Potential of Direct Agglutination Test Based on Promastigote and Amastigote Antigens for Serodiagnosis of Post-Kala-Azar Dermal Leishmaniasis

Singh, Ruchi; Raju, B. V. Subba; Jain, R. K.; Salotra, Poonam

doi:10.1128/cdli.12.10.1191-1194.2005

Cited by 19 publications

(16 citation statements)

References 27 publications

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“…A comparison of the various diagnostic methods for identifying PKDL cases is reviewed in Table 3. So far, rk39 dipstick test has proven to be useful for PKDL diagnosis, although caution should be maintained to differentiate antibodies due to past VL infection (Salotra et al 2001b;Singh et al 2005). Sensitivity of nested PCR assay is greater than primary PCR allowing reliable diagnosis even in macular cases (Sreenivas et al 2004).…”

Section: Diagnosis Of Parasite Reservoirs In An Endemic Areamentioning

confidence: 99%

Diagnosis of visceral leishmaniasis: developments over the last decade

et al. 2011

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Diagnostic parameters for visceral leishmaniasis (VL), a potentially fatal parasitic disease caused by Leishmania donovani, have been redefined in the last decade with the development of serological and molecular tests, though a definitive diagnosis still banks on the century-old parasitological methods in many areas. Recombinant antigens have improved performance of serodiagnostic methods. Serology-based tests, rk39 antigen dipstick, and direct agglutination test commonly employed in the field are highly sensitive methods, however, fail to distinguish past infections. Molecular approaches have become increasingly relevant due to remarkable sensitivity, specificity, and flexibility in choice of samples. Quantitative polymerase chain reaction is a highly sensitive and specific tool used in referral labs for detection/assessment of parasite load in VL patients and subsequently in monitoring treatment response to antileishmanial agents. The method displays potential to provide threshold for distinguishing asymptomatics in endemic areas. Currently, improvement in VL diagnostics is required for successful decentralized (point-of-care) testing in field conditions and to detect VL-HIV co-infection. Techniques such as loop-mediated isothermal amplification offer a reliable molecular diagnostic method for field application. The diagnosis based on bioanalytics/biosensors promise frontiers for point-of-care VL detection after adequate standardization. This review summarizes the recent developments in VL diagnostics, drawing attention towards the need for standardization of the diagnostics across the affected regions.

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Section: Diagnosis Of Parasite Reservoirs In An Endemic Areamentioning

confidence: 99%

Diagnosis of visceral leishmaniasis: developments over the last decade

et al. 2011

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“…For detection of polymorphic PKDL (comprising both macular and papulo-nodular skin lesions), the sensitivity of the rK39 strip test is 95.6%, and for macular PKDL, the sensitivity is 86.3%. 6 This report deals with three cases where relying on the rK39 strip test led to misdiagnosis and subsequent therapeutic delay. The study was approved by the Institutional Ethical Committee, and peripheral blood or skin biopsy was collected after obtaining informed consent from the parent/ guardian of the minors.…”

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“…4 The K39 epitope is highly conserved in the visceralizing species of Leishmania and was used to develop a diagnostic test for VL and PKDL. 5,6 In cases of VL, the rK39 nitrocellulose-based dipstick test showed high sensitivity and specificity 4 and therefore, has gained substantial popularity for its ease of use, especially in the field setting. For detection of polymorphic PKDL (comprising both macular and papulo-nodular skin lesions), the sensitivity of the rK39 strip test is 95.6%, and for macular PKDL, the sensitivity is 86.3%.…”

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Case Series of Misdiagnosis with rK39 Strip Test in Indian Leishmaniasis

Das¹,

Singh²,

Ghosh³

et al. 2011

The American Journal of Tropical Medicine and Hygiene

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Abstract. This report presents three cases where the rK39 strip test failed to diagnose two cases of post-kala-azar dermal leishmaniasis and one case of visceral leishmaniasis. However, a strong clinical suspicion prompted further evaluation by polymerase chain reaction (PCR), which established the etiology. The present case series highlights the usefulness of PCR in the diagnosis of leishmaniasis.

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“…Histopathological diagnosis of PKDL is not very sensitive or specific, as visualization of intact parasites in tissue sections is difficult. Immunohistochemical staining is complex and has varied degrees of sensitivity (8,9,10).In recent years, several studies have proved that PCR is a very sensitive and specific technique for detection of leishmania DNA (11,12,13,14,15). Few PCR methods have been developed for PKDL diagnosis, but its efficacy on biopsy specimens from various types of lesions has not been assessed properly (12,15).…”

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Comparative Evaluation of PCR and Imprint Smear Microscopy Analyses of Skin Biopsy Specimens in Diagnosis of Macular, Papular, and Mixed Papulo-Nodular Lesions of Post-Kala-Azar Dermal Leishmaniasis

et al. 2013

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Diagnosis of post-kala-azar dermal leishmaniasis (PKDL), particularly the macular form, is difficult when based on microscopy. This study compared the results of nested PCR (91.9% positive samples) with imprint smear microscopy (70.9% positive samples) for 62 PKDL samples. We found that nested PCR, which indicated 87.5% positivity for the macular lesions, compared to 41.6% positivity by imprint smear microscopy, is an efficient method for early diagnosis of PKDL. P ost-kala-azar dermal leishmaniasis (PKDL), a chronic dermatosis, is a sequela of visceral leishmaniasis (VL), which is caused by Leishmania donovani infection. In India, it usually develops after 6 months to several years in 5 to 15% of cured VL cases. A past history of VL is absent in 15 to 20% of PKDL patients (1, 2).PKDL, which is characterized by macular, papular, or papulonodular lesions on the face and other parts of the body, is often confused clinically and pathologically with leprosy, vitiligo, or fungal infection (1). In India, PKDL cases are the known reservoir of the leishmania parasite and have a major role in anthroponotic transmission of VL (3, 4). Therefore, early detection and management of PKDL is an essential strategy for the goals of elimination of VL from the Indian subcontinent by 2015 and of PKDL by 2018 (5, 6, 7).Demonstration of leishmania parasites in skin biopsy specimen imprint/slit smear or culture from a PKDL lesion is considered the "gold standard" for diagnosis of PKDL. However, microscopy is less sensitive than molecular techniques, such as PCR, and requires prolonged searches, particularly in macular lesions with a very low parasite density. Cultures are often negative, prone to contamination, and this method is not feasible to perform in the field (1,8).Serological techniques do not provide direct evidence of parasite positivity, and they are not reliable in immunocompromised patients. Techniques involving use of monoclonal antibodies or isoenzyme or schizodeme analyses are tedious and require massive culturing of parasites. Histopathological diagnosis of PKDL is not very sensitive or specific, as visualization of intact parasites in tissue sections is difficult. Immunohistochemical staining is complex and has varied degrees of sensitivity (8,9,10).In recent years, several studies have proved that PCR is a very sensitive and specific technique for detection of leishmania DNA (11,12,13,14,15). Few PCR methods have been developed for PKDL diagnosis, but its efficacy on biopsy specimens from various types of lesions has not been assessed properly (12,15). This highlights an urgent need to develop a reliable and highly sensitive and specific technique to detect PKDL, especially for hypopigmented macular lesions (16).In the present study, a nested PCR designed for the internal transcribed spacer (ITS) region of the rRNA gene of L. donovani was used on biopsy samples from macular, papular, and papulo-nodular lesions of PKDL, and the results were compared with those obtained from imprint smear microscopy. The study was appr...

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Potential of Direct Agglutination Test Based on Promastigote and Amastigote Antigens for Serodiagnosis of Post-Kala-Azar Dermal Leishmaniasis

Cited by 19 publications

References 27 publications

Diagnosis of visceral leishmaniasis: developments over the last decade

Diagnosis of visceral leishmaniasis: developments over the last decade

Case Series of Misdiagnosis with rK39 Strip Test in Indian Leishmaniasis

Comparative Evaluation of PCR and Imprint Smear Microscopy Analyses of Skin Biopsy Specimens in Diagnosis of Macular, Papular, and Mixed Papulo-Nodular Lesions of Post-Kala-Azar Dermal Leishmaniasis

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