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PEDIATRICS Vol. 109 No. 2 February 2002, pp. e27

ELECTRONIC ARTICLE

Polymerase Chain Reaction in the Diagnosis and Prognosis of Mediterranean Visceral Leishmaniasis in Immunocompetent Children

Antonio Cascio, MD^*, Sara Calattini, BSc, Claudia Colomba, MD^*, Chiara Scalamogna, MD, Morena Galazzi, BSc, Massimo Pizzuto, MD, Romina Camilli, MD, Marina Gramiccia, MD, Lucina Titone, MD^*, Mario Corbellino, MD, Spinello Antinori, MD^*

^* Istituto di Patologia Infettiva e Virologia, Ospedale dei Bambini G. di Cristina, Università di Palermo, Italy
Istituto di Malattie Infettive e Tropicali, Ospedale L. Sacco, Università di Milano
Istituto Superiore di Sanità, Roma, Italy

--> Objective. To assess the usefulness of a polymerase chain reaction (PCR) assay amplifying the small subunit rRNA coding region of Leishmania species performed on peripheral blood (PB) and bone marrow (BM) aspirates for the diagnosis and follow-up of visceral leishmaniasis (VL) in children living in the Mediterranean basin.

Design. A prospective study was conducted on children consecutively hospitalized over a 1-year period at our Infectious Diseases Department in Sicily (Italy) presenting with fever, hepatosplenomegaly, and/or pancytopenia and a positive Leishmania serology (1:40).

Results. Among the 14 patients hospitalized with signs and symptoms suggestive of the disease and a positive serology, we identified 10 cases of Mediterranean VL. PCR performed on PB and BM aspirates was positive in all cases and concordant with microscopy and/or culture performed on BM. Leishmania DNA was cleared from PB a median of 6 days after the start of treatment; during follow-up (median: 9 months; range: 6–12 months) 1 child relapsed. In this case, BM PCR remained positive with rapid reappearance of a positive signal also in PB.

Conclusions. PB PCR allows a rapid and noninvasive parasitologic diagnosis of Mediterranean VL among immunocompetent children and is at least as sensitive as a diagnosis made on the basis of BM aspirates. The lack of disappearance from BM and the reappearance of positive PCR on PB is predictive of clinical relapse. Qualitative and semiquantitative PCR may be the standard method for monitoring response to therapy in immunocompetent children.

Key Words: visceral leishmaniasis • polymerase chain reaction • diagnosis • peripheral blood • bone marrow

Abbreviations: VL, visceral leishmaniasis • BMA, bone marrow aspirate • PB, peripheral blood • PCR, polymerase chain reaction • HIV,human immunodeficiency virus • RFLP, restriction fragment length polymorphism • BM, bone marrow.

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Received for publication Jul 26, 2001; Accepted Oct 19, 2001.

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