da Silva Mauro Roberto Biá, Brandão Natália Alberto Alves, Colovati Marco, de Sousa Margella Marconcine Pinheiro, de Lima Larissa Coelho, Dorta Miriam Leandro, Ribeiro-Dias Fátima, Costa Dorcas Lamounier, Costa Carlos Henrique Nery, de Oliveira Milton Adriano Pelli
Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Rua 235 S/N - Setor Universitário, Goiânia, GO, 74605-050, Brazil.
Instituto de Doenças Tropicais Natan Portela, R. Artur de Vasconcelos 151-Sul, Teresina, PI, 64001-450, Brazil.
Parasitol Res. 2018 Feb;117(2):419-427. doi: 10.1007/s00436-017-5716-3. Epub 2017 Dec 21.
Because of visceral leishmaniasis (VL) urbanization and spreading of the human immunodeficiency virus (HIV) infection to rural areas, coinfection has become more common. Here, we compared the accuracy of Kalazar Detect® (KD), an rK39-based immunochromatographic (IC) test, and OrangeLife® (OL), an rK39 + rK28 IC test, for diagnosing VL in patients coinfected with HIV in an endemic area in Brazil. Seventy-six VL patients and 40 patients with other diseases, of which 31 and 21 patients, respectively, were infected with HIV, were examined. The sensitivity of OL and KD tests was 88.89 and 95.45%, respectively, in patients without HIV. The sensitivity dropped to 67.74 and 61.29%, respectively, in coinfected patients. The decrease in sensitivity was not related to a decrease in the production of Leishmania-specific IgG. Because of the low sensitivity of rk39 test in HIV-infected patients, we suggest that patients with negative rK39 results should undergo further investigation with additional serological tests that are not based only on the rK39 antigen and examination of bone marrow aspirates.
由于内脏利什曼病（VL）的城市化以及人类免疫缺陷病毒（HIV）感染向农村地区的蔓延，合并感染变得更加常见。在此，我们比较了基于rK39的免疫层析（IC）检测Kalazar Detect®（KD）和rK39 + rK28 IC检测OrangeLife®（OL）在巴西一个流行地区诊断HIV合并感染患者VL时的准确性。对76例VL患者和40例患有其他疾病的患者进行了检查，其中分别有31例和21例患者感染了HIV。在未感染HIV的患者中，OL和KD检测的灵敏度分别为88.89%和95.45%。在合并感染的患者中，灵敏度分别降至67.74%和61.29%。灵敏度的降低与利什曼原虫特异性IgG产生的减少无关。由于rk39检测在HIV感染患者中的灵敏度较低，我们建议rK39结果为阴性的患者应通过不仅基于rK39抗原的额外血清学检测以及骨髓穿刺检查进行进一步调查。
