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Wortmann G, Sweeney C, Houng HS, Aronson N, Stiteler J, Jackson J, Ockenhouse C, 2001. Rapid diagnosis of leishmaniasis by fluorogenic polymerase chain reaction. Am J Trop Med Hyg 65: 583–587.
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Comparison of Parasitological, Serological, and Molecular Tests for Visceral Leishmaniasis in HIV-Infected Patients: A Cross-Sectional Delayed-Type Study
Gláucia Fernandes Cota
Gláucia Fernandes Cota
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Marcos Roberto de Sousa
Marcos Roberto de Sousa
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Betânia Mara de Freitas Nogueira
Betânia Mara de Freitas Nogueira
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Luciana Inácia Gomes
Luciana Inácia Gomes
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Edward Oliveira
Edward Oliveira
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Tália Santana Machado Assis
Tália Santana Machado Assis
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Andréa Laender Pessoa de Mendonça
Andréa Laender Pessoa de Mendonça
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Bruna Fernandes Pinto
Bruna Fernandes Pinto
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Juliana Wilke Saliba
Juliana Wilke Saliba
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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Ana Rabello
Ana Rabello
Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil; Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
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The aim of this study was to evaluate the accuracy of invasive and non-invasive tests for diagnosis of visceral leishmaniasis (VL) in a large series of human immunodeficiency virus (HIV)-infected patients. In this delayed-type cross-sectional study, 113 HIV-infected symptomatic patients were evaluated by an adjudication committee after clinical follow-up to establish the presence or absence of VL as the target condition (reference test). The index tests were recombinant K39 antigen-based immunochromatographic test (rK39), indirect fluorescent antibody test (IFAT), prototype kit of direct agglutination test (DAT-LPC), and real-time polymerase chain reaction (qPCR) in peripheral blood. Compared with parasitological test and adjudication committee diagnosis or latent class model analyses, IFAT and rk39 dipstick test presented the lowest sensitivity. DAT-LPC exhibited good overall performance, and there was no statistical difference between DAT-LPC and qPCR diagnosis accuracy. Real-time PCR emerges as a less invasive alternative to parasitological examination for confirmation of cases not identified by DAT.
Author Notes
Financial support: This work was supported by Fundação de Amparo à Pesquisa de Minas Gerais (FAPEMIG), Belo Horizonte, Minas Gerais, Brazil (Grant APQ-01562-11 to A.R.); FAPEMIG also provided scientific initiation scholarship for the undergraduate students A.L.P.d.M. and B.F.P. Financial support was also available from PDTIS-FIOCRUZ (Rede de Plataformas Tecnológicas do Programa de Desenvolvimento Tecnológico em Insumos para Saúde) [RID06] and National Counsel of Technological and Scientific Development (CNPq) Grant 311641/2009-1. A.R. is a research fellow of CNPq (304881/2009-0).
Authors' addresses: Gláucia Fernandes Cota, Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, and Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil, E-mail: glauciacota@uol.com.br. Marcos Roberto de Sousa, Post Graduation Program in Adult Health Sciences, Universidade Federal de Minas Gerai, Belo Horizonte, Minas Gerais, Brazil, E-mail: sousa.mr@uol.com.br. Betânia Mara de Freitas Nogueira and Andréa Laender Pessoa de Mendonça, Eduardo de Menezes Hospital, Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, E-mails: betaniamfn@hotmail.com and andrea.laender@yahoo.com.br. Luciana Inácia Gomes, Edward Oliveira, Tália Santana Machado Assis, Bruna Fernandes Pinto, Juliana Wilke Saliba, and Ana Rabello, Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil, E-mails: lgomes@cpqrr.fiocruz.br, edwardjo@cpqrr.fiocruz.br, talia@cpqrr.fiocruz.br, bruna.fernandes@cpqrr.fiocruz.br, julianawilke@yahoo.com.br, and ana@cpqrr.fiocruz.br.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Alvar J, Aparicio P, Aseffa A, Den Boer M, Canavate C, Dedet JP, Gradoni L, Ter Horst R, Lopez-Velez R, Moreno J, 2008. The relationship between leishmaniasis and AIDS: the second 10 years. Clin Microbiol Rev 21: 334–359.
-
2.
Chang MR, Taira CL, Paniago AM, Taira DL, Cunha RV, Wanke B, 2007. Study of 30 cases of histoplasmosis observed in the Mato Grosso do Sul State, Brazil. Rev Inst Med Trop Sao Paulo 49: 37–39.
-
3.
Hot A, Schmulewitz L, Viard JP, Lortholary O, 2007. Fever of unknown origin in HIV/AIDS patients. Infect Dis Clin North Am 21: 1013–1032.
-
4.
Dikshit B, Wanchu A, Sachdeva RK, Sharma A, Das R, 2009. Profile of hematological abnormalities of Indian HIV infected individuals. BMC Blood Disord 9: 5.
-
5.
Russo R, Laguna F, Lopez-Velez R, Medrano FJ, Rosenthal E, Cacopardo B, Nigro L, 2003. Visceral leishmaniasis in those infected with HIV: clinical aspects and other opportunistic infections. Ann Trop Med Parasitol 97 (Suppl 1): 99–105.
-
6.
Srivastava P, Dayama A, Mehrotra S, Sundar S, 2011. Diagnosis of visceral leishmaniasis. Trans R Soc Trop Med Hyg 105: 1–6.
-
7.
Cota GF, de Sousa MR, Demarqui FN, Rabello A, 2012. The diagnostic accuracy of serologic and molecular methods for detecting visceral leishmaniasis in HIV infected patients: meta-analysis. PLoS Negl Trop Dis 6: e1665.
-
8.
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.
-
9.
Pedras MJ, de Gouvea Viana L, de Oliveira EJ, Rabello A, 2008. Comparative evaluation of direct agglutination test, rK39 and soluble antigen ELISA and IFAT for the diagnosis of visceral leishmaniasis. Trans R Soc Trop Med Hyg 102: 172–178.
-
10.
Schallig HD, Canto-Cavalheiro M, da Silva ES, 2002. Evaluation of the direct agglutination test and the rK39 dipstick test for the sero-diagnosis of visceral leishmaniasis. Mem Inst Oswaldo Cruz 97: 1015–1018.
-
11.
ter Horst R, Tefera T, Assefa G, Ebrahim AZ, Davidson RN, Ritmeijer K, 2009. Field evaluation of rK39 test and direct agglutination test for diagnosis of visceral leishmaniasis in a population with high prevalence of human immunodeficiency virus in Ethiopia. Am J Trop Med Hyg 80: 929–934.
-
12.
Goswami RP, Rahman M, Guha SK, 2007. Utility of K39 strip test in visceral leishmaniasis (VL) and HIV co-infected patients: an early report from eastern India. J Assoc Physicians India 55: 154–155.
-
13.
Antinori S, Calattini S, Longhi E, Bestetti G, Piolini R, Magni C, Orlando G, Gramiccia M, Acquaviva V, Foschi A, Corvasce S, Colomba C, Titone L, Parravicini C, Cascio A, Corbellino M, 2007. Clinical use of polymerase chain reaction performed on peripheral blood and bone marrow samples for the diagnosis and monitoring of visceral leishmaniasis in HIV-infected and HIV-uninfected patients: a single-center, 8-year experience in Italy and review of the literature. Clin Infect Dis 44: 1602–1610.
-
14.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG, 2003. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. The Standards for Reporting of Diagnostic Accuracy Group. Croat Med J 44: 639–650.
-
15.
Wortmann G, Sweeney C, Houng HS, Aronson N, Stiteler J, Jackson J, Ockenhouse C, 2001. Rapid diagnosis of leishmaniasis by fluorogenic polymerase chain reaction. Am J Trop Med Hyg 65: 583–587.
-
16.
Gomes LI, Gonzaga FM, de Morais-Teixeira E, de Souza-Lima BS, Freire VV, Rabello A, 2012. Validation of quantitative real-time PCR for the in vitro assessment of antileishmanial drug activity. Exp Parasitol 131: 175–179.
-
17.
Musso O, Sommer P, Drouet E, Cotte L, Neyra M, Grimaud JA, Chevallier M, 1996. In situ detection of human cytomegalovirus DNA in gastrointestinal biopsies from AIDS patients by means of various PCR-derived methods. J Virol Methods 56: 125–137.
-
18.
dos Santos Marques LH, Gomes LI, da Rocha IC, da Silva TA, Oliveira E, Morais MH, Rabello A, Carneiro M, 2012. Low parasite load estimated by qPCR in a cohort of children living in urban area endemic for visceral leishmaniasis in Brazil. PLoS Negl Trop Dis 6: e1955.
-
19.
Overbergh L, Valckx D, Waer M, Mathieu C, 1999. Quantification of murine cytokine mRNAs using real time quantitative reverse transcriptase PCR. Cytokine 11: 305–312.
-
20.
Harith AE, Kolk AH, Kager PA, Leeuwenburg J, Muigai R, Kiugu S, Kiugu S, Laarman JJ, 1986. A simple and economical direct agglutination test for serodiagnosis and sero-epidemiological studies of visceral leishmaniasis. Trans R Soc Trop Med Hyg 80: 583–586.
-
21.
Oliveira E, Saliba SW, Saliba JW, Rabello A, 2013. Validation of a direct agglutination test prototype kit for the diagnosis of visceral leishmaniasis. Trans R Soc Trop Med Hyg 107: 243–247.
-
22.
Hanley JA, McNeil BJ, 1982. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143: 29–36.
-
23.
Hanley JA, McNeil BJ, 1983. A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148: 839–843.
-
24.
Vercammen F, Berkvens D, Le Ray D, Jacquet D, Vervoort T, 1997. Development of a slide ELISA for canine leishmaniasis and comparison with four serological tests. Vet Rec 141: 328–330.
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