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Journal of Clinical Microbiology, January 2001, p. 357-361, Vol. 39, No. 1
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.1.357-361.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Role of PCR in Diagnosis and Prognosis of Visceral Leishmaniasis in Patients Coinfected with Human Immunodeficiency Virus Type 1

Massimo Pizzuto,1 Manuela Piazza,1 Daniela Senese,1 Chiara Scalamogna,1 Sara Calattini,1 Laura Corsico,1 Tiziana Persico,1 Beatrice Adriani,2 Carlo Magni,3 Giovanni Guaraldi,4 Giovanni Gaiera,5 Alessandra Ludovisi,6 Marina Gramiccia,6 Massimo Galli,1 Mauro Moroni,1 Mario Corbellino,1 and Spinello Antinori1,7,*

Institute of Infectious Diseases and Tropical Medicine, University of Milan,1 2nd Division of Infectious Diseases,2 and 1st Division of Infectious Diseases,3 L. Sacco Hospital Institute of Infectious Diseases, University of Modena,4 and San Luigi Center for Infectious Diseases, San Raffaele Hospital,5 Milan, Department of Parasitology, Istituto Superiore di Sanità, Rome,6 and Institute of Infectious Pathology and Virology, University of Palermo, Palermo,7 Italy

Received 15 May 2000/Returned for modification 27 July 2000/Accepted 18 October 2000

A group of 76 consecutive human immunodeficiency virus (HIV)-positive patients with fever of unknown origin (n = 52) or fever associated with pulmonary diseases was evaluated in order to assess the usefulness of PCR with peripheral blood in the diagnosis and follow-up of visceral leishmaniasis. We identified 10 cases of visceral leishmaniasis among the 52 patients with fever of unknown origin. At the time of diagnosis, all were parasitemic by PCR with peripheral blood. During follow-up, a progressive decline in parasitemia was observed under therapy, and all patients became PCR negative after a median of 5 weeks (range, 6 to 21 weeks). However, in eight of nine patients monitored for a median period of 88 weeks (range, 33 to 110 weeks), visceral leishmaniasis relapsed, with positive results by PCR with peripheral blood reappearing 1 to 2 weeks before the clinical onset of disease. Eight Leishmania infantum and two Leishmania donovani infections were identified by PCR-restriction fragment length polymorphism analysis. PCR with peripheral blood is a reliable method for diagnosis of visceral leishmaniasis in HIV-infected patients. During follow-up, it substantially reduces the need for traditional invasive tests to assess parasitological response, while a positive PCR result is predictive of clinical relapse.

* Corresponding author. Mailing address: Institute of Infectious Diseases and Tropical Medicine, University of Milan L. Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy. Phone: 39 02 3567031. Fax: 39 02 3560805. E-mail: spantin{at}tin.it.

Journal of Clinical Microbiology, January 2001, p. 357-361, Vol. 39, No. 1
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.1.357-361.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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