Department of Tropical Medicine and Infectology, Federal University of Triângulo Mineiro, Uberaba, Brazil.
Am J Trop Med Hyg. 2011 Feb;84(2):261-6. doi: 10.4269/ajtmh.2011.10-0092.
The objective of this study was to evaluate the behavior of different tests used for the diagnosis of visceral leishmaniasis (VL) in asymptomatic subjects living in an endemic area. No gold standard is available for the diagnosis of asymptomatic infection with Leishmania. In continuation of a previous study, 1,017 subjects living in a VL-endemic area were clinically reevaluated. Of these, 576 had at least one positive serological test in a first assessment. About 3 years after the first evaluation, none of the subjects had progressed to clinical VL. Among this group, 246 subjects were selected, and five serological tests (enzyme-linked immunosorbent assay p [ELISAp], ELISArK39, ELISArK26, indirect immunofluorescence test [IIFT] using L. amazonensis promastigote antigen, and an immunochromatographic test using rK39 antigen [TRALd]) and the Montenegro skin test (MST) were repeated. There was a significant increase in the number of subjects who tested positive in the MST, IIFT, ELISAp, and ELISArK39 in the second evaluation. For all tests, there were subjects who tested positive in the first evaluation and negative in the second evaluation. A positive result in the serological tests and MST in subjects from the endemic area studied did not indicate a risk of progression to VL and may only be temporary.
本研究的目的是评估用于诊断地方性内脏利什曼病（VL）的无症状感染者的不同检测方法的表现。由于目前尚无诊断无症状利什曼原虫感染的金标准，我们在先前的一项研究的基础上，对生活在 VL 流行地区的 1017 名受试者进行了临床重新评估。其中，576 名受试者在初次评估时至少有一项血清学检测呈阳性。初次评估 3 年后，所有受试者均未进展为临床 VL。在该组中，我们选择了 246 名受试者，对他们进行了五种血清学检测（酶联免疫吸附试验 p [ELISAp]、ELISArK39、ELISArK26、使用 L. amazonensis 前鞭毛体抗原的间接免疫荧光试验 [IIFT] 和使用 rK39 抗原的免疫层析检测 [TRALd]）和 Montenegro 皮肤试验（MST）的重复检测。第二次评估中，MST、IIFT、ELISAp 和 ELISArK39 的阳性受试者数量显著增加。对于所有检测方法，均有初次评估阳性而第二次评估阴性的受试者。在来自研究地区的受试者中，血清学检测和 MST 的阳性结果并不意味着进展为 VL 的风险，可能只是暂时的。
