leishmaniasis
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1. Chappuis F, Rijal S, Soto A, Menten J, Boelaert M. A meta-analysis of the diagnostic performance of the direct agglutination test and rK39 dipstick for visceral leishmaniasis. BMJ. 2006 Oct 7;333(7571):723. Geneva University Hospitals, Travel and Migration Medicine Unit, rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. francois.chappuis@hcuge.ch OBJECTIVE: To compare the performance of the direct agglutination test and rK39 dipstick for the diagnosis of visceral leishmaniasis. DATA SOURCES: Medline, citation tracking, January 1986 to December 2004. Selection criteria Original studies evaluating the direct agglutination test or the rK39 dipstick with clinical visceral leishmaniasis as target condition; adequate reference classification; and absolute numbers of true positive, true negative, false positive, and false negative observations available or derivable from the data presented. RESULTS: 30 studies evaluating the direct agglutination test and 13 studies evaluating the rK39 dipstick met the inclusion criteria. The combined sensitivity estimates of the direct agglutination test and the rK39 dipstick were 94.8% (95% confidence interval 92.7% to 96.4%) and 93.9% (87.7% to 97.1%), respectively. Sensitivity seemed higher and more homogenous in the studies carried out in South Asia. Specificity estimates were influenced by the type of controls. In phase III studies carried out on patients with clinically suspected disease, the estimated specificity of the direct agglutination test was 85.9% (72.3% to 93.4%) and of the rK39 dipstick was 90.6% (66.8% to 97.9%). CONCLUSION: The diagnostic performance of the direct agglutination test and the rK39 dipstick for visceral leishmaniasis is good to excellent and seem comparable. 2. El Mutasim M, Mansour D, Abass EM, Hassan WM, el Harith A. Evaluation of a glycerol-preserved antigen in the direct agglutination test for diagnosis of visceral leishmaniasis at rural level in eastern Sudan. J Med Microbiol. 2006 Oct;55(Pt 10):1343-7. Ahfad University for Women, PO Box 167, Omdurman, Sudan. Three-hundred and eight patients with suspected visceral leishmaniasis (VL) were received at Doka Hospital (eastern Sudan) during the period September 2004 to October 2005. The sensitivity and specificity of a glycerol-preserved (GP) antigen for VL diagnosis was assessed against the results of repeated lymph node aspiration and readings from a direct agglutination test (DAT) employing standard formaldehyde-fixed (FF) or freeze-dried (FD) antigen. Despite 13 months of storage at ambient temperature (28-47 degrees C), the GP antigen mean titres obtained from these 308 patients were no different from those that were FD (P=0.945) and stored under similar conditions, but were significantly different (P=0.019) from those that were FF and kept continuously at the optimum temperature for storage (4-8 degrees C). Taking the parasitological result as the gold standard and using a pre-established titre of 1 : 3200 as the DAT cut-off, the GP antigen revealed a sensitivity (91/105, 86.7 %) and specificity (187/203, 92.1 %) comparable to that of FD antigen (92/105, 87.6 %, and 188/203, 92.6 %, respectively) and FF antigen (94/105, 89.5 %, and 188/203, 92.6 %, respectively). At a titre range of 1 : 400-1 : 800, statistically determined as the optimum cut-off for the three antigens, sensitivities of 92.4, 90.5 and 96.2 % and specificities of 90.6, 90.1 and 88.7 % were achieved for the GP, FD and FF antigens, respectively, at a peripheral hospital. Regardless of the antigen preparation used, DAT results obtained in the peripheral hospital were highly reproducible in the central laboratory in Omdurman (weighted kappa: GP=0.957, FD=0.979 and FF=0.936). With a diagnostic reliability comparable to formaldehyde fixation and stability under ambient conditions similar to freeze drying, glycerol preservation, by virtue of its high potential for reproduction, meets the requirements for the management of VL in developing countries. 3. Rafati S, Hassani N, Taslimi Y, Movassagh H, Rochette A, Papadopoulou B. Amastin peptide-binding antibodies as biomarkers of active human visceral leishmaniasis. Clin Vaccine Immunol. 2006 Oct;13(10):1104-10. Molecular Immunology and Vaccine Research Laboratory, Pasteur Institute of Iran, 69 Pasteur Ave., Tehran 13164, Iran. s_rafati@yahoo.com Amastin surface proteins belong to a large family of developmentally regulated proteins comprising up to 45 members that have recently been discovered in the genus Leishmania and are highly similar to the amastin proteins in Trypanosoma cruzi. All members of the amastin gene family contain a highly conserved 11-amino-acid (aa) signature at the N terminus, which is unique to the amastin proteins and to the Trypanosomatidae family. Recent studies have demonstrated that this region is highly protective in a mouse model. The goal of the present study was to evaluate the potential of the 50-aa N-terminal domain of amastin proteins harboring the conserved 11-aa amastin signature peptide as a relevant immune biomarker of cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL). We report here the amastin-binding total immunoglobulins (IgG) and/or IgG subclasses in the sera of patients at different stages of CL (n=90) and VL (n=41). In CL cases, there is no significant difference in seroreactivities between active, recovered, and nonhealed cases. However, the amastin peptide-reactive antibodies were present at high titers in 19 of 20 sera collected from patients with active VL compared to sera from patients recovered from VL and asymptomatic cases of VL. These data suggest that the amastin signature peptide could represent a relevant biomarker for the serodiagnosis of VL and, most importantly, that it could permit differentiation among the different stages of the disease. Therapy: 15416. Badaro R, Lobo I, Munos A, Netto EM, Modabber F, Campos-Neto A, Coler RN, Reed SG. Immunotherapy for drug-refractory mucosal leishmaniasis. J Infect Dis. 2006 Oct 15;194(8):1151-9. 15417. Bern C, Adler-Moore J, Berenguer J, Boelaert M, den Boer M, Davidson RN, Figueras C, Gradoni L, Kafetzis DA, Ritmeijer K, Rosenthal E, Royce C, Russo R, Sundar S, Alvar J. Liposomal amphotericin B for the treatment of visceral leishmaniasis. Clin Infect Dis. 2006 Oct 1;43(7):917-24. 15418. De Almeida Silva L, Romero HD, Prata A, Costa RT, Nascimento E, Carvalho SF, Rodrigues V. Immunologic tests in patients after clinical cure of visceral leishmaniasis. Am J Trop Med Hyg. 2006 Oct;75(4):739-43. 15419. Lawn SD, Wilkinson RJ. Immune reconstitution disease associated with parasitic infections following antiretroviral treatment. Parasite Immunol. 2006 Nov;28(11):625-33. Review. 15420. Shrestha NK. Sodium stibogluconate. Clin Infect Dis. 2006 Nov 15;43(10):1371-2. 15421. Toubiana J, Armengaud JB, Camet JD, Gendrel D. Oral fluconazole treatment for extensive cutaneous leishmaniasis in an 11-year-old child. Pediatr Infect Dis J. 2006 Nov;25(11):1083-4. 15422. Yardley V, Ortuno N, Llanos-Cuentas A, Chappuis F, Doncker SD, Ramirez L, Croft S, Arevalo J, Adaui V, Bermudez H, Decuypere S, Dujardin JC. American tegumentary leishmaniasis: Is antimonial treatment outcome related to parasite drug susceptibility? J Infect Dis. 2006 Oct 15;194(8):1168-75.
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