Volume 94, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



A prerequisite for the control of visceral leishmaniasis (VL) is the accessibility to reference diagnostics. The high price of the freeze-dried direct agglutination test (FD-DAT) and the short shelf-life time of the rK39 strip test (rK39) have limited the application of these tests in Sudan. An original liquid DAT (LQ-DAT) with high reproducibility compared with the FD-DAT and rK39 has been routinely produced in our laboratory since 1999. In this study, a 3.4-year-old batch (of more than 90 test batches produced to date) was chosen to validate the diagnostic performance of this test against microscopy, FD-DAT, and rK39 in 96 VL and 42 non-VL serum samples. Relatively higher sensitivity (95/96, 99.0%) was recorded for the LQ-DAT than for the FD-DAT (92/96, 95.8%) and rK39 (76/96, 79.2%), probably because of the use of the endemic autochthonous isolate as the antigen. Experience with the LQ-DAT, its low cost of production, ease of providing this test, and diagnostic reliability compared with the FD-DAT suggest that widescale implementation of the LQ-DAT can contribute to sustainable VL control in Sudan.


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  1. Boelaert M, Bhattacharya S, Chappuis F, El Safi SH, Hailu A, Mondal D, Rijal S, Sundar S, Wasunna M, Peeling RW, , 2007. Evaluation of rapid diagnostic tests: visceral leishmaniasis. Nat Rev Microbiol 5: S30S39.[Crossref] [Google Scholar]
  2. Chappuis F, Sundar S, Hailu A, Ghalib H, Rijal S, Peeling RW, Alvar G, Boelaert M, , 2007. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol 5: 873882.[Crossref] [Google Scholar]
  3. el Harith A, Kolk AHJ, Leeuwenburg J, Muigai R, Huigen E, Jelsma T, Kager PA, , 1988. Improvement of a direct agglutination test for field studies of visceral leishmaniasis. J Clin Microbiol 26: 13211325. [Google Scholar]
  4. el Harith A, el Mutasim M, Mansour D, Mustafa F, Arvidson H, , 2003. Use of glycerol as alternative to freeze-drying for long-term preservation of antigen for the direct agglutination test. Trop Med Int Health 8: 10251029.[Crossref] [Google Scholar]
  5. el Mutasim M, Mansour D, Abass EM, Hassan WM, el Harith A, , 2006. Evaluation of a glycerol-preserved antigen in the direct agglutination test for diagnosis of visceral leishmaniasis at rural level in eastern Sudan. J Med Microbiol 55: 13431347.[Crossref] [Google Scholar]
  6. el Harith A, Chowdhury S, Al-Masum A, Semiao-Santos S, Karim E, el-Safi S, Haque I, , 1995. Evaluation of cleaving agents other than trypsin in direct agglutination test for further improving diagnosis of visceral leishmaniasis. J Clin Microbiol 33: 19841988. [Google Scholar]
  7. Sadigursky M, Brodskyn CI, , 1986. A new liquid medium without blood and serum for culture of hemoflagellates. Am J Trop Med Hyg 35: 942944. [Google Scholar]
  8. Jacquet D, Boelaert M, Seaman J, Rijal S, Sundar S, Menten J, Magnus E, , 2006. Comparative evaluation of freeze-dried and liquid antigens in the direct agglutination test for serodiagnosis of visceral leishmaniasis (ITMA-DAT/VL). Trop Med Int Health 11: 17771784.[Crossref] [Google Scholar]
  9. Abass E, Bollig N, Reinhard K, Camara B, Mansour D, Visektuna A, Lohoff M, Steinhoff U, , 2013. rKLO8, a novel Leishmania donovani-derived recombinant immunodominant protein for sensitive detection of visceral leishmaniasis in Sudan. PLoS Negl Trop Dis 7: e2322.[Crossref] [Google Scholar]
  10. Meredith SE, Kroon NC, Sondorp E, Seaman J, Goris MG, van Ingen CW, Oosting H, Schoone G, Terpstra WJ, Oskam L, , 1995. Leish-KIT, a stable direct agglutination test based on freeze-dried antigen for serodiagnosis of visceral leishmaniasis. J Clin Microbiol 33: 17421745. [Google Scholar]
  11. Mbati PA, Githure JI, Kagai JM, Kirigi G, Kibati F, Wasunna K, Koech DK, , 1999. Evaluation of a standardized direct agglutination test (DAT) for the diagnosis of visceral leishmaniasis in Kenya. Ann Trop Med Parasitol 93: 703710.[Crossref] [Google Scholar]
  12. Oliveira AE, Pedras MJ, De Assis IE, Rabello A, , 2009. Improvement of direct agglutination test (DAT) for laboratory diagnosis of visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg 103: 12791281.[Crossref] [Google Scholar]
  13. Islam MZ, Itoh M, Mirza R, Ahmed I, Ekram AR, Sarder AH, Shamsuzzaman SM, Hashiguchi Y, Kimura E, , 2004. Direct agglutination test with urine samples for the diagnosis of visceral leishmaniasis. Am J Trop Med Hyg 70: 7882. [Google Scholar]
  14. Mohebali M, Edrissian GH, Nadim A, Hajjaran H, Akhoundi B, Hooshamand B, Zarei Z, Mirsamadi N, Manoucherhri Naeini K, Mamishi Sanati AA, Moshfe AA, Charehdar S, Fakhar M, , 2006. Application of direct agglutination test (DAT) for the diagnosis and sero-epidemiological studies of visceral leishmaniasis in Iran. Iran J Parasitol 1: 1525. [Google Scholar]
  15. Boelaert M, El-Safi S, Hailu A, Mukhtar M, Rijal S, Sundar S, Wasunna M, Aseffa A, Mbui J, Menten J, Desjeux P, Peeling RW, , 2008. Diagnostic tests for kala-azar: a multi-centre study of the freeze-dried DAT, rK39 strip test and KAtex in east Africa and the Indian subcontinent. Trans R Soc Trop Med Hyg 102: 3240.[Crossref] [Google Scholar]
  16. Kuhls K, Keilonat L, Ochsenreither S, Schaar M, Schweynoch C, Presber W, Schönian G, , 2007. Multilocus microsatellite typing (MLMT) reveals genetically isolated populations between and within the main endemic regions of visceral leishmaniasis. Microbes Infect 9: 334343.[Crossref] [Google Scholar]
  17. Alam MZ, Kuhls K, Schweynoch C, Sundar S, Rijal S, Shamsuzzaman AK, Raju BV, Salotra P, Dujardin JC, Schönian G, , 2009. Multilocus microsatellite typing (MLMT) reveals genetic homogeneity of Leishmania donovani strains in the Indian subcontinent. Infect Genet Evol 9: 2431.[Crossref] [Google Scholar]
  18. Bhattacharyya T, Duncan EB, El-Safi S, Sundar S, Falconar AK, Singh OP, Kumar R, Ahmed O, Boelaert M, Miles MA, , 2014. Significantly lower anti-Leishmania IgG responses in Sudanese versus Indian visceral leishmaniasis. PLoS Negl Trop Dis 8: e2675.[Crossref] [Google Scholar]
  19. Pattabhi S, Whittle J, Mohamath R, El-Safi S, Moulton GG, Guderian JA, Colombara D, Abdoon AO, Mukhtar MM, Mondal D, Esfandiari J, Kumar S, Chun P, Reed SG, Bhatia A, , 2010. Design, development and evaluation of rK28-based point-of-care tests for improving rapid diagnosis of visceral leishmaniasis. PLoS Negl Trop Dis 4: e822.[Crossref] [Google Scholar]

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  • Received : 08 Aug 2015
  • Accepted : 29 Jan 2016
  • Published online : 04 May 2016

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