What are the approach considerations in the workup of systemic 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

Considerable experience has been gained and success achieved with using bone marrow aspirates (and especially a small piece of the spiculated core tissue) for cultivating the parasite or for looking for macrophages filled with amastigotes in the stained bone marrow aspirate smears.

A variety of immunodiagnostic serologic tests have been developed to aid in the diagnosis of systemic leishmaniasis. However, the only successfully deployed serologic tests are limited to species of Leishmania that cause visceral disease. Limitations include false-negative serologic results due to inadequate titers of antibodies late in the course of the disease and false-positive results in the setting of other infectious or autoimmune diseases.

Serologic testing is useful with the indirect fluorescent antibody (IFA) test, which is 80-100% sensitive in patients with visceral leishmaniasis who are not infected with human immunodeficiency virus (HIV). However, IFA may cross-react in patients who have leprosy, tuberculosis, malaria, schistosomiasis, Chagas disease, and African trypanosomiasis. Serologic tests such as isoenzyme or monoclonal antibody analysis are not well established.

An enzyme-linked immunosorbent assay (ELISA) can be combined with IFA and/or Western blot to increase sensitivity and specificity. Polymerase chain reaction (PCR) is being used more frequently; it is more accurate in determining new-onset leishmaniasis than serum tests (92-99% sensitivity; 100% specificity).


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