliensis Is Endemic

“…These parasites specifically stimulate an intense granulomatous reaction, resulting in disfiguring lesions in untreated patients (3).…”

“…The accurate diagnosis of American tegumentary leishmaniasis (ATL) is an essential task due to the disease's associated morbidity (1,2) but is hindered by the lack of a gold-standard laboratory test (3)(4)(5). Currently available parasitological tests based on stained smears and culture offer low sensitivity, and other options, such as the Montenegro (leishmanin) skin test (MST), have high sensitivity but low specificity (3,6,7).…”

“…Currently available parasitological tests based on stained smears and culture offer low sensitivity, and other options, such as the Montenegro (leishmanin) skin test (MST), have high sensitivity but low specificity (3,6,7). Additionally, serological techniques may yield widely varied accuracy values (3). In contrast, although not completely sensitive, PCR can improve the accuracy of ATL diagnosis (5,8,9).…”

Métodos diagnósticos da leishmaniose tegumentar americana: uma revisão de literatura

“…Devido a ausência de um exame padrão ouro, os testes devem ser escolhidos em função do tempo de evolução da doença, nível de complexidade do teste e viabilidade de aplicação do mesmo. (GOMES et al, 2014) Segue uma descrição dos testes disponíveis para diagnóstico da LTA no Brasil. …”

“…(FERREIRA; GOMES; PEREIRA-CHIOCCOLA, 2015; SHIRIAN et al, 2014; BARCAROL et al, 2011) O sucesso do diagnóstico e tratamento da doença baseia-se, portanto, numa anamnese sólida, conhecimentos sobre a epidemiologia e exames complementares para confirmação da doença. (GOMES et al, 2014) Existem diversos exames e testes empregados no diagnóstico da LTA, esses variam muito de sensibilidade e especificidade, não existindo um exame considerado padrão ouro, (ANDRADE et al, 2005).…”