Pós-graduação em Medicina Tropical e Infectologia da Universidade Federal do Triângulo Mineiro, Uberaba, Brasil; Fundação Ezequiel Dias, Belo Horizonte, Brasil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou (CPqRR), Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brasil.
Pós-graduação em Medicina Tropical e Infectologia da Universidade Federal do Triângulo Mineiro, Uberaba, Brasil; Fundação Ezequiel Dias, Belo Horizonte, Brasil; Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou (CPqRR), Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Brasil
Am J Trop Med Hyg. 2014 Aug;91(2):329-35. doi: 10.4269/ajtmh.13-0418. Epub 2014 Jun 16.
The diagnosis of Leishmania (Leishmania) infantum infection in children from birth may serve as a reference for the early identification of cases that would progress to classical visceral leishmaniasis (VL) in endemic areas. This study prospectively evaluated newborns of mothers living in the municipality of Paracatu, Minas Gerais, Brazil. The infants were followed up at 6-month intervals by clinical examination, serological tests (immunofluorescence [IIF] and enzyme-linked immunosorbent assay with rK39 [ELISA-rK39]) and polymerase chain reaction (PCR) until they had completed 18 months of age. A total of 166 pregnant women were included to evaluate the possible transfer of antibodies or even congenital transmission. Twenty-two of the women tested positive by IIF, four by ELISA-rK39, and one by PCR. Three infants of the 25 women with some positive test results were also positive in the first test (one by IIF, one by ELISA-rK39, and the third by ELISA-rK39 and PCR). One hundred and sixty infants were included in the study; of these, 43 had at least one positive sample over time. However, agreement between tests was low. Follow-up of children with a positive result in the tests studied revealed no progression to classical disease within a period of 18 months. In contrast, two children with negative IIF, PCR, and ELISA-rK39 results developed classical VL at 9 and 12 months of age. In conclusion, a positive test result was variable and sometimes temporary and agreement between tests was low. Therefore, the early diagnosis of Leishmania infection was not associated with the early identification of cases that would progress to classical VL in the endemic area studied.
先天性婴儿利什曼原虫（Leishmania）感染的诊断可作为在流行地区早期识别可能发展为经典内脏利什曼病（VL）病例的参考。本研究前瞻性评估了巴西米纳斯吉拉斯州帕拉卡图市居民的新生儿。通过临床检查、血清学试验（免疫荧光[IIF]和 rK39 酶联免疫吸附试验[ELISA-rK39]）和聚合酶链反应（PCR），每隔 6 个月对婴儿进行随访，直到他们完成 18 个月的随访。共有 166 名孕妇被纳入评估，以评估是否存在抗体转移甚至先天性传播的可能性。22 名孕妇 IIF 检测阳性，4 名 ELISA-rK39 检测阳性，1 名 PCR 检测阳性。25 名检测结果呈阳性的妇女中有 3 名婴儿在首次检测中也呈阳性（1 名 IIF，1 名 ELISA-rK39，第 3 名 ELISA-rK39 和 PCR）。160 名婴儿被纳入研究；其中，43 名婴儿在随访期间至少有一次样本呈阳性。然而，各检测方法之间的一致性较低。对研究中检测结果呈阳性的儿童进行随访，未发现其在 18 个月内进展为经典疾病。相比之下，2 名 IIF、PCR 和 ELISA-rK39 结果均为阴性的儿童在 9 个月和 12 个月时出现了经典 VL。综上所述，阳性检测结果具有变异性，有时是暂时性的，各检测方法之间的一致性较低。因此，在研究的流行地区，早期诊断利什曼原虫感染与早期识别可能发展为经典 VL 的病例之间没有关联。
