• 1.

    Sousa AQ, Pompeu MM, Frutuoso MS, Lima JW, Tinel JM, Pearson RD, 2014. Press imprint smear: a rapid, simple, and cheap method for the diagnosis of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis. Am J Trop Med Hyg 91: 905907.

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  • 2.

    Weigle KA, de Da'valos M, Heredia P, Molineros R, Saravia NG, D'Alessandro A, 1987. Diagnosis of cutaneous and mucocutaneous leishmaniasis in Colombia: a comparison of seven methods. Am J Trop Med Hyg 36: 489496.

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    • Export Citation
  • 3.

    Aviles H, Belli A, Armijos R, Monroy FP, Harris E, 1999. PCR detection and identification of Leishmania parasites in clinical specimens in Ecuador: a comparison with classical diagnostic methods. J Parasitol 85: 181187.

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    • Export Citation
  • 4.

    Sharquie KE, Hassen AS, Hassan SA, Al-Hamami IA, 2002. Evaluation of diagnosis of cutaneous leishmaniasis by direct smear, culture and histopathology. Saudi Med J 23: 925928.

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    • Export Citation
  • 5.

    Bari A, Azam S, Ejaz A, Mahmood T, 2010. Comparison of various cytodiagnostic tests in the rapid diagnosis of cutaneous leishmaniasis. J Pak Assoc Dermatol 20: 6369.

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    • Export Citation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

In Response

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  • E-mail: aqsousa@gmail.com

Dear Sir:

We read with interest Mello and Madeira's comments on our article1 and herein we discuss the points they raised. They emphasized skin scraping for the diagnosis of cutaneous leishmaniasis. We agree that skin scraping is a good method for the diagnosis of cutaneous leishmaniasis; however, it has shown to be less sensitive than press imprint smear (PIS),25 and skin scraping should not be done in clearly infected ulcers and should not be performed in non-ulcerated lesions. On the other hand, local anesthesia is recommended for the comfort of the patient. As skin scraping does not elucidate a large proportion of cases of cutaneous leishmaniasis, neither does it allow the diagnosis of several other diseases, so we recommend that a skin biopsy should be performed at the same time. To do it, one will need all things used in PIS, plus a scalpel blade or a curette, making its cost a little higher than with PIS. Suturing is not necessary for a 3-mm punch biopsy. We understand that a microscopy technician with a short training course can learn to identify amastigotes, because he or she is someone already used to see other microorganisms. We are not referring to a lay person on microscopy. On the other hand, the performance of procedures (skin scraping or other) by technicians, is a matter that concerns us because before doing scraping or other procedures, it is necessary to evaluate the patient and the lesion: if the lesion is infected, if it is close to varicose veins, and other aspects of it. These interventions require training and qualification that a technician does not have to perform the tasks Mello and Moreira suggest. We should make all efforts to guarantee that even in poor-resource areas, any intervention in humans, even the simplest one should be done in accordance with the best practices, by qualified professional and under good supervision.

  • 1.

    Sousa AQ, Pompeu MM, Frutuoso MS, Lima JW, Tinel JM, Pearson RD, 2014. Press imprint smear: a rapid, simple, and cheap method for the diagnosis of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis. Am J Trop Med Hyg 91: 905907.

    • Search Google Scholar
    • Export Citation
  • 2.

    Weigle KA, de Da'valos M, Heredia P, Molineros R, Saravia NG, D'Alessandro A, 1987. Diagnosis of cutaneous and mucocutaneous leishmaniasis in Colombia: a comparison of seven methods. Am J Trop Med Hyg 36: 489496.

    • Search Google Scholar
    • Export Citation
  • 3.

    Aviles H, Belli A, Armijos R, Monroy FP, Harris E, 1999. PCR detection and identification of Leishmania parasites in clinical specimens in Ecuador: a comparison with classical diagnostic methods. J Parasitol 85: 181187.

    • Search Google Scholar
    • Export Citation
  • 4.

    Sharquie KE, Hassen AS, Hassan SA, Al-Hamami IA, 2002. Evaluation of diagnosis of cutaneous leishmaniasis by direct smear, culture and histopathology. Saudi Med J 23: 925928.

    • Search Google Scholar
    • Export Citation
  • 5.

    Bari A, Azam S, Ejaz A, Mahmood T, 2010. Comparison of various cytodiagnostic tests in the rapid diagnosis of cutaneous leishmaniasis. J Pak Assoc Dermatol 20: 6369.

    • Search Google Scholar
    • Export Citation
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