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UTILITY OF LYMPH NODE ASPIRATION IN THE DIAGNOSIS OF VISCERAL LEISHMANIASIS IN SUDAN

We evaluated lymph node aspiration (LNA) as a simple diagnostic procedure for visceral leishmaniasis (VL). Lymph node aspiration was compared with the direct agglutination test (DAT) using a diagnostic titer 1:6,400 in 7,880 suspected VL patients in eastern Sudan. Compared with DAT, LNA had a sensitivity of 65.1% (95% confidence interval = 63.5–66.6%). Parasite density in LNA correlated strongly with DAT titers (P < 0.0001), and low parasite density accounted for 78.1% of positive LNA results with DAT titers < 1:6,400 (n = 782). Risk factors predictive of a positive LNA result were an age of 1–29 years, male sex, a hemoglobin level < 10.0 g/dL, a DAT titer 1:800, and a location with a higher prevalence of VL. Lymph node and splenic aspirations were similarly accurate as tests of cure after treatment of 50 VL patients in southern Sudan. Pre-treatment LNA results were negative in 20 cases of severe post kala-azar dermal leishmaniasis.

Received October 10, 2006. Accepted for publication January 4, 2007.

Acknowledgments: We thank MSF staff in both northern and southern Sudan missions for their diligence and high quality work. We also thank Professor Brian Greenwood and Jim Todd (London School of Hygiene and Tropical Medicine) for their support. Médecins Sans Frontières–Holland provided all diagnostic and treatment materials for the study.

^* Address correspondence to Zahir O. E. Babiker, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Delaunays Road, Manchester M8 5RB, United Kingdom. E-mail: zahir_babiker{at}yahoo.co.uk

Authors’ addresses: Zahir O. E. Babiker, Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital, Delaunays Road, Manchester M8 5RB, United Kingdom, E-mail: zahir_babiker{at}yahoo.co.uk. Robert Davidson, Department of Infection and Tropical Medicine, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, United Kingdom, E-mail: r.n.davidson{at}imperial.ac.uk. Charles Mazinda, Sammy Kipngetich, and Koert Ritmeijer, Médecins Sans Frontières–Holland, PO Box 10014, 1001 EA, Amsterdam, The Netherlands, E-mails: csmazinda{at}hotmail.com, msfh-lankien{at}field.amsterdam.msf.org, and koert.ritmeijer{at}amsterdam.msf.org.

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