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M9470102.TXT
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1994-07-02
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Document 0102
DOCN M9470102
TI Comparison of PCR with direct examination of bone marrow aspiration,
myeloculture, and serology for diagnosis of visceral Leishmaniasis in
immunocompromised patients.
DT 9409
AU Piarroux R; Gambarelli F; Dumon H; Fontes M; Dunan S; Mary C; Toga B;
Quilici M; Laboratoire de Parasitologie-Mycologie, Faculte de Medecine
de; la Timone, Marseille, France.
SO J Clin Microbiol. 1994 Mar;32(3):746-9. Unique Identifier : AIDSLINE
MED/94253342
AB A PCR assay amplifying a repeated sequence from the Leishmania infantum
genome was compared with direct examination of bone marrow aspirate,
myeloculture, and serology for the diagnosis of visceral leishmaniasis
in immunocompromised patients. Of 73 patients living in an area endemic
for leishmaniasis and where visceral leishmaniasis was suspected by
physicians, only 10 had an indisputable diagnosis of visceral
leishmaniasis. None of the diagnostic tests performed in the study
achieved 100% sensitivity for diagnosing visceral leishmaniasis. PCR
exhibited superior sensitivity (82%) in comparison with bone marrow
aspirate examination (55%) and myeloculture (55%). Our PCR assay also
showed good specificity (97%), negative predictive value (97%), and
positive predictive value (82%) even when all unconfirmed PCR results
were scored as false positives. Serology exhibited good sensitivity
(80%) and excellent specificity (100%), negative predictive value (98%),
and positive predictive value (100%) in diagnosing new cases of visceral
leishmaniasis but failed to diagnose relapses. We also observed
consistent negative serological results using several different
immunological detection methods for 2 of the 10 patients with confirmed
cases of visceral leishmaniasis. This lack of serological reactivity
persisted throughout the course of their infections. These results
demonstrate the importance of using PCR as an aid in the diagnosis of
visceral leishmaniasis in immunocompromised patients.
DE Adolescence Adult Aged Animal Antibodies, Protozoan/BLOOD
AIDS-Related Opportunistic Infections/COMPLICATIONS/DIAGNOSIS/
IMMUNOLOGY Base Sequence Bone Marrow/PARASITOLOGY Comparative Study
DNA Primers/GENETICS DNA, Protozoan/GENETICS Human *Immunocompromised
Host Leishmania infantum/GENETICS/IMMUNOLOGY/ISOLATION & PURIF
Leishmaniasis, Visceral/COMPLICATIONS/*DIAGNOSIS/*IMMUNOLOGY Middle Age
Molecular Sequence Data Parasitology/METHODS/STATISTICS & NUMER DATA
*Polymerase Chain Reaction/STATISTICS & NUMER DATA Sensitivity and
Specificity Serodiagnosis/STATISTICS & NUMER DATA JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).