14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 75.025
Session: Diagnostics
Date: Friday, March 12, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Usefulness of Montenegro skin test for the diagnosis of Mucosal Leishmaniasis
B. Valencia 1 , P. Diaz 2 , O. Ponce 2 , A. Ramos 1 , A. Llanos-Cuentas 1
1 Institute of Tropical Medicine "Alexander von Humboldt", Lima, Peru, 2 Universidad Peruana
Cayetano Heredia, Lima, Peru
Background: Mucosal leishmaniasis (ML) represents the hyperergic pole of American
Tegumentary Leishmaniasis (ATL). This behavior makes its diagnosis difficult due to the scarce
parasite load as a consequence of a strong local TH1 immune response. Only PCR has a good
performance in comparison to traditional techniques like direct examination, culture and
histopathology for the diagnosis of ML. Even when ATL is endemic in our country, only two
centers can perform PCR for Leishmania detection in Peru. Since ML is a neglected disease,
patients with mucosal involvement belong to poor, rural and remote areas. Montenegro Skin Test
(MST) measures TH1 response, and theoretically ML patients have a longer skin reaction
compared to patients with cutaneous leishmaniasis (CL).
Methods: A retrospective study was performed. Only medical records of patients with confirmed
ML or CL, through scrapping, culture, PCR or an adequate clinical response, coming from jungle
areas endemic in L. (V) braziliensis, and a well-defined intradermal reaction size were reviewed.
Results: We identified 358 medical records: 170(47%) of CL and 188(53%) of ML. Patients from
both groups acquired the infection in Madre de Dios, Junin and Huanuco. Median age (IQR) of
CL was 26 years (IQR:19-38) and 72% were male. Median age of ML patients was 30 years
(IQR:21-75), 86% were male, and 99% had previous CL with 8 months (IQR:3-18) of active
ulcerative lesion. ML patients reported CL 10 years ago (IQR:6-19): 40% received Pentavalent
antimonials, 11% trivalent antimonials and 26% reported a spontaneous cure. The diagnosis of
ML was done by PCR (9%), scrapping (22%), culture (38%), and/or an adequate clinical
response (31%). MST was 15 mm (IQR:10-18) in ML and 8 mm (IQR:6-10) in CL. Using a MST
diameter of 15mm as cut point for the diagnosis of ML, we found a sensitivity of 52%, specificity
of 93%, positive predictive value of 90% and a negative predictive value of 63%.
Conclusion: Patients with lesions compatible with ML, previous CL, and an MST>15mm, have a
high likelihood of ML; therefore, we can use this approach for diagnosis in low-resources
settings where physicians have limitations in diagnosis and they need to provide a justified
treatment.