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Leishmaniasis, visceral
Diagnostic Methods
Diagnostic methodsPros and cons
Parasitological diagnosis 
Only rarely can amastigotes be demonstrated in buffy coat preparations from peripheral blood. Biopsies of spleen (risky!), liver, lymph node or bone marrow (sternum) have to be taken and stained for the detection of amastigote parasites.
Biopsies can be put into culture medium in which amastigotes transform to promastigotes and multiply.
  • Invasive methods have to be used to detect the parasite microscopically
  • Cultivation is a time-consuming process
Molecular diagnosis 
Highly sensitive and specific nested PCR and real-time PCR methods have been developed to detect DNA in blood or in biopsies. Molecular methods are more sensitive than microscopy.
  • Identification of causative species is possible
Antigen detection 
No tests developed so far 
Antibody detection 
The detection of specific antibodies is a cornerstone of a diagnostic strategy in visceral leishmaniasis. ELISA and IFA tests have been standardized and are commercially available.
For the field, a direct agglutination test (DAT) using a freeze-dried antigen, and an immunochromatographic dipstick test with a recombinant antigen (K39) are available. A recent meta-analysis revealed that both tests have high sensitivities (around 95%) but limitations in specificity (approx. 90%). Variations in the sensitivity of the dipstick test in different endemic areas ask for improvements.
  • Rapid diagnostic tests available
  • Moderate specificity
  • Persistence of antibodies after cure (unable to detect relapses!)