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Toxoplasma gondii infection in pigs is commonly diagnosed using serological tests that detect IgG antibodies targeted against the parasite. Such tests include enzyme-linked immunosorbent assay (ELISA), modified agglutination test (MAT), and western blot (WB), which are commercially available as rapid test kits. In this study, we evaluated the manufacturer recommended cut-off of ELISA-PrioCHECK test kit and determined a new optimal cut-off for identifying T. gondii infections in pigs. Assessment of the commercial ELISA kit was done by including data from two additional serological tests, MAT, and WB, applied to seven pig population categories with varying prevalences. A total of 233 plasma samples that were previously used in other studies for investigating T. gondii seroprevalence in pigs in Denmark were randomly selected for inclusion, including 95 samples that had previously been analysed with all three tests and an additional 138 samples that were analysed using the three serological tests for this study. In the absence of a gold standard test, a latent class model was fit to the data to obtain estimates of sensitivity and specificity for each of the tests along with prevalence in each of the populations. A cut-off that maximized the sensitivity and specificity of the ELISA test was then selected. The optimal cut-off value for percent of positive control (PP) in ELISA-PrioCHECK was estimated to be 27.7 PP, which is higher than the cut-off value of 20 PP that is recommended by the manufacturer. At this cut-off, the estimated sensitivities of ELISA, MAT and WB were 99.2% (96.3–100.0%), 96.3% (88.0–100.0%), and 89.8% (80.0–98.0%), respectively. The estimated specificities of ELISA, MAT and WB were 95.2% (92.5–97.6%), 99.6% (97.5–100.0%), and 98.2% (95.9–100.0%), respectively. Our findings have broad relevance to the use of the ELISA-PrioCHECK test kit for detecting Toxoplasma gondii infection in pigs. [ABSTRACT FROM AUTHOR]

Background: The present case contributes to the limited literature on central nervous system involvement of blastic plasmacytoid dendritic cell neoplasm (BPDCN).  CASE PRESENTATION : A 63-year-old male presented to the department of neurology with a three-day history of rapidly progressing headache, fatigue, and confusion. Physical examination revealed multiple bruise-like skin lesions. Initial laboratory workup raised suspicion of acute leukemia, and a brain computer tomography identified several hyperdense processes. A bone marrow biopsy gave the diagnosis BPDCN, a rare and aggressive hematologic malignancy derived from plasmacytoid dendritic cells with a poor prognosis. Lumbar puncture showed not only signs of BPDCN, but also cerebral toxoplasmosis, thus providing a differential diagnosis. Despite intensive systemic and intrathecal chemotherapy, the patient died 25 days later due to multi-organ failure.Discussion: The exact incidence of BPDCN is unknown and perhaps underestimated but may account for 0.5 - 1% of all hematological malignancies. The median age at onset is 60 to 70 years, and most patients are men. Cutaneous lesions are the most frequent clinical manifestation at diagnosis. Other symptoms present at time of diagnosis or during disease progression include lymphadenopathy, splenomegaly and cytopenia caused by bone marrow involvement. Although the majority of BPDCN patients have no symptoms or signs of central nervous system involvement, plasmacytoid dendritic cells have been detected in the cerebrospinal fluid in more than 50%.Conclusions: This case highlights the importance of considering hematological malignancies as a differential diagnosis in patients developing acute neurological symptoms and raises suspicion of a possible association between toxoplasmosis and hematological malignancies. [ABSTRACT FROM AUTHOR]

Background: Neoehrlichia mikurensis (N. mikurensis) is a newly discovered tick‐borne pathogen that can inflict life‐threatening illness in immunocompromised patients. N. mikurensis infection is only detectable by polymerase chain reaction (PCR)‐based methodologies. We describe three distinct clinical manifestations of N. mikurensis infection (neoehrlichiosis) in Danish patients receiving B‐lymphocyte‐depleting therapy, rituximab, for underlying hematological, rheumatological, or neurological disorders. All three patients went through a protracted pre‐diagnostic period. Methods: N. mikurensis DNA was detected and confirmed using two methods. Blood was tested by specific real‐time PCR targeting the groEL gene and by 16S and 18S profiling followed by sequencing. Bone marrow was analyzed by 16S and 18S profiling. Results: N. mikurensis was detected in blood samples in all three cases and in bone marrow from one of the three. The severity of the symptoms ranged from prolonged fever lasting more than 6 months to life‐threatening hyperinflammation in the form of hemophagocytic lymphohistiocytosis (HLH). Interestingly, all patients presented with splenomegaly and two with hepatomegaly. After starting doxycycline therapy, symptoms were relieved within a few days, and biochemistry and organomegaly quickly normalized. Conclusion: We present three Danish patients recognized by the same clinician over a period of 6 months, strongly suggesting that many cases are going unrecognized. Second, we describe the first case of N. mikurensis‐induced HLH and emphasize the potential severity of undetected neoehrlichiosis. [ABSTRACT FROM AUTHOR]

Aims: Diarrhoea is a common health problem in calves and a main reason for use of antimicrobials. It is associated with several bacterial, viral and parasitic pathogens, most of which are commonly present in healthy animals. Methods, which quantify the causative agents, may therefore improve confidence in associating a pathogen to the disease. This study evaluated a novel commercially available, multiplex quantitative polymerase chain reaction (qPCR) assay (Enterit4Calves) for detection and quantification of pathogens associated with calf‐diarrhoea. Methods and Results: Performance of the method was first evaluated under laboratory conditions. Then it was compared with current routine methods for detection of pathogens in faecal samples from 65 calves with diarrhoea and in 30 spiked faecal samples. The qPCR efficiencies were between 84%–103% and detection limits of 100–1000 copies of nucleic acids per sample were observed. Correct identification was obtained on 42 strains of cultured target bacteria, with only one false positive reaction from 135 nontarget bacteria. Kappa values for agreement between the novel assay and current routine methods varied between 0.38 and 0.83. Conclusion: The novel qPCR method showed good performance under laboratory conditions and a fair to good agreement with current routine methods when used for testing of field samples. Significance and impact of study: In addition to having fair to good detection abilities, the novel qPCR method allowed quantification of pathogens. In the future, use of quantification may improve diagnosis and hence treatment of calf diarrhoea. [ABSTRACT FROM AUTHOR]

The gut microbiota may be involved in the aetiopathogenesis of irritable bowel syndrome (IBS). We studied the role of intestinal parasites by describing the epidemiology and risk factors for infection in primary care patients aged 18-50 y with IBS. One hundred and thirty-eight patients at baseline and 78/116 patients returning 1 y later, submitted faecal samples that were examined by microscopy, culture for Blastocystis, and real-time PCR for Dientamoeba fragilis, Entamoeba (dispar and histolytica), Cryptosporidium spp., and Giardia intestinalis. Overall, 42-45% of patients harboured intestinal parasites (baseline and follow-up, respectively): D. fragilis carriage was 35-41%; Blastocystis 14-20%. Incidence rates for D. fragilis and Blastocystis were 10 and 4 per 100 person-y, respectively. Blastocystis carriage increased the odds for carrying D. fragilis. Clinical comparisons showed D. fragilis to be associated with a low frequency of defecation. Further, D. fragilis was associated with having children aged 5-18 y and Blastocystis with increasing age. [ABSTRACT FROM AUTHOR]

Entamoeba gingivalis has been associated with periodontal diseases. Baseline data from the background population, which could help delimit the role of the parasite in health and disease, remain limited. To describe epidemiological features, genetic diversity, and associations with oral microbiome signatures of E. gingivalis colonisation in Tanzanians with non-oral/non-dental diseases. DNAs from 92 oral washings from 52 participants were subject to metabarcoding of ribosomal genes. DNA sequences were identified to genus level and submitted to oral microbiota diversity analyses. Sixteen (31%) of the 52 study participants were E. gingivalis-positive, with no difference in positivity rate according to gender or age. Only one subtype (ST1) was found. Individuals testing positive for E. gingivalis had higher oral microbiota alpha diversity than those testing negative (P = 0.03). Eight of the top-ten most common bacterial genera were shared between the two groups (Alloprevotella, Fusobacterium, Gemella, Haemophilus, Neisseria, Porphyromonas, Prevotella, Streptococcus, and Veillonella). Meanwhile, E. gingivalis carriers and non-carriers were more likely to have Aggregatibacter and Rothia, respectively, among the top-ten most common genera. About one third of the cohort carried E. gingivalis ST1, and carriers had higher oral microbiome diversity and were more predominantly colonized by Aggregatibacter. [ABSTRACT FROM AUTHOR]

Microbial co‐infections may contribute to the pulmonary deterioration in COVID‐19 patients needing intensive care treatment. The present study portrays the extent of co‐infections in COVID‐19 ICU patients. Conventional culture, molecular detections for atypical aetiologies, QiaStat‐Dx® respiratory panel V2 detecting 21 respiratory pathogens and ribosomal DNA genes 16S/18S amplicon‐based microbiome analyses were performed on respiratory samples from 34 COVID‐19 patients admitted to the ICU. Potential pathogens were detected in seven patients (21%) by culturing, in four patients (12%) by microbiome analysis and in one patient (3%) by respiratory panel. Among 20 patients receiving antibiotics prior to ICU admission, fungi (3 Candidaalbicans, 1 C. tropicalis, 1 C. dubliniensis) were cultured in 5 (15%) endotracheal aspirates. Among 14 patients who were antibiotic‐naive at ICU admission, two patients (6%) had bacterial respiratory pathogens (Staphylococcusaureus, Streptococcuspseudopneumoniae) cultured in their endotracheal aspirates. Microbiome analysis recognized four potential respiratory pathogens (3 Haemophilusinfluenza, 1 Fusobacterium necrophorum) isolated in samples from four other patients (12%). QiaStat‐Dx® respiratory panel V2 detected adenovirus in one patient (3%). The prevalence of pulmonary microbial co‐infections is modest among COVID‐19 patients upon admission to ICU. Microbiome analysis complements conventional microbial diagnostics in characterization of respiratory co‐infections. [ABSTRACT FROM AUTHOR]

Background Maternal obesity is associated with adverse pregnancy outcomes. Probiotic supplementation during pregnancy may have positive effects on blood glucose, gestational weight gain (GWG), and the risk of gestational diabetes mellitus [GDM and glycated hemoglobin (HbA1c)]. Objectives This feasibility study involved a daily probiotic intervention in obese pregnant women from the early second trimester until delivery. The primary aim was to investigate the effect on GWG and maternal glucose homeostasis (GDM and HbA1c). Secondary aims were the effect on infant birth weight, maternal gut microbiota, and other pregnancy outcomes. Methods We carried out a randomized double-blinded placebo-controlled study in 50 obese pregnant women. Participants were randomly allocated (1:1) to multistrain probiotic (4 capsules of Vivomixx®; total of 450 billion CFU/d) or placebo at 14–20 weeks of gestation until delivery. Participants were followed with 2 predelivery visits at gestational week 27–30 and 36–37 and with 1 postdelivery visit. All visits included blood and fecal sampling. An oral-glucose-tolerance test was performed at inclusion and gestational week 27–30. Results Forty-nine participants completed the study. Thirty-eight participants took >80% of the capsules (n  = 21), placebo (n  = 17). There was no significant difference in GWG, GDM, HbA1c concentrations, and infant birth weight between groups. Fecal microbiota analyses showed an overall increase in α-diversity over time in the probiotic group only (P =  0.016). Conclusions Administration of probiotics during pregnancy is feasible in obese women and the women were willing to participate in additional study visits and collection of fecal samples during pregnancy. Multistrain probiotic can modulate the gut microbiota in obese women during pregnancy. A larger study population is needed to uncover pregnancy effects after probiotic supplementation. This trial was registered at clincaltrials.gov as NCT02508844. [ABSTRACT FROM AUTHOR]

Despite their ubiquity, in most cases little is known about the impact of eukaryotic parasites on their mammalian hosts. Comparative approaches provide a powerful method to investigate the impact of parasites on host ecology and evolution, though two issues are critical for such efforts: controlling for variation in methods of identifying parasites and incorporating heterogeneity in sampling effort across host species. To address these issues, there is a need for standardized methods to catalogue eukaryotic parasite diversity across broad phylogenetic host ranges. We demonstrate the feasibility of a metabarcoding approach for describing parasite communities by analysing faecal samples from 11 nonhuman primate species representing divergent lineages of the primate phylogeny and the full range of sampling effort (i.e. from no parasites reported in the literature to the best‐studied primates). We detected a number of parasite families and regardless of prior sampling effort, metabarcoding of only ten faecal samples identified parasite families previously undescribed in each host (x̅ = 8.5 new families per species). We found more overlap between parasite families detected with metabarcoding and published literature when more research effort—measured as the number of publications—had been conducted on the host species' parasites. More closely related primates and those from the same continent had more similar parasite communities, highlighting the biological relevance of sampling even a small number of hosts. Collectively, results demonstrate that metabarcoding methods are sensitive and powerful enough to standardize studies of eukaryotic parasite communities across host species, providing essential new tools for macroecological studies of parasitism. [ABSTRACT FROM AUTHOR]

Background: Congenital toxoplasmosis (CT) causes a substantial disease burden worldwide. The aim of this study was to estimate the disease burden of CT in Denmark, a developed country with free public healthcare and nationwide data available. Methods: Using data primarily from two public health surveillance programmes conducted between 1992 and 2007, we estimated the incidence, occurrence of sequelae, mortality and the burden of disease in terms of disability-adjusted life years (DALYs) of CT in Denmark in 2014. Findings: We estimated that 14 children were born with CT in 2014, of which six will have developed sequelae by the age of 12. CT resulted in a total disease burden of 123 DALYs (95% uncertainty interval [UI], 100–148), of which 78 (95% UI, 64–94) were due to foetal loss and 2 (95% UI, 1–3) were due to neonatal death; the remaining burden was due to moderate to severe life-long sequelae. A comparison of the estimated incidence of CT with the number of reported CT cases in 2008–2014 indicated that for each reported CT case, at least five other CT cases could be expected to have occurred and gone unreported. Interpretation: Early onset, severity, and life-long duration of sequelae have a major effect on the disease burden of CT. Our data suggest that CT is under-diagnosed or under-reported in Denmark. The estimated disease burden and public health impact in Denmark is lower than in other European countries, highlighting the need for country-specific studies. [ABSTRACT FROM AUTHOR]

Aim: Diarrhoea is very common in children attending day care centres. The aim of this study was to examine certain predisposing risk factors for an association with diarrhoea, including foreign travel, treatment with antibiotics, having household pets, infant colic, bottle feeding, using a pacifier and low birthweight.Methods: A dynamic one-year follow-up cohort study comprising 179 children from 36 day care centres was conducted from September 2009 to July 2013 in Copenhagen, Denmark. Questionnaires were sent to the children's parents or legal guardians every two months for a year, requesting information on gastrointestinal symptoms and exposure. A logistic regression was performed to identify the odds ratios of different risk factors for diarrhoea.Results: The odds ratios for diarrhoea were 1.97 (0.93-4.20) for children with a history of infant colic, 1.91 (0.90-4.04) for low birthweight children and 1.45 (0.74-2.82) for children who had used antibiotics. Having a pet in the household had a possible protective effect towards diarrhoeal events, with an odds ratio of 0.47 (0.20-1.09).Conclusion: A history of infant colic, low birthweight, and to a lesser extent antibiotic use, possibly increased the risk of diarrhoea in Danish children in day care centres. [ABSTRACT FROM AUTHOR]

Background: Newly recognized endemic foci for human babesiosis include Europe, where Ixodes ricinus, a vector for several species of Babesia, is the most commonly identified tick. Vector-based surveillance provides an early warning system for the emergence of human babesiosis, which is likely to be under-reported at emerging sites. In the present study, we set out to screen I. ricinus collected from Danish domestic dogs for Babesia, in order to identify whether humans in Denmark are exposed to the parasite. Findings: A total of 661 ticks (Ixodes spp.) were collected from 345 Danish domestic dogs during April-September 2011 and pooled, one sample per dog. DNA was extracted from each sample and examined by PCR and sequencing for Rickettsia spp., Borrelia burgdorferi sensu lato, Bartonella spp., Francisella tularensis, Candidatus Neoehrlichia mikurensis, and Babesia spp. In total, 34% of the samples were positive for tick-borne microorganisms potentially pathogenic to humans: Rickettsia spp. were detected in 16% of the pools, with 79% being R. helvetica. Borrelia burgdorferi sensu lato was found in 15%, with the main species identified as Borrelia afzelii (39%). Likewise, 8% of the samples were positive for Babesia spp. (Babesia microti, 82%; Babesia venatorum (‘EU1’), 18%). Lastly, 1% of the samples tested positive for Candidatus Neoehrlichia mikurensis, and 0.6% for Bartonella spp. No ticks were found to be infected with Francisella tularensis. Conclusions: Our data are in support of endemic occurrence of potentially zoonotic Babesia in Denmark and confirms I. ricinus as a vector of multiple pathogens of public health concern. [ABSTRACT FROM AUTHOR]

Abstract: With no evidence of a cyst stage, the mode of transmission of Dientamoeba fragilis, an intestinal protozoon of common occurrence and suggested pathogenicity, is incompletely known. Numerous studies have suggested that eggs of intestinal nematodes, primarily Enterobius vermicularis (pinworm), can serve as vectors for D. fragilis, although attempts to culture D. fragilis from pinworm eggs have been unsuccessful and data from epidemiological studies on D. fragilis/pinworm co-infection have been conflicting. The aim of this study was to investigate whether we could detect D. fragilis DNA from pinworm eggs collected from routine diagnostic samples (cellophane tape) and surface-sterilised by hypochlorite. DNA was extracted from individual eggs and tested by PCR using D. fragilis- and E. vermicularis-specific primers; amplicons were sequenced for confirmation. In cellophane tape samples from 64 patients with unknown D. fragilis status we detected D. fragilis DNA in 12/238 (5%) eggs, and in a patient known to harbour D. fragilis we detected D. fragilis DNA in 39/99 (39%) eggs. The finding of D. fragilis DNA within eggs of E. vermicularis strongly supports the hypothesis of D. fragilis-transmission by pinworm and has implications for antimicrobial intervention as well as control and public health measures. [Copyright &y& Elsevier]

To investigate the prevalence and clinical significance of intestinal parasites in human immunodeficiency virus (HIV)-infected patients, faecal specimens from 96 HIV-infected patients were submitted to microbiological analyses, including microscopy and polymerase chain reaction for protozoa and enteropathogenic bacteria. Results of microbiological analyses were compared with self-reported gastrointestinal complaints collected using a validated questionnaire. Thirty-two (33%) patients were positive for parasites. However, opportunistic parasites (Isospora and Cryptosporidium) were detected in only 2 instances. Entamoeba dispar was detected in 10 cases, 9 of which represented men who have sex with men (MSM). Despite generally low HIV RNA loads and high CD4+ T-cell counts, 42% of the 76 patients reporting symptoms complained of diarrhoea, 31% of whom were parasite-positive. The presence of diarrhoea was not associated with the presence or absence of parasites; neither was it associated with receiving highly active anti-retroviral therapy (HAART) in general, or protease inhibitors (PI) in particular. A CD4+ T-cell count <200 cells/mm3 was not associated with parasitic infection or with diarrhoea. The data show that diarrhoea is a common symptom among HIV-infected patients in Denmark, but do not indicate that the diarrhoea is due to intestinal parasites. [ABSTRACT FROM AUTHOR]

Abstract: Blastocystis is a very common unicellular intestinal parasite of ubiquitous occurrence. In order to describe the molecular epidemiology of Blastocystis infections in Turkey, 87 isolates from 69 symptomatic and 18 asymptomatic individuals were sequenced. Sequence data were phylogenetically analyzed and statistically tested against unmodifiable risk factors such as gender and age. Blastocystis-positive males were complaining mainly of gastroenteritis, whereas dyspepsia was the chief complaint among Blastocystis-positive females. Blastocystis sp. subtypes detected in the study included subtypes 1, 2, 3 and 4, subtype 3 being the most predominant (75.9%). No association was detected between Blastocystis sp. subtype and symptoms (p >0.365), or between infection intensity and symptoms (p >0.441). There was a tendency of subtype 2 isolates being more common among older study individuals, and subtype 2 isolates were significantly associated with higher parasite abundance (p =0.017). Compared to data from similar studies, the distribution of Blastocystis sp. isolates in Turkey was found to more or less reflect the one seen in other countries, and it was deduced that subtype 3 is generally by far the most common subtype infecting humans, followed by subtypes 1, 2 and 4. [Copyright &y& Elsevier]

Pigs are one of several host species for Toxoplasma gondii parasites, and consumption of infected pork may lead to toxoplasmosis in humans. We estimated seroprevalence in sows and finishers from conventional and organic herds in Denmark and discussed the strategies for reducing the risk from pork. We collected 447 blood samples from 59 herds, and additional meat-juice samples from 212 of the same pigs. Using a T. gondii IgG commercial ELISA test, we found 2% (95% CI = 0.4%–5%) apparent seroprevalence of T. gondii in conventional finishers, 11% (95% CI = 6%–17%) in organic finishers, 19% (95% CI = 11%–30%) in conventional sows and 60% (95% CI = 47%–72%) in organic sows. The odds of an animal testing positive for T. gondii was 16 times higher (95% CI = 4.6–74.3) in organic compared to conventional herds. The odds were 22 times higher (95% CI = 6.5–88.3) if the animal was a sow compared to a finisher. Meat-juice ELISA values were significantly correlated with plasma results (P < 0.001), but on average 64% of the blood-plasma ELISA values. Lowering the recommended cut-off from 20 to 13 percent positive values of the positive control for meat-juice ELISA, resulted in the meat-juice ELISA identifying 93% of the plasma positives as positive and 99% of the plasma negatives as negative. The time taken to detect one or more infected pigs from a T. gondii positive herd at slaughter was estimated using abattoir data on pigs (17,195,996) and batches (165,569) delivered to Danish abattoirs in 2018. The time to detection was affected by the seroprevalence, frequency at which the pigs were delivered, the number of samples tested per batch delivery and the batch sizes. Time to detection was long in conventional finisher herds due to low prevalence, and in sow herds because of intermittent delivery of a low number of sows. In organic finisher herds, time to detection was short due to medium prevalence and frequent delivery of a high number of finishers. Conventional finisher herds may be classified as low-risk, organic finisher herds as medium-risk, and conventional and organic sow herds as high-risk herds. Risk-mitigation strategies at processing plants (freezing or curing) or at the consumer level (heat treatment) for meat originating from high-risk herds, surveillance of medium-risk herds, and auditing for controlled housing (high biosecurity) in low-risk herds may be cost-effective alternatives to serological surveillance of all Danish pig herds. [ABSTRACT FROM AUTHOR]

Background: Toxoplasma gondii is found worldwide, and consumption of undercooked meat is considered a significant risk factor for human infections. In Denmark, little is known about the distribution of T. gondii, but a recent study revealed a seroprevalence of 34% in Danish indoor sows. The present cross-sectional study aimed to investigate the role of mice for the transmission of T. gondii in Danish indoor sow herds. Results: In total, 56 sow herds were visited, 137 mice were caught by snap traps from 32 farms, and 52 cat faecal samples were collected from 22 farms. Eight percent of the mice were positive for T. gondii DNA, representing 11% of the farms. Significant associations were found between the presence of T. gondii-positive mice and both open feed systems (P= 0.041) and extra rodent control on the farm (P= 0.024). All cat faecal samples were deemed negative for T. gondii by light microscopy examination and real-time polymerase chain reaction analysis. Conclusion: Mice captured inside Danish sow herds were found to be infected with T. gondii and may thus contribute to the transmission of T. gondii to sows, which may explain the high seroprevalence found in Danish pigs. [ABSTRACT FROM AUTHOR]

Anti-Leishmania antibodies may be detectable in patients with leishmaniasis. Here, we compared a commercial enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Leishmania antibodies, with an immunofluorescence antibody test (IFAT) that is no longer commercially available. Eighty-six serum samples from 73 patients were tested. The results obtained by the NovaLisa™ Leishmania infantum IgG ELISA, interpreted according to the instructions of the manufacturer, but with a modified cut-off for borderline positive values, were compared with the IFAT results that were already available. Moreover, Leishmania Western blot IgG results were available for 43 of the samples. The overall concordance of ELISA and IFAT was 67%. The ELISA and IFAT tests scored as 24% and 15% of the samples being positive, respectively, while 13% and 33% scored as borderline-positive, respectively. Using a Western blot (WB) as the reference, the sensitivities and specificities for the positive plus borderline-positive samples combined was 95.5% (95% confidence interval (CI), 77.2–99.9%) and 81.0% (95% CI, 58.1–94.6%) for ELISA, and 95.5% (95% CI, 77.2–99.9%) and 42.9% (95% CI, 21.8–66.0%) for IFAT, respectively. Overall, the ELISA proved to be a cost-effective alternative to the IFAT, due to its higher accuracy and specificity, and with a consequently lower number of confirmatory WB tests being required. Lastly, we also present data on the associations between seroconversion and the type of leishmaniasis. [ABSTRACT FROM AUTHOR]