In
Brazil, sophisticated
techniques currently employed for
diagnosis of
visceral leishmaniasis, such as
polymerase chain reaction-based assays, are only available in major
research centers, whereas conventional
methods are still used in many areas where the
disease occurs. In the
state of Mato Grosso do Sul, in the country's Center-West Region,
visceral leishmaniasis has recently emerged in many cities, and duration of the
disease, from the onset of symptoms to
diagnosis, has been short. Considering that results of
diagnostic tests may depend on the phase of the
disease, we compared direct examination of
bone marrow aspirates (BMAs), BMA
culture, and
serology by
Indirect Immunofluorescence Antibody Test (IFAT) for
diagnosis in
children, according to
time of evolution (< 30 days or >30 days) and to
spleen size (< 5 cm or > 5 cm) at admission. Duration of the illness did not interfere with test positivity direct smear examination and IFAT were positive in more than 80 percent of
patients, as was
culture in around 60 percent. Results of positive
microscopy, however, where predominant in
patients with larger spleens. Thanks to the
association of traditional
techniques, only a few
patients had to begin a
treatment trial without confirming the
diagnosis. Conventional
methods for
diagnosis of
visceral leishmaniasis are still indispensable in our region, and
training professionals in basic
techniques should be incremented. The highest
sensitivity in
laboratory diagnosis among the cases investigated was that obtained with a combination of BMA direct examination and IFAT, nearing 100 percent.