Abstract

The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). However, no studies have validated the reference value (5mm) typically used to discriminate positive and negative results. We investigated MST results and evaluated its performance using different cut-off points. The results of laboratory tests for 4,256 patients with suspected ATL were analyzed, and 1,182 individuals were found to fulfill the established criteria. Two groups were formed. The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles. The PCL and NCL groups included 769 and 413 individuals, respectively. The mean ± standard deviation MST in the PCL group was 12.62 ± 5.91mm [95% confidence interval (CI): 12.20-13.04], and that in the NCL group was 1.43 ± 2.17mm (95% CI: 1.23-1.63). Receiver-operating characteristic curve analysis indicated 97.4% sensitivity and 93.9% specificity for a cut-off of 5mm and 95.8% sensitivity and 97.1% specificity for a cut-off of 6mm. Either 5mm or 6mm could be used as the cut-off value for diagnosing ATL, as both values had high sensitivity and specificity.

Highlights

  • The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL)

  • Descriptive, analytical study, we analyzed laboratory test results of patients with suspected American tegumentary leishmaniasis (ATL) who were referred by the 15th Regional Health Division of the State of Paraná and attended the Laboratório de Leishmanioses of the Laboratório de Ensino e Pesquisa em Análises Clínicas, Universidade Estadual de Maringá (LEPAC/UEM) between June 1999 and February 2014

  • Indirect immunofluorescence was performed with L. (V.) braziliensis promastigotes and anti-human immunoglobulin G conjugated to fluorescein, with positive titers considered as ≥40

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Summary

Introduction

The Montenegro skin test (MST) has good clinical applicability and low cost for the diagnosis of American tegumentary leishmaniasis (ATL). The positive cutaneous leishmaniasis (PCL) group included patients with skin lesions and positive direct search for parasites (DS) results. The negative cutaneous leishmaniasis (NCL) group included patients with skin lesions with evolution up to 2 months, negative DS results, and negative indirect immunofluorescence assay results who were residents of urban areas that were reported to be probable sites of infection at domiciles and peridomiciles. Results: The PCL and NCL groups included 769 and 413 individuals, respectively. American tegumentary leishmaniasis (ATL) is widely distributed from northern to southern Brazil. From 1990 to 2013, 635,399 cases of ATL were reported in Brazil, 13,889 from the southern region and 95% from the State of Paraná, from 276 of the 399 municipal districts(2) (3). The main species of Leishmania that cause ATL in Brazil are Leishmania (Viannia) braziliensis, Leishmania (Viannia) guyanensis, and Leishmania (Leishmania) amazonensis(4)

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