Gani Zainab Hameed, Hassan Meaad Kadhum, Jassim Abdul-Mohsin Hameed
Department of Microbiology, Basrah Medical College, Iraq.
J Pak Med Assoc. 2010 Jun;60(6):464-9.
To study selected epidemiological aspects of visceral leishmaniasis, assess direct agglutination test (DAT) as a diagnostic method and the sero-epidemiological prevalence of the disease among apparently healthy children in Basrah, Iraq.
This prospective study included 146 children suspected of visceral leishmaniasis who were admitted to Basrah Maternity and Children Hospital and Basrah General Hospital from November 2004 till November 2005 and 37 serum samples that were collected from patients with different diseases considered in the differential diagnosis of visceral leishmaniasis. In addition, 1000 apparently healthy children were randomly selected for the sero-epidemiological survey. Direct agglutination test was done for all of them.
Out of 146 suspected visceral leishmaniasis cases, 124 (84.9%) were proved by the examination of bone marrow aspirate, 132 (91.1%) were positive by direct agglutination test (DAT) and only 3 (2%) were positive by immunochromatographic strip test. The sensitivity and specificity of DAT were (100%), with a cut-off point of 1:800. In the in-patient group children less than 2 years of age were mainly affected. The highest frequency of disease was reported in July, 24 cases (18.8%). Sand flies were recorded in the environment of all sero-positive cases (100%) in each group, stray dogs and wild canines were present in (75.7% and 15.5%) in in-patients group compared to (69% and 22.5%) in sero-epidemiological group, respectively. Low maternal education was present in a significantly higher frequency among sero-positive cases.
Direct agglutination test can be used as a screening tool for visceral leishmaniasis on a wide range in endemic areas, with a high sensitivity and specificity.
研究内脏利什曼病的部分流行病学特征，评估直接凝集试验（DAT）作为一种诊断方法以及该疾病在伊拉克巴士拉表面健康儿童中的血清流行病学患病率。
这项前瞻性研究纳入了2004年11月至2005年11月入住巴士拉妇幼医院和巴士拉综合医院的146名疑似内脏利什曼病儿童，以及从内脏利什曼病鉴别诊断中考虑的不同疾病患者采集的37份血清样本。此外，随机选择1000名表面健康儿童进行血清流行病学调查。对所有对象均进行了直接凝集试验。
在146例疑似内脏利什曼病病例中，124例（84.9%）经骨髓穿刺检查确诊，132例（91.1%）直接凝集试验（DAT）呈阳性，仅3例（2%）免疫层析试纸条试验呈阳性。DAT的敏感性和特异性均为100%，截断值为1:800。住院组中主要是2岁以下儿童受影响。7月报告的疾病发生率最高，为24例（18.8%）。在每组所有血清阳性病例（100%）的环境中均记录到了白蛉，住院组中有流浪狗和野生犬科动物的比例分别为75.7%和15.5%，血清流行病学组中分别为69%和22.5%。血清阳性病例中母亲受教育程度低的比例明显更高。
直接凝集试验可作为流行地区广泛筛查内脏利什曼病的工具，具有高敏感性和特异性。
