Diagnosis and Treatment of Leishmaniasis

1. The Panel recommends using multiple diagnostic approaches to maximize the likelihood of a positive Leishmania result, using methods such as visualization of the characteristic amastigote in smears or tissue (histopathology); parasite isolation by in vitro culture; molecular detection of parasite DNA; and, for VL, serologic testing (see Recs. 5, 6, 9, 21, 22 and Table 2). Simultaneous testing for other diagnoses (eg, by histopathology and culture) should be considered. ( S , L)

2. The Panel recommends attempting parasite isolation with the assistance of reference laboratories. The Panel recommends that clinicians contact their leishmaniasis reference laboratory before collecting specimens (Table 2). If Leishmania parasites are isolated in culture, reference laboratories can identify the species by DNA-based assays or isoenzyme analysis. ( S , L)

3. Molecular amplification assays typically should be performed because they are the most sensitive Leishmania tests currently available (see Rec. 6) ( S , M)

4. Leishmania skin testing is NOT recommended or available in the United States or Canada. There are no standardized, approved, or commercially available skin-test products in North America. ( S , VL)

5. The Panel suggests that identification of the infecting parasite to the species level be attempted in cases of suspected CL. Species identification may help inform clinical management decisions for individual persons (eg, whether and how to treat). ( W , M)

6. DNA-based assays should be performed, especially if other diagnostic testing is unrevealing. They are emerging as the most sensitive assays for the diagnosis of leishmaniasis. (S, M)