Affirmation of the infection
In all cases, the analysis of leishmaniasis is affirmed by the finding of the etiological specialist or its antigen or particle in the example got from the injury. At the point when these methodologies fizzle, immunological tests are utilized to give circuitous parameters to the diagnosis.
Parasitological diagnosis
A scan for amastigotes is performed using light microscopy to straightforwardly look at the biopsy sample, scratching or impression spreads exposed to Giemsa recoloring. Biopsy and suction tests can be additionally refined in blood agar base, earlier known as Novy, McNeal and Nicolle medium, overlaid by liver mixture triptose or Schneider's fluid medium, or infused into a helpless creature, for example, a hamster for parasite recuperation.
Results of Parasitological diagnosis Pa
Old World The affectability of the immediate examination is low ~50– 70%.
New World The affectability of the immediate examination is even lower, at roughly 15– 30%.
Diagnosis methods
Discovery of Leishmania DNA
This approach is based on the detection of Leishmanial DNA, it has two goals:
Detection of Leishmania (similar to other parasitological methods) Identification of the Leishmanial species (not achieved by other methods) the cultured promastigotes are analyzed using Leishmania species-specific monoclonal antibodies or by isoenzyme profiling.
Diagnosis methods
Immunological test-based diagnosis
Montenegro/Leishmanin skin test
It reveals Leishmania infection.
Positive results have been observed in patients who underwent diagnosis, more than 19 months after treatment
Positive results were also observed in 75% of non-infected individuals with no disease manifestations in the past even though living in an endemic area.
This test proves useful for diagnosing travellers living in nonendemic areas.
This test as a diagnostic tool is questionable for people living in endemic areas as it does not distinguish between the present and past infection.
Diagnosis methods
Serological and Molecular diagnosis
These include:
Indirect immunofluorescence assay (IIFA)
ELISA
Serodiagnosis does not act as a routine procedure for the diagnosis of CL in the Old World due to the variable/ low sensitivity of the tests and cross-reactivity with other infections.
Some earlier studies showed sensitivity of 60% when using ELISA.
(In recent studies (from Turkey), the sensitivity reached 88% by ELISA, demonstrating its potential as a complementary diagnostic approach.
Diagnosis methods
Molecular Methods
PCR-based assay leishmanial infection diagnosis enhance sensitivity, reliability, and rapidity for the benefit of researchers and health professionals.
PCR-ELISA diagnosis VL in blood samples.
However, the method has been validated mostly with HIV- positive patients who are known to have high levels of parasitaemia.
RT-PCR The benefit is that it allows the researcher to better determine the amount of starting DNA in the sample before the amplification by PCR.
Also it can distinguish specific sequences from a complex mixture of DNA.
PCR- ELISA is more sensitive (83.9%) than conventional PCR (73.2%) and demonstrated 100% and 87.2% specificity when healthy controls who had never travelled to a VL-endemic area and controls from a VL-endemic area as references, respectively, were used.
Diagnosis methods
Developments in Antileishmanial Drugs
Pentavalent antimonials are the first choice in the treatment of both VL and CL over more than five decades where resistance is not reported.
Pentamidine overcomes clinical resistances to antimony.
Used to treat VL. Also, was the first drug to be used for patients resistance to pentavalent antimony (SbV).
Amphotericin B most effective antileishmanial drug.
Miltefosine has an excellent antileishmanial activity.
Paromomycin is an aminoglycoside antibiotic with unique antileishmanials activity.
Sitamaquine orally administrable compound.