Singhai Monil, Kakkar Neeru, Gupta Naveen, Bala Manju, Singh Ram, Singh Sujeet K
Centre for Arboviral and Zoonotic Diseases, National Centre for Disease Control, Delhi, India.
BCG Vaccine Laboratory, Chennai, Tamil Nadu, India.
Trop Parasitol. 2022 Jan-Jun;12(1):54-58. doi: 10.4103/tp.tp_7_21. Epub 2022 Jun 26.
A range of assays have been developed to detect specific antileishmanial antibody, such as rK 39 immunochromatographic test (ICT), KE 16 ICT, ELISA test, and indirect immunofluorescent antibody test (IFAT), which play a crucial role in serological diagnosis of visceral leishmaniasis (VL). However, limited published reports are available on the utility of serological test (IFAT test/rk 39), smear examination, and culture in the diagnosis of VL and post-kala-azar dermal leishmaniasis (PKDL) in our country.
We present utility of serological test (IFAT test/rK 39), smear examination for (LD) bodies, and culture in 2589 samples from 2294 VL/PKDL suspected patients (January 2009-December 2019) tested in Centre for Arboviral and Zoonotic diseases, National Centre for Disease Control, New Delhi, India, for laboratory diagnosis of VL/PKDL.
A total of 80/553 (14.4%) cases were confirmed of VL (74/522 cases by demonstration of LD bodies in bone marrow smear examination, 5/12 in splenic smear examination 1/19 by culture) and 4/21 (19.0%) cases were confirmed of PKDL (demonstration of LD bodies in slit skin smear examination. In our study 197/1368 (14.4%) cases were diagnosed positive by IFAT, 34/646 (5.2%) cases by rk 39 ICT for VL/PKDL by demonstration of specific antileishmanial antibodies.
As the goal of elimination of VL as a public health problem is approaching, apart from serological tests such as rk 39 and IFAT, direct methods of detection such as (parasitic demonstration in BM smear, culture, and molecular tests) for Leishmania may play a crucial role for achieving a correct diagnosis and treatment. We also concluded that IFAT though not field-friendly, its optimal use as an adjunct test with BM smear in all stages of infections may be required. Further rk39 is a simple, reliable, noninvasive, and field-friendly test for diagnosis VL, especially in endemic areas.
已经开发了一系列检测特定抗利什曼原虫抗体的检测方法，如rK39免疫层析试验（ICT）、KE16 ICT、酶联免疫吸附测定（ELISA）试验和间接免疫荧光抗体试验（IFAT），这些方法在内脏利什曼病（VL）的血清学诊断中发挥着关键作用。然而，关于血清学检测（IFAT试验/rk39）、涂片检查和培养在我国VL和黑热病后皮肤利什曼病（PKDL）诊断中的应用，公开报道有限。
我们介绍了血清学检测（IFAT试验/rK39）、利杜体（LD）涂片检查和培养在2294例疑似VL/PKDL患者的2589份样本（2009年1月至2019年12月）中的应用情况，这些样本在印度新德里国家疾病控制中心虫媒病毒和人畜共患病中心进行检测，用于VL/PKDL的实验室诊断。
总共确诊80/553（14.4%）例VL（74/522例通过骨髓涂片检查发现利杜体确诊，5/12例通过脾涂片检查确诊，1/19例通过培养确诊），4/21（19.0%）例确诊为PKDL（通过裂隙皮肤涂片检查发现利杜体确诊）。在我们的研究中，197/1368（14.4%）例通过IFAT诊断为阳性，34/646（5.2%）例通过rk39 ICT诊断为VL/PKDL阳性，通过检测特异性抗利什曼原虫抗体确诊。
随着将VL作为公共卫生问题消除的目标日益临近，除了rk39和IFAT等血清学检测方法外，利什曼原虫的直接检测方法（如骨髓涂片寄生虫检测、培养和分子检测）对于实现正确诊断和治疗可能起着关键作用。我们还得出结论，IFAT虽然不便于现场使用，但在感染的各个阶段作为骨髓涂片的辅助检测方法可能需要优化使用。此外，rk39是一种简单、可靠、无创且便于现场使用的VL诊断方法，尤其是在流行地区。
