Prevalence of and Factors Associated with Negative Microscopic Diagnosis of Cutaneous Leishmaniasis in Rural Peru

Ryan Lamm Stony Brook University School of Medicine, Stony Brook, New York;
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;
US Naval Medical Research Unit No. 6, Lima, Peru;

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Clark Alves University of Arizona, Tucson, Arizona;

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Grace Perrotta Stony Brook University School of Medicine, Stony Brook, New York;

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Meagan Murphy Stony Brook University School of Medicine, Stony Brook, New York;

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Catherine Messina Stony Brook University School of Medicine, Stony Brook, New York;

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Juan F. Sanchez US Naval Medical Research Unit No. 6, Lima, Peru;
School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru;
Universidad Peruana Cayetano Heredia, Lima, Peru;

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Erika Perez US Naval Medical Research Unit No. 6, Lima, Peru;

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Luis Angel Rosales US Naval Medical Research Unit No. 6, Lima, Peru;

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Andres G. Lescano US Naval Medical Research Unit No. 6, Lima, Peru;
Universidad Peruana Cayetano Heredia, Lima, Peru;

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Edward Smith US Naval Medical Research Unit No. 6, Lima, Peru;

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Hugo Valdivia US Naval Medical Research Unit No. 6, Lima, Peru;

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Jack Fuhrer Stony Brook University School of Medicine, Stony Brook, New York;

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Sarah-Blythe Ballard US Naval Medical Research Unit No. 6, Lima, Peru;
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

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Cutaneous leishmaniasis is endemic to South America where diagnosis is most commonly conducted via microscopy. Patients with suspected leishmaniasis were referred for enrollment by the Ministry of Health (MoH) in Lima, Iquitos, Puerto Maldonado, and several rural areas of Peru. A 43-question survey requesting age, gender, occupation, characterization of the lesion(s), history of leishmaniasis, and insect-deterrent behaviors was administered. Polymerase chain reaction (PCR) was conducted on lesion materials at the Naval Medical Research Unit No. 6 in Lima, and the results were compared with those obtained by the MoH using microscopy. Factors associated with negative microscopy and positive PCR results were identified using χ2 test, t-test, and multivariate logistic regression analyses. Negative microscopy with positive PCR occurred in 31% (123/403) of the 403 cases. After adjusting for confounders, binary multivariate logistic regression analyses revealed that negative microscopy with positive PCR was associated with patients who were male (adjusted odds ration [OR] = 1.93 [1.06–3.53], P = 0.032), had previous leishmaniasis (adjusted OR = 2.93 [1.65–5.22], P < 0.0001), had larger lesions (adjusted OR = 1.02 [1.003–1.03], P = 0.016), and/or had a longer duration between lesion appearance and PCR testing (adjusted OR = 1.12 [1.02–1.22], P = 0.017). Future research should focus on further exploration of these underlying variables, discovery of other factors that may be associated with negative microscopy diagnosis, and the development and implementation of improved testing in endemic regions.

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Author Notes

Address correspondence to Ryan Lamm, Thomas Jefferson University Hospital, 111 S. 11th St., Philadelphia, PA 19107. E-mail: ryan.lamm@jefferson.edu

Financial support: This work was supported by the United States Department of Defense Global Emerging Infections Surveillance and Response System (GEIS) work number [847705 82000 25GB B0016]. The sponsor had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Medical students (Ryan Lamm, Grace Perotta, and Meagan Murphy) received funding from Stony Brook University’s Global Health Scholarship to pay for their airfare and stay in Puerto Maldonado during the sample collection phase.

Copyright statement: Several authors of this manuscript are employees of the U.S. Government. This work was prepared as part of their duties. Title 17 U.S.C. § 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 U.S.C. § 101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

Authors’ addresses: Ryan Lamm, Thomas Jefferson University Hospital, Philadelphia, PA, E-mail: ryan.lamm@jefferson.edu. Clark Alves, University of Arizona College of Medicine, Tucson, AZ, E-mail: calves@email.arizona.edu. Grace Perrotta, Meagan Murphy, Catherine Messina, and Jack Fuhrer, Stony Brook University School of Medicine, Stony Brook, NY, E-mails: grace.perrotta@stonybrookmedicine.edu, meagan.murphy@stonybrookmedicine.edu, catherine.messina@stonybrookmedicine.edu, and jack.fuhrer@stonybrookmedicine.edu. Juan F. Sanchez, Erika Perez, Luis Angel Rosales, Andres G. Lescano, Edward Smith, Hugo Valdivia, and Sarah-Blythe Ballard, Naval Medical Research Unit 6 (NAMRU-6), Bellavista, Peru, and Peruvian Navy Hospital, Lima, Peru, E-mails; chiroque@gmail.com, erikasofiaperez@gmail.com, larhpe@hotmail.com, willy.lescano@med.navy.mil, edward.s.smith121.fn@mail.mil, hvalrod@hotmail.com, and sarah.b.ballard2.mil@mail.mil.

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