Volume 83, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We evaluated performance characteristics of five diagnostic methods for cutaneous leishmaniasis. Patients who came to the Leishmania Clinic of Hospital Nacional Cayetano Heredia in Lima, Peru, were enrolled in the study. Lesion smears, culture, microculture, polymerase chain reaction (PCR), and leishmanin skin test (LST) were performed. A total of 145 patients with 202 lesions were enrolled: 114 patients with 161 lesions fulfilled criteria for cutaneous leishmaniasis. Sensitivity and specificity were 57.8% (95% confidence interval [CI] = 50.2–65.4%) and 100.0% for culture, 78.3% (95% CI = 71.9–84.7%) and 100.0% for microculture, 71.4% (95% CI = 64.4–78.4%) and 100.0% for smears, 78.2% (95% CI = 70.6–85.8%) and 77.4% (95% CI = 62.7–92.1%) for LST, and 96.9% (95% CI = 94.2–99.6%) and 65.9% (95% CI = 51.4–80.4%) for PCR. PCR was more sensitive than the other assays ( < 0.001). Sensitivities of culture, smears, and LST varied by lesion duration and appearance. PCR offers performance advantages over other assays, irrespective of patient age, sex, lesion duration, or appearance. That clinical factors influence performance of non-molecular assays offers clinicians a patient-focused approach to diagnostic test selection.


Article metrics loading...

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

Full text loading...



  1. Desjeux P, , 2004. Leishmaniasis: current situation and new perspectives. Comp Immunol Microbiol Infect Dis 27: 305318.[Crossref] [Google Scholar]
  2. Pan American Health Organization. Peru. Available at: www.paho.org/English/DD/AIS/cp_604.htm. Accessed January 28, 2010. [Google Scholar]
  3. Arevalo J, Ramirez L, Adaui V, Zimic M, Tulliano G, Miranda-Verestegui C, Lazo M, Loayza-Muro R, De Doncker S, Maurer A, Chappuis F, Dujardin JC, Llanos-Cuentas A, , 2007. Influence of Leishmania (Viannia) species on the response to antimonial treatment in patients with American tegumentary leishmaniasis. J Infect Dis 195: 18461851.[Crossref] [Google Scholar]
  4. Lucas CM, Franke ED, Cachay MI, Tejada A, Cruz ME, Kreutzer RD, Barker DC, McCann SH, Watts DM, , 1998. Geographic distribution and clinical description of leishmaniasis cases in Peru. Am J Trop Med Hyg 59: 312317. [Google Scholar]
  5. Santrich C, Segura I, Arias AL, Saravia NG, , 1990. Mucosal disease caused by Leishmania braziliensis guyanensis . Am J Trop Med Hyg 42: 5155. [Google Scholar]
  6. Blum J, Desjeux P, Schwartz E, Beck B, Hatz C, , 2004. Treatment of cutaneous leishmaniasis among travelers. J Antimicrob Chemother 53: 158166.[Crossref] [Google Scholar]
  7. Murray HW, Berman JD, Davies CR, Saravia NG, , 2005. Advances in leishmaniasis. Lancet 366: 15611577.[Crossref] [Google Scholar]
  8. Tavares CA, Fernandes AP, Melo MN, , 2003. Molecular diagnosis of leishmaniasis. Expert Rev Mol Diagn 3: 657667.[Crossref] [Google Scholar]
  9. Reithinger R, Dujardin JC, Louzir H, Pirmez C, Alexander B, Brooker S, , 2007. Cutaneous leishmaniasis. Lancet Infect Dis 7: 581596.[Crossref] [Google Scholar]
  10. Reithinger R, Dujardin JC, , 2007. Molecular diagnosis of leishmaniasis: current status and future applications. J Clin Microbiol 45: 2125.[Crossref] [Google Scholar]
  11. Singh S, , 2006. New developments in diagnosis of leishmaniasis. Indian J Med Res 123: 311330. [Google Scholar]
  12. Herwaldt BL, , 1999. Leishmaniasis. Lancet 354: 11911199.[Crossref] [Google Scholar]
  13. Boggild AK, Miranda-Verastegui C, Espinosa D, Arevalo J, Adaui V, Tulliano G, Llanos-Cuentas A, Low DE, , 2007. Evaluation of a microculture method for the isolation of Leishmania parasites from cutaneous lesions in Peru. J Clin Microbiol 45: 36803684.[Crossref] [Google Scholar]
  14. Boggild AK, Miranda-Verastegui C, Espinosa D, Arevalo J, Martinez-Medina D, Llanos-Cuentas A, Low DE, , 2008. Optimisation of microculture and evaluation of miniculture for the isolation of Leishmania parasites from cutaneous lesions in Peru. Am J Trop Med Hyg 79: 847852. [Google Scholar]
  15. Llanos-Cuentas A, Tulliano G, Araujo-Castillo R, Miranda-Verestegui C, Santamaria-Castrellon G, Ramirez L, Lazo M, De Doncker S, Boelaert M, Robays J, Dujardin JC, Arevalo J, Chappuis F, , 2008. Clinical and parasite species risk factors for pentavalent antimonial treatment failure in cutaneous leishmaniasis in Peru. Clin Infect Dis 46: 223231.[Crossref] [Google Scholar]
  16. Bourreau E, Ronet C, Darisissac E, Lise MC, Marie DS, Clity E, Tacchini-Cottier F, Couppie P, Launois P, , 2009. In leishmaniasis due to Leishmania guyanensis infection, distinct intralesional interleukin-10 and Foxp3 mRNA expression are associated with unresponsiveness to treatment. J Infect Dis 199: 576579.[Crossref] [Google Scholar]
  17. Sadeghian G, Momeni A, Hossein Siadat A, Usefi P, , 2006. Evaluation of leishmanin skin test and its relationship with the clinical form and duration of cutaneous leishmaniasis. Dermatol Online J 12: 3. [Google Scholar]
  18. Ben Salah A, Ben Alaya Bouafif N, Chlif S, Gharbi A, Bel Haj Hamida N, Zaatour A, Dellagi K, , 2003. Risk factors of leishmanin-skin test positivity in transmission of Leishmania infantum in the center of Tunisia. Arch Inst Pasteur Tunis 80: 1727. [Google Scholar]
  19. 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: 475479. [Google Scholar]
  20. Sambrook J, Fritsch EF, Maniatis T, , 1989. Molecular Cloning: A Laboratory Manual. Second edition. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press. [Google Scholar]
  21. Lopez M, Orrego C, Cangalaya M, Inga R, Arevalo J, , 1993. Diagnosis of Leishmania via the polymerase chain reaction: a simplified procedure for field work. Am J Trop Med Hyg 49: 348356. [Google Scholar]
  22. Banoo S, Bell D, Bossuyt P, Herring A, Mabey D, Poole F, Smith PG, Sriram N, Wongsrichanalai C, Linke R, O'Brien R, Perkins M, Cunningham J, Matsoso P, Nathanson CM, Olliaro P, Peeling RW, Ramsay A, , 2007. Evaluating diagnostic tests for infectious diseases: general principles. Nat Rev Microbiol 5 (Suppl 11): S17S29. [Google Scholar]
  23. Allahverdiyev AM, Uzun S, Bagirova M, Durdu M, Memisoglu HR, , 2004. A sensitive new microculture method for diagnosis of cutaneous leishmaniasis. Am J Trop Med Hyg 70: 294297. [Google Scholar]
  24. Pirmez C, Yamamura M, Uyemura K, Paes-Oliveira M, Conceicao-Silva F, Modlin RL, , 1993. Cytokine patterns in the pathogenesis of human leishmaniasis. J Clin Invest 91: 13901395.[Crossref] [Google Scholar]
  25. Ribeiro-de-Jesus A, Almeida RP, Lessa H, Bacellar O, Carvalho EM, , 1998. Cytokine profile and pathology in human leishmaniasis. Braz J Med Biol Res 31: 143148.[Crossref] [Google Scholar]
  26. Sassi A, Louzir H, Ben Salah A, Mokni M, Ben Osman A, Dellagi K, , 1999. Leishmanin skin test lymphoproliferative response and cytokine production after symptomatic or asymptomatic Leishmania major infection in Tunisia. Clin Exp Immunol 116: 127132.[Crossref] [Google Scholar]
  27. Rocha PN, Almeida RP, Bacellar O, de Jesus AR, Filho DC, Filho AC, Barral A, Coffman RL, Carvalho EM, , 1999. Down-regulation of Th1 type of response in early human American cutaneous leishmaniasis. J Infect Dis 180: 17311734.[Crossref] [Google Scholar]

Data & Media loading...

  • Received : 22 Jul 2009
  • Accepted : 23 Apr 2010
  • Published online : 05 Aug 2010

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