Volume 76, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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 ( < 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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Chulay JD, Bryceson AD, 1983. Quantitation of amastigotes of Leishmania donovani in smears of splenic aspirates from patients with visceral leishmaniasis. Am J Trop Med Hyg 32 : 475–479. [Google Scholar]
  2. Kirk R, Sati MH, 1940. Studies in leishmaniasis in the Anglo-Egyptian Sudan II. The skin and lymph glands in kala-azar. Trans R Soc Trop Med Hyg 33 : 501–506. [Google Scholar]
  3. Zijlstra EE, El-Hassan AM, 2001. Leishmaniasis in Sudan: visceral leishmaniasis. Trans R Soc Trop Med Hyg 95 (Suppl 1): S27–S58. [Google Scholar]
  4. Siddig M, Ghalib H, Shillington DC, Petersen EA, Khidir S, 1990. Visceral leishmaniasis in Sudan: clinical features. Trop Geogr Med 42 : 107–112. [Google Scholar]
  5. Zijlstra EE, Ali MS, El-Hassan AM, El-Toum IA, Satti M, Ghalib HW, Sondorp E, Winkler A, 1991. Kala-azar in displaced people from southern Sudan: epidemiological, clinical and therapeutic findings. Trans R Soc Trop Med Hyg 85 : 365–369. [Google Scholar]
  6. Collin S, Davidson R, Ritmeijer K, Keus K, Melaku Y, Kipngetich S, Davies C, 2004. Conflict and kala-azar: determinants of adverse outcomes of kala-azar among patients in southern Sudan. Clin Infect Dis 38 : 612–619. [Google Scholar]
  7. Boelaert M, Criel B, Leeuwenburg J, van Damme W, Le Ray D, van der Stuyft P, 2000. Visceral leishmaniasis control: a public health perspective. Trans R Soc Trop Med Hyg 94 : 465–471. [Google Scholar]
  8. Veeken H, Ritmeijer K, Seaman J, Davidson R, 2003. Comparison of an rK39 dipstick rapid test with direct agglutination test and splenic aspiration for the diagnosis of kala-azar in Sudan. Trop Med Int Health 8 : 164–167. [Google Scholar]
  9. Chappuis F, Rijal S, Soto A, Menten J, Boelaert M, 2006. A meta-analysis of the diagnostic performance of the direct agglutination test and rK39 dipstick for visceral leishmaniasis. BMJ 333 : 723–726. [Google Scholar]
  10. El Harith A, Kolk AH, Leeuwenburg J, Muigai R, Huigen E, Jelsma T, Kager P, 1988. Improvement of a direct agglutination test for field studies of visceral leishmaniasis. J Clin Microbiol 26 : 1321–1325. [Google Scholar]
  11. Victora CG, Huttly SR, Fuchs SC, Olinto MTA, 1997. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol 26 : 224–227. [Google Scholar]
  12. Manson-Bahr PEC, Heisch RB, 1956. Studies in leishmaniasis in east Africa.III. Clinical features and treatment. Trans R Soc Trop Med Hyg 50 : 465–471. [Google Scholar]
  13. Siddig M, Ghalib H, Shillington DC, Peterson EA, 1988. Visceral leishmaniasis in the Sudan: comparative parasitological methods of diagnosis. Trans R Soc Trop Med Hyg 82 : 66–68. [Google Scholar]
  14. Zijlstra EE, Ali MS, El-Hassan AM, El-Toum IA, Satti M, Ghalib HW, Kager PA, 1992. Kala-azar: a comparative study of parasitological methods and the direct agglutination test in diagnosis. Trans R Soc Trop Med Hyg 86 : 505–507. [Google Scholar]
  15. Boelaert M, Lynen L, Desjeux P, van der Stuyft P, 1999. Cost-effectiveness of competing diagnostic-therapeutic strategies for visceral leishmaniasis. Bull World Health Organ 77 : 667–674. [Google Scholar]
  16. UNAIDS, 2004. Report on the Global HIV/AIDS Epidemic: Fourth Global Report. New York: United Nations.
  17. Ritmeijer K, Veeken H, Melaku Y, Leal G, Amsalu R, Seaman J, Davidson RN, 2001. Ethiopian visceral leishmaniasis: generic and proprietary sodium stibogluconate are equivalent; HIV co-infected patients have a poor outcome. Trans R Soc Trop Med Hyg 95 : 668–672. [Google Scholar]
  18. Hailu A, Berhe N, 2002. The performance of direct agglutination test in the diagnosis of visceral leishmaniasis among Ethiopian patients with HIV co-infection. Ann Trop Med Parasitol 96 : 25–30. [Google Scholar]

Data & Media loading...

  • Received : 10 Oct 2006
  • Accepted : 04 Jan 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error