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流行地区无症状内脏利什曼病血清学诊断检测的比较研究

Comparative study of serologic tests for the diagnosis of asymptomatic visceral leishmaniasis in an endemic area.

作者信息

Romero Héctor Dardo, Silva Luciana de Almeida, Silva-Vergara Mario Leon, Rodrigues Virmondes, Costa Roberto Teodoro, Guimarães Sílvio Fernandes, Alecrim Wilson, Moraes-Souza Helio, Prata Aluízio

机构信息

Department of Tropical Medicine and Infectology, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil.

出版信息

Am J Trop Med Hyg. 2009 Jul;81(1):27-33.

Abstract

Serologic tests have been widely used for the diagnosis of asymptomatic visceral leishmaniasis. This study evaluated five serologic tests used for the diagnosis of asymptomatic infection: enzyme-linked immunosorbent assay (ELISA) using promastigote antigen (ELISAp), ELISA using recombinant K39 (ELISA rK39), and K26 (ELISA rK26) antigens, an indirect immunofluorescence test using Leishmania (Leishmania) amazonensis promastigote antigen (IIFT), and an immunochromatographic test using rK39 antigen (TRALd). As a reference regarding the performance of the tests, patients with classic visceral leishmaniasis originating from Minas Gerais, Brazil (N = 36), were defined as the positive group and samples of healthy individuals from nonendemic areas (Argentina) (N = 127) were used as negative controls. Patients with other diseases such as cutaneous leishmaniasis (N = 53) and malaria (N = 56) were also studied to evaluate the chance of cross-reactivity in these tests. Finally, subjects from an area endemic for visceral leishmaniasis in Brazil (Porteirinha, northern Minas Gerais) (N = 1241) were screened for asymptomatic infection with Leishmania and Chagas disease. The sensitivity of the serologic tests was 50% (18/36), 66.7% (24/36), 69.4% (25/36), 83.3% (30/36), and 88.9% (32/36) for ELISAp, ELISA rK26, ELISA rK39, IIFT, and TRALd, respectively. Specificity, calculated using the truly negative group, was 96% (122/127) for TRALd, 97.6% (124/127) for ELISAp and IIFT, and 100% (127/127) for ELISA rK39 and rK26. Positivity in at least one test employing recombinant antigen was observed in 24 (45%) patients with cutaneous leishmaniasis and 47 (82.4%) with malaria. In the visceral leishmaniasis-endemic area, the positivity of the serologic tests ranged from 3.9% to 37.5%. The enzyme-linked immunosorbent assay (ELISA) tests using recombinant antigens were more frequently positive in subjects with a history of exposure to human or canine visceral leishmaniasis (ELISArK39: 14.6% [149/1017] versus 37.5% [84/224]; ELISA rK26: 12.7% [129/1017] versus 21.4% [48/224], P < 0.001 for both). Kappa agreement was low, with a maximum value of 0.449 between ELISAp and IIFT. In addition, among the 112 IIFT-positive subjects, 75 (67%) also presented positive serology for Chagas disease. In conclusion, IIFT and TRALd presented the best performance to diagnose classic cases of visceral leishmaniasis in an endemic area. Cross-reactivity of the tests with Chagas disease, cutaneous leishmaniasis, and malaria should be taken into account. However, the differences in the positivity of the tests used, together with the low agreement between results, do not permit to select the best test for the diagnosis of asymptomatic Leishmania infection.

摘要

血清学检测已广泛用于无症状内脏利什曼病的诊断。本研究评估了用于诊断无症状感染的五种血清学检测方法:使用前鞭毛体抗原的酶联免疫吸附测定(ELISA)(ELISAp)、使用重组K39(ELISA rK39)和K26(ELISA rK26)抗原的ELISA、使用亚马逊利什曼原虫前鞭毛体抗原的间接免疫荧光试验(IIFT)以及使用rK39抗原的免疫层析试验(TRALd)。作为检测性能的参考,将来自巴西米纳斯吉拉斯州的经典内脏利什曼病患者(N = 36)定义为阳性组,并将来自非流行地区(阿根廷)的健康个体样本(N = 127)用作阴性对照。还对患有其他疾病如皮肤利什曼病(N = 53)和疟疾(N = 56)的患者进行了研究,以评估这些检测中交叉反应的可能性。最后,对巴西内脏利什曼病流行地区(米纳斯吉拉斯州北部的波特里尼亚)的1241名受试者进行了利什曼原虫和恰加斯病无症状感染筛查。ELISAp、ELISA rK26、ELISA rK39、IIFT和TRALd的血清学检测敏感性分别为50%(18/36)、66.7%(24/36)、69.4%(25/36)、83.3%(30/36)和88.9%(32/36)。使用真正阴性组计算的特异性,TRALd为96%(122/127),ELISAp和IIFT为97.6%(124/127),ELISA rK39和rK26为100%(127/127)。在24名(45%)皮肤利什曼病患者和47名(82.4%)疟疾患者中观察到至少一项使用重组抗原的检测呈阳性。在内脏利什曼病流行地区,血清学检测的阳性率在3.9%至37.5%之间。使用重组抗原的酶联免疫吸附测定(ELISA)检测在有接触人类或犬内脏利什曼病病史的受试者中更频繁呈阳性(ELISA rK39:14.6%[149/1017]对37.5%[84/224];ELISA rK26:12.7%[129/1017]对21.4%[48/224],两者P < 0.001)。卡帕一致性较低,ELISAp和IIFT之间的最大值为0.449。此外,在112名IIFT阳性受试者中,75名(67%)恰加斯病血清学也呈阳性。总之,IIFT和TRALd在诊断流行地区经典内脏利什曼病病例方面表现最佳。应考虑检测与恰加斯病、皮肤利什曼病和疟疾的交叉反应。然而,所用检测方法阳性率的差异以及结果之间较低的一致性,不允许选择用于诊断无症状利什曼原虫感染的最佳检测方法。

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