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Journal of Clinical Microbiology, April 2004, p. 1853-1854, Vol. 42, No. 4
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.4.1853-1854.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Noninvasive Method for Diagnosis of Visceral Leishmaniasis by a Latex Agglutination Test for Detection of Antigens in Urine Samples


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LETTER
 
Since the appearance of human immunodeficiency virus (HIV), visceral leishmaniasis (VL) has emerged as an opportunistic infection in developed countries (1, 3, 10). It appears in advanced stages of HIV infection and is supposed to accelerate the progression of AIDS (3, 5, 8). Therapeutic failures and relapses are common.

Accurate diagnosis is usually difficult in HIV-coinfected patients because VL has atypical clinical expressions and because serological diagnosis becomes unreliable (1). Demonstration of the parasite in cultured samples or in stained preparations is considered the "gold standard" (GS) for diagnosis but requires invasive techniques. A noninvasive and accurate test is needed in order to improve diagnosis of VL, especially in individuals with an increased risk of suffering complications after invasive methods (2, 6).

We have evaluated the effectiveness of a rapid latex agglutination test (LAT) (KATEX; Kalon Biological Ltd., Aldershot, Hants, United Kingdom) in the detection of a leishmanial antigen (9) in urine from patients with VL and its usefulness in treatment monitoring.

A bone marrow aspirate and a fresh urine specimen were collected from 85 patients with suggestive clinical symptoms and signs of VL. The demonstration of the parasite by culture or Giemsa stain in bone marrow aspirate was considered the GS.

In 16 out of 89 cases the VL clinical diagnosis was confirmed by the GS (group 1), while in 73 it was not (group 2). Urine samples from 73 patients without any suspicion of VL were collected as negative controls (group 3). The percentages of HIV-infected individuals were as follows: 100% in group 1, 91% in group 2, and 21% in group 3.

The LAT was performed in previously boiled urine specimens according to the manufacturer's instructions. A clear agglutination was recorded as positive.

All specimens from group 1, three from group 2, and none from group 3 were positive by the LAT (Table 1). One of the three patients from group 2 who tested positive had been diagnosed with VL 1 year before. The sensitivity was 100%, and specificity was 96% (Table 1).


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  		TABLE 1. Leishmanial urinary antigen detection in different patient groups

We followed up the cases of 13 of the 16 patients from group 1. A urine specimen was collected each time they came to the hospital, and a bone marrow aspirate was also collected if a VL relapse was suspected. The LAT was performed for all urine samples obtained. The leishmanial antigen could be detected in urine up to 1 year after VL diagnosis in HIV-coinfected patients, probably due to their inability to control the parasitosis (4, 7). Therefore, this technique does not seem very helpful in monitoring treatment and predicting relapses.

However, our results show that the test is a sensitive and specific noninvasive tool for diagnosing VL. It is easy to perform and interpret, so it could be used as a screening test in developing areas and among susceptible populations. However, due to the low number of patients with VL included in our evaluation, further studies are needed to confirm these data.


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REFERENCES
 
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  1. Alvar, J., C. Cañavate, B. Gutiérrez-Solar, M. Jiménez, F. Laguna, R. López-Vélez, R. Molina, and J. Moreno. 1997. Leishmania and human immunodeficiency virus coinfection: the first 10 years. Clin. Microbiol. Rev. 10:298-319.[Abstract]
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  2. Attar, Z. J., M. L. Chance, S. El-Safi, J. Carney, A. Azazy, M. El-Hadi, C. Dourado, and M. Hommel. 2001. Latex agglutination test for the detection of urinary antigens in visceral leishmaniasis. Acta Trop. 78:11-16.[CrossRef][Medline]
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  3. Berhe, N., D. Wolday, A. Hailu, Y. Abraham, A. Ali, T. Gebre-Michael, P. Desjeux, A. Sonnerborg, H. Akuffo, and S. Britton. 1999. HIV viral load and response to antileishmanial chemotherapy in coinfected patients. AIDS 13:1921-1925.[CrossRef][Medline]
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  4. Davidson, R. N., and R. Russo. 1994. Relapse of visceral leishmaniasis in patients who were coinfected with human immunodeficiency virus and who received treatment with liposomal amphotericin B. Clin. Infect. Dis. 19:560.[Medline]
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  5. Gradoni, L., A. Scalone, M. Gramiccia, and M. Troiani. 1996. Epidemiological surveillance of leishmaniasis in HIV-1-infected individuals in Italy. AIDS 10:785-791.[Medline]
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  6. Hommel, M. 2001. Le KATEX pour le diagnostic de la leishmaniose viscerale. Med. Trop. 61:255.
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  7. Morales, M. A., I. Cruz, J. M. Rubio, C. Chicharro, C. Canavate, F. Laguna, and J. Alvar. 2002. Relapses versus reinfections in patients coinfected with Leishmania infantum and human immunodeficiency virus type 1. J. Infect. Dis. 185:1533-1537.[CrossRef][Medline]
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  8. Pineda, J. A., J. A. Gallardo, J. Macías, J. Delgado, C. Regordán, F. Morillas, F. Relimpio, J. Martín-Sánchez, A. Sánchez-Quijano, M. Leal, and E. Lissen. 1998. Prevalence of and factors associated with visceral leishmaniasis in human immunodeficiency virus type 1-infected patients in southern Spain. J. Clin. Microbiol. 36:2419-2422.[Abstract/Free Full Text]
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  9. Sarkari, B., M. Chance, and M. Hommel. 2002. Antigenuria in visceral leishmaniasis: detection and partial characterisation of a carbohydrate antigen. Acta Trop. 82:339-348.[CrossRef][Medline]
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  10. World Health Organization. 1999. Leishmania/HIV co-infection: south-western Europe, 1990-1998. Retrospective analysis of 965 cases. Wkly. Epidemiol. Rec. 74:365-375.[Medline]
C. Vilaplana
S. Blanco
J. Domínguez
M. Giménez
V. Ausina*
Department of Microbiology
Hospital Germans Trias i Pujol
Crtra. Del Canyet, s/n
08916 Badalona
Spain
Cristina Tural
HIV Clinical Unit
Department of Internal Medicine
Hospital Germans Trias i Pujol
Crtra. Del Canyet, s/n
08916 Badalona
Spain

Carme Muñoz
Department of Microbiology
Hospital de la Santa Creu i Sant Pau
08025 Barcelona
Spain

* Phone: 34934978894,Fax: 34934978895,E-mail: vausina{at}ns.hugtip.scs.es

Journal of Clinical Microbiology, April 2004, p. 1853-1854, Vol. 42, No. 4
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.4.1853-1854.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

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  • Garcia-Garcia, J. A., Martin-Sanchez, J., Gallego, M., Rivero-Roman, A., Camacho, A., Riera, C., Morillas-Marquez, F., Vergara, S., Macias, J., Pineda, J. A. (2006). Use of Noninvasive Markers To Detect Leishmania Infection in Asymptomatic Human Immunodeficiency Virus-Infected Patients. J. Clin. Microbiol. 44: 4455-4458 [Abstract] [Full Text]  
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