Abstract
The diagnosis of mucocutaneous leishmaniasis (MCL) is hampered by the absence of a gold standard. An accurate diagnosis is essential because of the high toxicity of the medications for the disease. This study aimed to assess the ability of polymerase chain reaction (PCR) to identify MCL and to compare these results with clinical research recently published by the authors. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement was performed using comprehensive search criteria and communication with the authors. A meta-analysis considering the estimates of the univariate and bivariate models was performed. Specificity near 100% was common among the papers. The primary reason for accuracy differences was sensitivity. The meta-analysis, which was only possible for PCR samples of lesion fragments, revealed a sensitivity of 71% [95% confidence interval (CI) = 0.59; 0.81] and a specificity of 93% (95% CI = 0.83; 0.98) in the bivariate model. The search for measures that could increase the sensitivity of PCR should be encouraged. The quality of the collected material and the optimisation of the amplification of genetic material should be prioritised.
Highlights
American tegumentary leishmaniasis (ATL) is caused by parasites of the Leishmania genre
The clinical manifestations of ATL are predominantly classified as cutaneous (CL) or mucocutaneous leishmaniasis (MCL), depending on the absence of mucous lesions or on the involvement of mucous membranes, respectively (Gomes et al 2014b)
Some authors have reported that systematic reviews on diagnostic accuracy testing tend to result in studies of differing quality compared with reviews that examine clinical trials (Devillé et al 2002, Leeflang et al 2008, Leeflang 2014)
Summary
American tegumentary leishmaniasis (ATL) is caused by parasites of the Leishmania genre. The etiologic diagnosis of ATL in all its forms is a difficult task. This difficulty is increased in cases of MCL, in which sampling frequently requires invasive techniques because of the potential presence of deep nasopharyngeal lesions (Maretti-Mira et al 2011, Weinkopff et al 2013). Studies have indicated that molecular biology techniques, polymerase chain reaction (PCR), offer good sensitivity and specificity and, increased accuracy compared with immunological and parasitological tests (Medeiros et al 2002, Garcia et al 2005, Silva et al 2012). The primary objective of this study was to assess the status of various molecular biology techniques in recognising MCL and to compare these data with the recent clinical research published by our group (Gomes et al 2014a)
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