Retrospectiva e perspectiva no diagnóstico da Leishmaniose visceral humana

Abstract

The leishmaniases are a group of vector-borne diseases caused by obligate intracellular protozoan of different species of the genus Leishmania, and its peculiarities of the diversity and complexity. They can be divided into two groups: cutaneous and visceral leishmaniasis (VL). In Brazil, the cutaneous form is usually caused by species: L. braziliensis, L. amazonensis and L. guyanensis, while the visceral form is caused by L. infantum (= L. chagasi). There are two types of VL that differ in their transmission characteristics: the zoonotic VL is transmitted from animals to and from this vector to humans, and antroponótico which is transmitted from human to human through the vector. The zoonotic form, initially, was known as a rural disease in a wild environment, affecting man or animals that have contact with this environment. Recently, it was characterized as a reemerging disease have been established in urban or peripheral is a good environment for the life cycle of the vector. The disease is a public health problem in at least 88 countries and is considered among the six priority endemic diseases in the world. The clinical evaluation of new tests is fraught with difficulties. The lack of a gold standard makes studies of diagnostic accuracy of VL extremely complex. A gold standard in diagnosing VL splenic aspirate culture. However, obtaining splenic aspirates are invasive and culture techniques are often not available in endemic areas of VL. In the routine the clinical epidemiological diagnosis is associated with serological tests before initiating treatment. In the atual era of molecular biology, there is great prospect for the use of molecular diagnostics, especially the detection of parasite’ DNA in blood of patients by using the polymerase chain reaction. This is a method of high sensitivity and specificity that has increasingly reduced cost.