Document 0102
 DOCN  M9470102
 TI    Comparison of PCR with direct examination of bone marrow aspiration,
       myeloculture, and serology for diagnosis of visceral Leishmaniasis in
       immunocompromised patients.
 DT    9409
 AU    Piarroux R; Gambarelli F; Dumon H; Fontes M; Dunan S; Mary C; Toga B;
       Quilici M; Laboratoire de Parasitologie-Mycologie, Faculte de Medecine
       de; la Timone, Marseille, France.
 SO    J Clin Microbiol. 1994 Mar;32(3):746-9. Unique Identifier : AIDSLINE
       MED/94253342
 AB    A PCR assay amplifying a repeated sequence from the Leishmania infantum
       genome was compared with direct examination of bone marrow aspirate,
       myeloculture, and serology for the diagnosis of visceral leishmaniasis
       in immunocompromised patients. Of 73 patients living in an area endemic
       for leishmaniasis and where visceral leishmaniasis was suspected by
       physicians, only 10 had an indisputable diagnosis of visceral
       leishmaniasis. None of the diagnostic tests performed in the study
       achieved 100% sensitivity for diagnosing visceral leishmaniasis. PCR
       exhibited superior sensitivity (82%) in comparison with bone marrow
       aspirate examination (55%) and myeloculture (55%). Our PCR assay also
       showed good specificity (97%), negative predictive value (97%), and
       positive predictive value (82%) even when all unconfirmed PCR results
       were scored as false positives. Serology exhibited good sensitivity
       (80%) and excellent specificity (100%), negative predictive value (98%),
       and positive predictive value (100%) in diagnosing new cases of visceral
       leishmaniasis but failed to diagnose relapses. We also observed
       consistent negative serological results using several different
       immunological detection methods for 2 of the 10 patients with confirmed
       cases of visceral leishmaniasis. This lack of serological reactivity
       persisted throughout the course of their infections. These results
       demonstrate the importance of using PCR as an aid in the diagnosis of
       visceral leishmaniasis in immunocompromised patients.
 DE    Adolescence  Adult  Aged  Animal  Antibodies, Protozoan/BLOOD
       AIDS-Related Opportunistic Infections/COMPLICATIONS/DIAGNOSIS/
       IMMUNOLOGY  Base Sequence  Bone Marrow/PARASITOLOGY  Comparative Study
       DNA Primers/GENETICS  DNA, Protozoan/GENETICS  Human  *Immunocompromised
       Host  Leishmania infantum/GENETICS/IMMUNOLOGY/ISOLATION & PURIF
       Leishmaniasis, Visceral/COMPLICATIONS/*DIAGNOSIS/*IMMUNOLOGY  Middle Age
       Molecular Sequence Data  Parasitology/METHODS/STATISTICS & NUMER DATA
       *Polymerase Chain Reaction/STATISTICS & NUMER DATA  Sensitivity and
       Specificity  Serodiagnosis/STATISTICS & NUMER DATA  JOURNAL ARTICLE

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