What are the approach considerations in the workup of leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

Historically, the diagnosis of leishmaniasis has been confirmed by isolating, visualizing, and culturing the parasite from infected tissue. For confirmation of cutaneous disease, procedures consist principally with performing biopsies, obtaining dermal scrapings, and/or needle aspirates. The smears are stained in Leishman, Giemsa, or Wright stains and examined under oil immersion microscope.

For visceral disease, the parasite can be detected through direct evidence (amastigotes in tissue) from peripheral blood, bone marrow, liver, or splenic aspirates. The most sensitive method is splenic puncture, although iatrogenic complications can be serious, including potentially life-threatening hemorrhage. In current practice, the high sensitivity and specificity of the recombinant K39 assay has generally made such invasive procedures unnecessary.

In endemic areas, the diagnosis of leishmaniasis is often made based on the history and physical examination. Very few of the diagnostic tests discussed in the sections below are available in developing countries.

In both the localized cutaneous and mucocutaneous forms of leishmaniasis, cell-mediated immunity to the parasite is vigorous and organism density in the skin and/or mucosa is low, especially in long-standing disease (although very early in the disease large numbers of the parasites are frequently found). Therefore, growing organisms in culture can be difficult, as can finding them in pathologic specimens.

A Practical Guide for Laboratory Diagnosis of Leishmaniasis is available through the Centers for Disease Control and Prevention (CDC) at: http://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#tx. Note that serologic testing is not discussed in the CDC’s guide.


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