Comparison of New Diagnostic Tools for Management of Pediatric Mediterranean Visceral Leishmaniasis

Abstract

New techniques are available for diagnosing leishmaniasis, but their efficacy in the identification of pediatric visceral leishmaniasis (VL) has not been compared with that of traditional methods. Blood, bone marrow, and urine samples were taken from 25 children with VL during their first clinical episode, 22 days after the start of treatment with liposomal amphotericin B (3 mg/kg/day on 6 days over a 10-day period), and when a relapse was suspected during follow-up. The results obtained suggest that antibody detection techniques, the antigen detection in urine (KAtex kit), and Leishmania nested PCR (LnPCR) analysis of the blood could be used for diagnosis of the first clinical episode. After treatment, clinical improvement was associated with negativization of Novy-MacNeal-Nicolle culture and microscopy of bone marrow aspirate, KAtex test, and LnPCR blood analysis results. Interestingly, LnPCR analysis of the bone marrow aspirate showed that sterile cure was not achieved in eight patients, two of which suffered a relapse within 10 to 20 weeks. All of the new noninvasive techniques tested showed high diagnostic sensitivity. However, LnPCR analysis of the bone marrow was the most sensitive; this test was able to detect the persistence of parasites and predict potential relapses.

Contribution of Quantitative Real-Time Polymerase Chain Reaction to Follow-Up of Visceral Leishmaniasis Patients Treated with Meglumine Antimoniate

“…Such persistence of Leishmania DNA after treatment has been reported after treatment with meglumine antimoniate or amphotericin. 6,10 However, decreased kinetics of parasitemia after treatment with meglumine antimoniate is different of from that observed after treatment with liposomal amphotericin, which induces an undetectable parasitemia in nearly all patients in 5-10 days. 6,9,10 This difference is probably caused by different modes of action of the two drugs or relative resistance levels of parasites to antimony.…”

“…6,10 However, decreased kinetics of parasitemia after treatment with meglumine antimoniate is different of from that observed after treatment with liposomal amphotericin, which induces an undetectable parasitemia in nearly all patients in 5-10 days. 6,9,10 This difference is probably caused by different modes of action of the two drugs or relative resistance levels of parasites to antimony. 6,11 The two patients who showed no improvement after treatment (Rs 1 and Rs 2) and the relapsed patient (Rl) represent the first patients reported regarding a lack of sensitivity of L. infantum isolates in Tunisia to meglumine antimoniate.…”

Evaluation of rK-39 Strip Test Using Urine for Diagnosis of Visceral Leishmaniasis in an Endemic Region of India

“…Nearly one-half of VL cases occur in children. 33 However, collecting urine from this cohort is relatively easier because of less reluctance. Moreover, blood-borne transmission of HIV, hepatitis B surface antigen (HbsAg), and hepatitis C virus (HCV) can also occur by drawing blood through unsterile needles/syringes as well as using improper techniques.…”

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation

“…such as rK39 have been used in ELISAs as well as in rapid immunochromatography tests. A positive reaction would have a correlation with an active episode of VL, although occasionally, antibodies against the rK39 antigen may persist even after cure (91,419).…”