non-invasive cytology brush pcr diagnostic testing in mucosal leishmaniasis superior performance to conventional biopsy with histopathology非侵入性细胞学刷在粘膜利什曼病pcr诊断检测性能优越常规活检组织病理学.pdfVIP

Non-Invasive Cytology Brush PCR Diagnostic Testing in Mucosal Leishmaniasis: Superior Performance to Conventional Biopsy with Histopathology 1 . 2. 2 2 2 Andrea K. Boggild * , Braulio Mark Valencia , Nicolas Veland , Ana Pilar Ramos , Flor Calderon , Jorge Arevalo2,3, Donald E. Low4,5, Alejandro Llanos-Cuentas2,6 1Tropical Disease Unit, Division of Infectious Diseases, Toronto General Hospital, University of Toronto, Toronto, Canada, 2 Instituto de Medicina Tropical ‘‘Alexander von Humboldt’’, Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru, 3 Departamento de Bioquimica, Biologia Molecular y Farmacologia, Facultad de Ciencias, Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru, 4 Laboratories Branch, Ontario Agency for Health Protection and Promotion, Etobicoke, Canada, 5 Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada, 6 Hospital Nacional Cayetano Heredia, Lima, Peru Abstract Background: Traditional methods of diagnosing mucosal leishmaniasis (ML), such as biopsy with histopathology, are insensitive and require collection of an invasive diagnostic specimen. Methods: We compared standard invasive procedures including biopsy histopathology, biopsy PCR, and leishmanin skin test (LST) to a novel, non-invasive, cytology-brush based PCR for the diagnosis of ML in Lima, Peru. Consensus reference standard was 2/4 tests positive, and outcome measures were sensitivity and specificity. Leishmania species identification was performed by PCR-based assays of positive specimens. Results: Twenty-eight patients were enrolled, 23 of whom fulfilled criteria for a diagnosis of ML. Sensitivity and specificity of biopsy with histopathology were 21.7% [95% CI 4.9–38.5%]