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The accuracy of the Montenegro skin test for leishmaniasis in PCR-negative patients
- Source :
- Revista da Sociedade Brasileira de Medicina Tropical, Revista da Sociedade Brasileira de Medicina Tropical, Vol 53 (2020), Revista da Sociedade Brasileira de Medicina Tropical v.53 2020, Sociedade Brasileira de Medicina Tropical (SBMT), instacron:SBMT
- Publication Year :
- 2020
- Publisher :
- Sociedade Brasileira de Medicina Tropical - SBMT, 2020.
-
Abstract
- INTRODUCTION: As highly specific molecular biology-based techniques may not be sensitive enough for the diagnosis of American tegumentary leishmaniasis (ATL), clinicians frequently rely on immunological tests before treatment initiation. Hence, the correct combination of diagnostic tests is imperative for ATL diagnosis. We aimed to evaluate the accuracy of the Montenegro (Leishmanin) skin test (MST) in polymerase chain reaction (PCR)-negative patients to accurately detect ATL. METHODS: Patients with a clinical picture compatible with ATL were divided into ATL (confirmed by lesion smear, culture indirect immunofluorescence, and/or histopathology) and no-ATL (diseases that can mimic leishmaniasis) groups. Conventional PCR for the minicircle kDNA of Leishmania was performed, and the MST was carried out for PCR-negative patients. RESULTS: Ninety-nine patients were included in this study, including 79 diagnosed with ATL (6 with mucocutaneous leishmaniasis) and 20 without ATL (no-ATL group). The MST showed a high sensitivity of 90.0% (95% confidence interval [CI] = 69.90-97.21) in PCR-negative patients that was 10% higher than the sensitivity reported in PCR-positive population (79.66%; 95% CI = 67.73-87.96). CONCLUSIONS: One of the most important reasons for PCR negativity among patients with active ATL is the presence of a strong cellular immunological response, especially in chronic and mucocutaneous leishmaniasis. This reinforces the considerable utility of the tests that detect cellular responses against Leishmania antigens such as the MST in PCR-negative patients when the performance in screening situations is questionable.
- Subjects :
- 0301 basic medicine
Male
Mucocutaneous
RC955-962
Polymerase Chain Reaction
law.invention
0302 clinical medicine
law
Arctic medicine. Tropical medicine
hemic and lymphatic diseases
Diagnosis
Fluorescent Antibody Technique, Indirect
Leishmaniasis
Polymerase chain reaction
education.field_of_study
biology
Middle Aged
Infectious Diseases
Female
medicine.symptom
Polymorphism, Restriction Fragment Length
Microbiology (medical)
Adult
medicine.medical_specialty
030231 tropical medicine
030106 microbiology
Population
Mucocutaneous zone
Leishmaniasis, Cutaneous
Sensitivity and Specificity
Leishmania braziliensis
Lesion
03 medical and health sciences
Antigen
parasitic diseases
medicine
Major Article
Humans
education
Aged
business.industry
DNA, Protozoan
Intradermal Tests
medicine.disease
Leishmania
biology.organism_classification
Dermatology
Cutaneous
Cross-Sectional Studies
Chronic Disease
Parasitology
Histopathology
business
Subjects
Details
- Language :
- English
- ISSN :
- 16789849 and 00378682
- Volume :
- 53
- Database :
- OpenAIRE
- Journal :
- Revista da Sociedade Brasileira de Medicina Tropical
- Accession number :
- edsair.doi.dedup.....b7589afe9e1195666ef0431851054053