Fine‐needle sampling provides appreciable diagnostic yield in lesions of post kala azar dermal leishmaniasis: Analysis of four cases from North Eastern India

Bandyopadhyay, Arghya; Majumdar, Dipanwita; Gangopadhyay, Mimi; Koley, Sankha

doi:10.1002/dc.22953

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…The need to perform skin biopsy, which is invasive and requires suturing, causes discomfort and limits the number of people who agree to this invasive procedure for diagnostic purposes. Recently, several studies reported the promising diagnostic efficacy of the less invasive slit skin, microbiopsy, and fine needle biopsy methods [ 24 , 33 , 38 , 39 ]. Further validation is needed before these methods can be used for PKDL patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Real-time PCR for Diagnosis of Post-Kala-azar Dermal Leishmaniasis in Endemic Foci of Bangladesh

Ghosh

Hasnain

Hossain

et al. 2018

Open Forum Infectious Diseases

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BackgroundPost-kala-azar dermal leishmaniasis (PKDL) is a sequel to visceral leishmaniasis (VL), which is found in VL-endemic countries including Bangladesh. Because of these enigmatic cases, the success of the National Kala-azar Elimination Program is under threat. To date, diagnostic methods for PKDL cases in endemic regions have been limited to clinical examination and rK39 test or microscopy, and a suitable and accurate alternative method is needed. In this study, we investigated the application of real-time polymerase chain reaction (PCR) as a potential method for diagnosis of PKDL in comparison with microscopy.MethodsNinety-one suspected macular PKDL cases from Mymensingh district, Bangladesh, were enrolled in the study after diagnosis by clinical examination and an rK39 strip test. All of them responded after completion of the treatment with miltefosine. During enrollment, a skin biopsy was done for each patient, and both microscopy and real-time PCR were performed for detection and quantification of Leishmania donovan body (LDB) and LD DNA, respectively.ResultsReal-time PCR detected 83 cases among all suspected PKDL patients, with an encouraging sensitivity of 91.2% (83.4%–96.1%), whereas microscopy showed 50.6% (39.9%–61.2%) sensitivity. Among all suspected PKDL cases, 42 cases were positive in both microscopy and qPCR, whereas 41 cases were detected as positive through qPCR only.ConclusionsThis study provides evidence that real-time PCR is a promising tool for diagnosis of PKDL in endemic regions. In addition to diagnosis, the quantitative ability of this method could be further exploited for after-treatment prognosis and cure assessment of PKDL cases.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Real-time PCR for Diagnosis of Post-Kala-azar Dermal Leishmaniasis in Endemic Foci of Bangladesh

Ghosh

Hasnain

Hossain

et al. 2018

Open Forum Infectious Diseases

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“…The skin biopsy procedure is invasive and requires surgical set-up, which limits the ability to collect multiple biopsies without negatively impacting patient participation and use as an active field-based case detection method. Several recent studies have indicated the satisfactory diagnostic efficacies of the less invasive slit skin, microbiopsy, and fine needle biopsy methods [21,41,42]. Further evidence is required, however, before these invasive sample collection procedures can be applied for diagnosis of PKDL.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Rapid Extraction Methods Coupled with a Recombinase Polymerase Amplification Assay for Point-of-Need Diagnosis of Post-Kala-Azar Dermal Leishmaniasis

et al. 2020

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To detect Post-kala-azar leishmaniasis (PKDL) cases, several molecular methods with promising diagnostic efficacy have been developed that involve complicated and expensive DNA extraction methods, thus limiting their application in resource-poor settings. As an alternative, we evaluated two rapid DNA extraction methods and determined their impact on the detection of the parasite DNA using our newly developed recombinase polymerase amplification (RPA) assay. Skin samples were collected from suspected PKDL cases following their diagnosis through national guidelines. The extracted DNA from three skin biopsy samples using three different extraction methods was subjected to RPA and qPCR. The qPCR and RPA assays exhibited highest sensitivities when reference DNA extraction method using Qiagen (Q) kit was followed. In contrast, the sensitivity of the RPA assay dropped to 76.7% and 63.3%, respectively, when the boil & spin (B&S) and SpeedXtract (SE) rapid extraction methods were performed. Despite this compromised sensitivity, the B&S-RPA technique yielded an excellent agreement with both Q-qPCR (k = 0.828) and Q-RPA (k = 0.831) techniques. As expected, the reference DNA extraction method was found to be superior in terms of diagnostic efficacy. Finally, to apply the rapid DNA extraction methods in resource-constrained settings, further methodological refinement is warranted to improve DNA yield and purity through rigorous experiments.

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“…The morbidity of PKDL in the Indian subcontinent is prolonged irrespective of the morphology of lesions. Several histopathology studies have gone through the infected skin lesion tissues having numerous intracellular and extracellular L. donovani bodies [5,9,58,73,[127][128][129]. A retrospective study, with biopsies of 88 skin and 16 mucosal lesions of PKDL patients were studied from 2004 to 2011 in Bihar has shown histo-morphological patterns having follicular plugging, grenz zone, and dermal infiltrates arranged in three modes: diffused infiltrates (46.6%), perivascular and perifollicular infiltrates (27.3%), and superficial perivascular infiltrates (18.1%) [127].…”

Section: Histopathologymentioning

confidence: 99%

Post kala-azar dermal leishmaniasis: A threat to elimination program

et al. 2020

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Leishmaniasis remains a public health concern around the world that primarily affects poor folks of the developing world spanning across 98 countries with mortality of 0.2 million to 0.4 million annually. Post kala-azar dermal leishmaniasis (PKDL) is the late skin manifestation of visceral leishmaniasis (VL). It has been reported that about 2.5% to 20% of patients recovered from VL develop PKDL having stilted macular or nodular lesions with parasites. In the Indian subcontinent (ISC), it manifests a few months after recovery from VL, though in Africa it can occur simultaneously with VL or a little later. New cases of PKDL are also observed without prior VL in the ISC. These individuals with PKDL represent an important but largely neglected reservoir of infection that perpetuates anthroponotic Leishmania donovani transmission in the ISC and can jeopardize the VL elimination program as these cases can infect the sand flies and spread the endemic. Therefore, it becomes imperative to eradicate PKDL as a part of the VL elimination program. With the limited treatment options besides little knowledge on PKDL, this review stands out in focusing on different aspects that should be dealt for sustained VL elimination.

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Fine‐needle sampling provides appreciable diagnostic yield in lesions of post kala azar dermal leishmaniasis: Analysis of four cases from North Eastern India

Cited by 3 publications

References 15 publications

Evaluation of Real-time PCR for Diagnosis of Post-Kala-azar Dermal Leishmaniasis in Endemic Foci of Bangladesh

Evaluation of Real-time PCR for Diagnosis of Post-Kala-azar Dermal Leishmaniasis in Endemic Foci of Bangladesh

Evaluation of Rapid Extraction Methods Coupled with a Recombinase Polymerase Amplification Assay for Point-of-Need Diagnosis of Post-Kala-Azar Dermal Leishmaniasis

Post kala-azar dermal leishmaniasis: A threat to elimination program

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