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Journal of Clinical Microbiology, October 2000, p. 3768-3773, Vol. 38, No. 10
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Diagnosis of Cutaneous Leishmaniasis in Colombia: the Sampling Site within Lesions Influences the Sensitivity of Parasitologic Diagnosis

José Robinson Ramírez,1,* Sonia Agudelo,1 Carlos Muskus,1 Juan Fernando Alzate,1 Christof Berberich,2 Douglas Barker,3 and Ivan Darío Velez1

Programa de Estudio y Control de Enfermedades Tropicales, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia1; Institut für Molekulare Infektionsbiologie, Universität Würzburg, Würzburg, Germany2; and Molteno Laboratories, University of Cambridge, Cambridge, United Kingdom3

Received 10 February 2000/Returned for modification 28 April 2000/Accepted 30 June 2000

Parasitologic confirmation of cutaneous leishmaniasis is obligatory before chemotherapy can be considered. Direct microscopic examination of scrapings taken from indurated borders of ulcers has been routinely used as primary method of diagnosis. In this report we compared the sensitivity of examination of dermal scrapings taken from the bottoms of ulcers (BDS) with that of dermal scrapings taken from indurated active margins of lesions (MDS) in a total of 115 patients. The sensitivities of the microscopic examination were 90.4 and 78.3% for BDS and MDS samples, respectively. When the PCR method was used with a group of 40 patients, we also observed a higher sensitivity when BDS samples were examined (80.8% in BDS samples versus 57.7% in MDS samples). The improvement of the diagnostic sensitivity in the BDS samples appears to be related to the higher parasite load and more easily detectable morphology of amastigotes in the centers of the ulcers. Other parasitologic diagnostic methods, such as culture and histopathologic examination of biopsies, are less sensitive (67.5 and 64.3%, respectively). Aspirate culture, however, was shown to be the most sensitive method for the diagnosis of patients with chronic ulcers. When microscopic examinations of both MDS and BDS samples are combined, the sensitivity of diagnosis may rise up to 94%. We therefore recommend this method as a primary routine procedure for diagnosis of cutaneous leishmaniasis.

* Corresponding author. Mailing address: Programa de Estudio y Control de Enfermedades Tropicales, Facultad de Medicina, Universidad de Antioquia, Carrera 50A no. 63-85, Medellín, Colombia. Phone: 57 4 2631930. Fax: 57 4 5716675. E-mail: ramirezpineda{at}hotmail.com.

Journal of Clinical Microbiology, October 2000, p. 3768-3773, Vol. 38, No. 10
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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