APPLICABILITY OF kDNA-PCR FOR ROUTINE DIAGNOSIS OF AMERICAN TEGUMENTARY LEISHMANIASIS IN A TERTIARY REFERENCE HOSPITAL

Satow, Marcela M.; Yamashiro-Kanashiro, Edite H.; Rocha, Mussya C.; Oyafuso, Luiza K.; Soler, Rita C.; Cotrim, Paulo C.; Lindoso, José Angelo L.

doi:10.1590/S0036-46652013000600004

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Revista do Instituto de Medicina Tropical de São Paulo

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Sumário

LEISHMANIASIS • Rev. Inst. Med. Trop. Sao Paulo 55 (6) • Nov-Dec 2013 • https://doi.org/10.1590/S0036-46652013000600004 copy

APPLICABILITY OF kDNA-PCR FOR ROUTINE DIAGNOSIS OF AMERICAN TEGUMENTARY LEISHMANIASIS IN A TERTIARY REFERENCE HOSPITAL

Aplicação do kDNA-PCR para diagnóstico de rotina de leishmaniose tegumentar americana em um hospital de referência

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

This study evaluated the applicability of kDNA-PCR as a prospective routine diagnosis method for American tegumentary leishmaniasis (ATL) in patients from the Instituto de Infectologia Emílio Ribas (IIER), a reference center for infectious diseases in São Paulo - SP, Brazil. The kDNA-PCR method detected Leishmania DNA in 87.5% (112/128) of the clinically suspected ATL patients, while the traditional methods demonstrated the following percentages of positivity: 62.8% (49/78) for the Montenegro skin test, 61.8% (47/76) for direct investigation, and 19.3% (22/114) for in vitro culture. The molecular method was able to confirm the disease in samples considered negative or inconclusive by traditional laboratory methods, contributing to the final clinical diagnosis and therapy of ATL in this hospital. Thus, we strongly recommend the inclusion of kDNA-PCR amplification as an alternative diagnostic method for ATL, suggesting a new algorithm routine to be followed to help the diagnosis and treatment of ATL in IIER.

American tegumentary leishmaniasis; Diagnostic; kDNA-PCR; Leishmania (Viannia) braziliensis

Clinical manifestation	Cutaneous		Mucosal		Total
Clinical manifestation	N	(%)	N	(%)	N	(%)
Patients	69	53.9%	59	46.1%	128
Direct investigation (76)
Not performed (52)
Positive	38	67.9%	9	45.0%	47	61.8%
Negative	6	10.7%	4	20.0%	10	13.2%
Suggestive	12	21.4%	7	35.0%	19	25.0%
Total	56		20		76
Montenegro skin test (78)
Not performed (50)
Positive (> 5 mm)	18	50.0%	31	73.8%	49	62.8%
Negative (< 5 mm)	18	50.0%	11	26.2%	29	37.2%
Total	36		42		78
In vitro culture (114)
Not performed (14)
Positive	14	23.7%	8	14.5%	22	19.3%
Negative	34	57.6%	17	30.9%	51	44.7%
Contamination	11	18.6%	30	54.5%	41	36.0%
Total	59		55		114
kDNA-PCR (128)
Positive	61	88.4%	51	86.4%	112	87.5%
Negative	8	11.6%	8	13.6%	16	12.5%
Total	69		59		128

kDNA-PCR	Traditional diagnostic methods
	In vitro culture			DI test			MST
	P	N	Cont.	P	N	Sug.	P	N
Positive	22 (100%)	41 (80.4%)	36 (87.8%)	47 (100%)	5 (50%)	15 (78.9%)	48 97.9%)	25 (86.2%)
Negative	0	10 (19.6%)	5 (12.2%)	0	5 (50%)	4 (21%)	1 (2%)	4 (13.8%)

	Result/group	Traditional methods
	Result/group	Positive^* * The same sample could be analyzed by more than one diagnostic method. CATL	Negative NCATL	Total
kDNA-PCR	Positive	82 (98.8%)	30 (66.6%)	112
	Negative	1 (1.2%)	15 (33.3%)	16
	Total	83	45	128

Instituto de Medicina Tropical de São Paulo Av. Dr. Enéas de Carvalho Aguiar, 470, 05403-000 - São Paulo - SP - Brazil, Tel. +55 11 3061-7005 - São Paulo - SP - Brazil
E-mail: revimtsp@usp.br

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[1] Correspondence to: Marcela M. Satow, Instituto de Medicina Tropical de São Paulo, Av. Dr. Enéas de Carvalho Aguiar 500, 05403-000 São Paulo, SP, Brasil. E-mail: mmsatow@usp.br