{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:20:36Z","timestamp":1790709636006,"version":"4.1.0"},"reference-count":23,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,11]]},"abstract":"<jats:p>Visceral leishmaniasis (VL) is a fatal parasitic disease. Unfortunately, diagnosis of VL in east Africa currently relies on aspiration of tissue from the spleen or bone marrow, which is painful and potentially dangerous. We sought to determine whether peripheral blood could be used instead of invasive tissue aspirates to diagnose VL, using three parasite concentration techniques. Three hundred and one consecutive people suspected of having VL were recruited. Compared with microscopy of tissue aspirates, the diagnostic accuracy of peripheral blood microscopy was as follows: whole blood thin smear sensitivity 1.5% (95% confidence interval [CI] 0.0\u20138.3) and specificity 100% (95% CI 76.8\u2013100); buffy-coat smear sensitivity 19.5% (95% CI 14.3\u201325.6) and specificity 98.9% (95% CI 94.1\u2013100); peripheral blood mononuclear cell (PBMC) smear sensitivity 33.7% (95% CI 27.3\u201340.5) and specificity 95.7% (95% CI 89.6\u201398.6). Sensitivity of PBMC smears was significantly higher in human immunodeficiency virus (HIV)-coinfected patients (<jats:italic>N<\/jats:italic> = 48\/301); two-sample test of proportions, <jats:italic>P<\/jats:italic> = 0.0097; sensitivity 55.9% (95% CI 37.9\u201372.8) and specificity 92.9% (95% CI 66.1\u201399.8), and correlated with the degree of parasite load in the tissue. Combining the results from smears of both PBMC and buffy coat yielded a sensitivity and specificity of 67.6% (95% CI 49.1\u201382.6) and 92.9% (95% CI 66.1\u201399.8), respectively, in HIV-coinfected patients. In this setting, VL could be ruled-in with peripheral blood microscopy in a substantial number of VL suspects and may reduce the number of tissue aspirations performed, particularly in HIV-coinfected patients. More sensitive and logistically feasible methods than light microscopy are needed to detect <jats:italic>Leishmania donovani<\/jats:italic> parasites present in blood.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0362","type":"journal-article","created":{"date-parts":[[2016,11,1]],"date-time":"2016-11-01T01:20:20Z","timestamp":1477963220000},"page":"190-196","source":"Crossref","is-referenced-by-count":15,"title":["Diagnosis of Visceral Leishmaniasis Using Peripheral Blood Microscopy in Ethiopia: A Prospective Phase-III Study of the Diagnostic Performance of Different Concentration Techniques Compared to Tissue Aspiration"],"prefix":"10.4269","volume":"96","author":[{"given":"Ermias","family":"Diro","sequence":"first","affiliation":[{"name":"University of Gondar, Gondar, Ethiopia."},{"name":"Institute of Tropical Medicine, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric P.","family":"Yansouni","sequence":"additional","affiliation":[{"name":"J.D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yegnasew","family":"Takele","sequence":"additional","affiliation":[{"name":"University of Gondar, Gondar, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bewketu","family":"Mengesha","sequence":"additional","affiliation":[{"name":"University of Gondar, Gondar, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutgarde","family":"Lynen","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asrat","family":"Hailu","sequence":"additional","affiliation":[{"name":"School of Medicine, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"van Griensven","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen","family":"Boelaert","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"B\u00fcscher","sequence":"additional","affiliation":[{"name":"Institute of Tropical Medicine, Antwerp, Belgium."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"PLoS One","first-page":"e35671","article-title":"Leishmaniasis worldwide and global estimates of its incidence","volume":"7","author":"Alvar","year":"2012"},{"key":"ref2","series-title":"Infect Dis Clin North Am","first-page":"309","article-title":"Visceral leishmaniasis","volume":"26","author":"van Griensven","year":"2012"},{"key":"ref3","series-title":"Am J Trop Med Hyg","first-page":"275","article-title":"Kala-azar outbreak in Libo Kemkem, Ethiopia: epidemiologic and parasitologic assessment","volume":"77","author":"Alvar","year":"2007"},{"key":"ref4","series-title":"PLoS Negl Trop Dis","first-page":"e313","article-title":"Complexities of assessing the disease burden attributable to leishmaniasis","volume":"2","author":"Bern","year":"2008"},{"key":"ref5","series-title":"Cochrane Database Syst Rev","first-page":"CD009135","article-title":"Rapid tests for the diagnosis of visceral leishmaniasis in patients with suspected disease","volume":"6","author":"Boelaert","year":"2014"},{"key":"ref6","series-title":"Clin Infect Dis","first-page":"1312","article-title":"A global comparative evaluation of commercial immunochromatographic rapid diagnostic tests for visceral leishmaniasis","volume":"55","author":"Cunningham","year":"2012"},{"key":"ref7","series-title":"Am J Trop Med Hyg","first-page":"155","article-title":"The role of serology in the diagnosis and prognosis of visceral leishmaniasis in patients coinfected with human immunodeficiency virus type-1","volume":"59","author":"Medrano","year":"1998"},{"key":"ref8","series-title":"Clin Infect Dis","first-page":"1702","article-title":"Concordant HIV infection and visceral leishmaniasis in Ethiopia: the influence of antiretroviral treatment and other factors on outcome","volume":"46","author":"ter Horst","year":"2008"},{"key":"ref9","series-title":"PLoS Negl Trop Dis","first-page":"e2869","article-title":"Visceral Leishmaniasis and HIV coinfection in east Africa","volume":"8","author":"Diro","year":"2014"},{"key":"ref10","series-title":"Clin Vaccine Immunol","first-page":"346","article-title":"Persistence of Leishmania donovani antibodies in past visceral leishmaniasis cases in India","volume":"18","author":"Gidwani","year":"2011"},{"key":"ref11","series-title":"Trop Med Int Health","first-page":"395","article-title":"Latent class analysis permits unbiased estimates of the validity of DAT for the diagnosis of visceral leishmaniasis","volume":"4","author":"Boelaert","year":"1999"},{"key":"ref12","series-title":"Med Mal Infect","first-page":"390","article-title":"Contribution of leukoconcentration in the diagnosis of Kala-azar in Tunisia [in French]","volume":"36","author":"Chemli","year":"2006"},{"issue":"(Suppl 1)","key":"ref13","series-title":"Ann Trop Med Parasitol","first-page":"115","article-title":"The biological diagnosis of leishmaniasis in HIV-infected patients","volume":"97","author":"Deniau","year":"2003"},{"key":"ref14","series-title":"Presse Med","first-page":"1010","article-title":"Visceral leishmaniasis. Parasitological diagnosis by leukocyte concentration [in French]","volume":"22","author":"Izri","year":"1993"},{"key":"ref15","series-title":"Bull World Health Organ","first-page":"91","article-title":"Leishmaniasis in AIDS patients: results of leukocytoconcentration, a fast biological method of diagnosis","volume":"74","author":"Izri","year":"1996"},{"key":"ref16","series-title":"Nat Rev Microbiol","first-page":"S30","article-title":"Evaluation of rapid diagnostic tests: visceral leishmaniasis","volume":"5","author":"Boelaert","year":"2007"},{"key":"ref17","series-title":"Control of the Leishmaniases","author":"World Health Organization","year":"2010"},{"key":"ref18","series-title":"Am J Trop Med Hyg","first-page":"637","article-title":"Microscopic diagnosis of blood parasites following a cytoconcentration technique","volume":"57","author":"Petithory","year":"1997"},{"key":"ref19","series-title":"Am J Trop Med Hyg","first-page":"72","article-title":"A comparative study of the effectiveness of diagnostic tests for visceral leishmaniasis","volume":"70","author":"Boelaert","year":"2004"},{"key":"ref20","series-title":"PLoS Negl Trop Dis","first-page":"e2875","article-title":"High parasitological failure rate of visceral leishmaniasis to sodium stibogluconate among HIV co-infected adults in Ethiopia","volume":"8","author":"Diro","year":"2014"},{"key":"ref21","series-title":"J Clin Epidemiol","first-page":"210","article-title":"In defense of discrepant analysis","volume":"54","author":"Green","year":"2001"},{"key":"ref22","series-title":"Clin Chem","first-page":"108","article-title":"Quantifying the bias associated with use of discrepant analysis","volume":"44","author":"Lipman","year":"1998"},{"key":"ref23","series-title":"J Clin Epidemiol","first-page":"211","article-title":"In defense of discrepant analysis","volume":"54","author":"Schachter","year":"2001"}],"container-title":["The American Society of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/96\/1\/article-p190.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/96\/1\/article-p190.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/96\/1\/article-p190.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T22:44:47Z","timestamp":1723070687000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/96\/1\/article-p190.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,11]]},"references-count":23,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.16-0362","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,11]]}}}