How is a biopsy performed in the workup of visceral 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, bone marrow, liver, or splenic aspirates were the key to the laboratory diagnosis of visceral disease, but in current practice the high sensitivity and specificity of the recombinant K39 assay has generally made such invasive unnecessary.

The safest and most common way to obtain tissue is through bone-marrow aspiration obtained from the sternum or the iliac crest, although splenic aspiration may be used in cases that are difficult to diagnose. Amastigote forms are revealed in plain film, and the promastigote forms are revealed in culture. Although safer than splenic puncture, the parasites are scant and may give a false-negative test result. Positivity rates of 54-86% have been obtained using bone marrow.

Splenic aspiration has a higher sensitivity than bone-marrow aspiration—as many as 98% of positive results have been obtained using splenic aspiration—but this procedure should be attempted only by experienced physicians. Splenic puncture is associated with the risk of uncontrolled hemorrhage and, therefore, should be carried out only when bone marrow examination findings are inconclusive. Contraindications include low platelet count, abnormal prothrombin time, and a spleen that is palpable 4 cm or less below the costophrenic angle.

Additional tissue can be obtained through liver biopsy and lymph node dissection.


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