Diagnostic and prognostic potential of a competitive enzyme-linked immunosorbent assay for leishmaniasis in India.

A Leishmania donovani species-specific monoclonal antibody (monoclonal antibody D2) was evaluated for its diagnostic and prognostic potential by a competitive enzyme-linked immunosorbent assay (C-ELISA) in sera from Indian patients with visceral leishmaniasis (VL) and seven patients with post-kala-azar dermal leishmaniasis (PKDL). These results were compared with those obtained by microscopy with Giemsa-stained tissue smears and a direct enzyme-linked immunosorbent assay (direct ELISA) with crude parasite antigen. Of 121 patients with clinically diagnosed VL examined, 103 (85.1%) were positive and 11 (9.1%) were negative by all three methods. An additional 7 (5.8%) who were negative by microscopy were positive by both C-ELISA and direct ELISA. Seven PKDL patients were also examined and were found to be positive by all three methods. Analysis of the chemotherapeutic response to sodium antimony gluconate of these 110 serologically positive VL patients showed that 57 (51.8%) were drug responsive and 53 (48.2%) were drug resistant. The C-ELISA with sera from 20 longitudinally monitored VL patients before and after chemotherapy showed a significant decrease in percent inhibition of monoclonal antibody D2 in drug-responsive patients. However, in drug-unresponsive patients, the percent inhibition of D2 was unchanged or was slightly increased. Our results therefore indicate (i) the applicability of L. donovani species-specific monoclonal antibody D2 for sensitive and specific serodiagnosis by C-ELISA, (ii) that the C-ELISA is more sensitive than microscopy, especially for early diagnosis, (iii) that L. donovani is still the main causative agent of VL, irrespective of the chemotherapeutic response, and (iv) that the C-ELISA can be used to evaluate the success of drug treatment.

Serodiagnostic assay for visceral leishmaniasis employing monoclonal antibodies.

A highly specific and sensitive competitive serodiagnostic assay for visceral leishmaniasis (VL) was developed using species specific Leishmania donovani monoclonal antibodies. This assay, either RIA or ELISA, is based on the specific inhibition of monoclonal antibody binding to a crude parasite homogenate by serum from patients with VL. 15 monoclonal antibodies were examined. The binding of 13 antibodies was significantly inhibited by VL serum and unaffected by normal serum. 3 species-specific monoclonal antibodies, D-2, D-13 and D-14, which recognize different parasite antigens, were chosen for use in the competitive serodiagnostic assay. In 90% of the positive cases, regardless of geographic origin, VL sera inhibited monoclonal antibody binding to the parasite antigen by more than 30%. No false positive was obtained with sera from Chagas disease, lepromatous leprosy, schistosomiasis, malaria, systemic lupus erythematosus, cutaneous or mucocutaneous leishmaniasis, even at serum dilutions (1:100) which cross-react strongly with Leishmania antigen in direct binding assays. Inhibition by negative control sera from areas endemic for VL and from non-endemic areas was negligible. The assay takes less than 24 h, requires minimum amounts of sera or antigen, and is easily standardized allowing interlaboratory comparison of test data. The competitive serodiagnostic assay will be especially useful in areas where Chagas disease is coendemic and the rapid diagnosis of VL by direct binding serodiagnostic assays presents a problem.