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Polymerase Chain Reaction Detection of Leishmania kDNA from the Urine of Peruvian Patients with Cutaneous and Mucocutaneous Leishmaniasis

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  • Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru; Departamento de Bioquimica, Biologia Molecular y Farmacologia, Facultad de Ciencias, Universidad Peruana Cayetano Heredia; Laboratories Branch, Ontario Agency for Health Protection and Promotion, Etobicoke, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Hospital Nacional Cayetano Heredia, Lima, Peru; Tropical Disease Unit, Division of Infectious Diseases, Toronto General Hospital, Toronto, Canada

We hypothesized that Leishmania kDNA may be present in urine of patients with cutaneous leishmaniasis (CL). Urine samples and standard diagnostic specimens were collected from patients with skin lesions. kDNA polymerase chain reaction (PCR) was performed on samples from patients and 10 healthy volunteers from non-endemic areas. Eighty-six of 108 patients were diagnosed with CL and 18 (21%) had detectable Leishmania Viannia kDNA in the urine. Sensitivity and specificity were 20.9% (95% confidence interval [CI] 12.3–29.5%) and 100%. Six of 8 patients with mucocutaneous involvement had detectable kDNA in urine versus 12 of 78 patients with isolated cutaneous disease (P < 0.001). L. (V.) braziliensis (N = 3), L. (V.) guyanensis (N = 6), and L. (V.) peruviana (N = 3) were identified from urine. No healthy volunteer or patient with an alternate diagnosis had detectable kDNA in urine. Sensitivity of urine PCR is sub-optimal for diagnosis. On the basis of these preliminary data in a small number of patients, detectable kDNA in urine may identify less localized forms of infection and inform treatment decisions.

Author Notes

*Address correspondence to Andrea K. Boggild, Tropical Disease Unit, UHN-Toronto General Hospital, 200 Elizabeth Street, North Wing, 13th Floor, Room 1350, Toronto, ON, M5G 2C4. E-mail: andrea.boggild@utoronto.ca†The first two authors contributed equally to this work.

Financial support: AKB was supported by a professional development grant (2009) and a Detweiler traveling fellowship (2010) through the Royal College of Physicians and Surgeons of Canada. This study was partially funded by the Ontario Association of Medical Laboratories. Personnel support for members of the Arevalo molecular laboratory (NV, DE, and JA) was provided by the Institutional Collaboration Framework Agreement 3 from the Belgian Development Cooperation.

Authors' addresses: Nicolas Veland, Braulio Mark Valencia, Ana Pilar Ramos, Flor Calderon, and Alejandro Llanos-Cuentas, Instituto de Medicina Tropical “Alexander von Humboldt,” Universidad Peruana Cayetano Heredia, Lima, Peru, E-mails: nicolasveland@yahoo.com, 18406@upch.edu.pe, anapilarupch@hotmail.com, calderon.flor@gmail.com, and elmer.llanos@upch.pe. Diego Espinosa, John Hopkins School of Public Health, Baltimore, MD, E-mail: despinos@jhsph.edu. Jorge Arevalo, Departmento de Bioquimica, Biologia Molecular y Farmacologia, Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru, E-mail: biomoljazz@gmail.com. Donald E. Low, Department of Microbiology, Mount Sinai Hospital, Toronto, ON and Laboratories Branch, Ontario Agency for Health Protection and Promotion, Etobicoke, ON, E-mail: Don.Low@oahpp.ca. Andrea K. Boggild, Tropical Disease Unit, UHN-Toronto General Hospital, Toronto, ON, E-mail: andrea.boggild@utoronto.ca.

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