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Alteration of Direct Agglutination Test (DAT) results in Iranian Kala-Azar patients: a case series

Journal of Parasitic Diseases volume 41, pages 446–449 (2017)Cite this article

Abstract

The early diagnosis of visceral leishmaniasis (VL) using Direct Agglutination Tests (DAT) and its treatment and control are essential actions taken in rural health centers in endemic foci of the infection based on the national protocols set by the Iranian Ministry of Health and Medical Education. Eleven clinically confirmed VL patients with typical VL symptoms and negative results of DAT, admitted to the pediatrics department of Valiasr Hospital in Meshkinshahr underwent parasitological tests. 7 of the total of 11 patients had positive result of bone marrow puncture smears and all of them had negative results of DAT. Thus factors that had led to false negative DAT results were examined. The patients’ blood samples were collected in microhematocrit tubes using the finger prick technique, centrifuged and their plasma then separated. The complete medical history of the patients was taken using a questionnaire. The laboratory staff therefore checked the quality of anti-leishmania antigen, materials and equipment used. The patients’ medical history showed that they had all been administered corticosteroid medications such as dexamethasone or hydrocortisone prior to visiting the laboratory. The DAT was repeated in these patients 2–3 weeks after their last administration of corticosteroids. The antibody titers were positive this time. A total of 3 of the collected specimens (27.3 %) showed a titer of 1.3200, 5 (46 %) showed a titer of 1.1600 and 3 (27.3 %) a titer of 1.800. Due to the effects of some medications, particularly corticosteroids, on serological tests, the patients’ full medical history should be taken prior to performing this test and physicians working at endemic regions of this infection should be notified about these drug interactions.

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References

  • Absavaran A, Rassi Y, Parvizi P, Oshaghi MA, Abai MR, Rafizadeh S, Mohebali M, Zarea Z, Javadian E (2009) Identification of sand flies of the subgenus Larroussius based on molecular and morphological characters in north western Iran. Iran J Arthropod Borne Dis 3(2):22–35

    CAS  PubMed  PubMed Central  Google Scholar 

  • Akhoundi B, Mohebali M, Edrissian GH, Eslami MB, Keshavarz H, Malekafzali H, Rokni MB (2012) Preparation and evaluation of a glycerol-preserved direct agglutination antigen for long-term preservation: a comparative study of the detection of anti- Leishmania infantum antibodies in human and dog. Asian Pac J Trop Med 5(2):117–120

    Article  PubMed  Google Scholar 

  • Azizi K, Rassi Y, Javadian E, Motazedian MH, Asgari Q, Yaghoobi-Ershadi MR (2008) First detection of Leishmania infantum in Phlebotomus (Larroussiuss) major Diptera:Psychodidae) fromIran. J Med Entomol 45:726–731

    CAS  PubMed  Google Scholar 

  • Dehkordi AS, Rassi Y, Oshaghi M, Abai M, Rafizadeh S, Yaghoobi-Ershadi M, Mohebali M, Zarei Z, Mohtarami F, Jafarzadeh B, Ranjbarkhah A, Javadian E (2011) Molecular detection of Leishmania infantum in naturally infected Phlebotomus perfiliewi transcaucasicus in Bilesavar district, Northwestern Iran. Iran J Arthropod Borne Dis 5(1):20–27

    PubMed  PubMed Central  Google Scholar 

  • Edrissian GH, Hajjaran H, Mohebali M, Soleimanzadeh G, Bokaei S (1996) Application and evaluation of direct agglutination test in sero diagnosis of visceral leishmaniasis in man and canine reservoirs in Iran. Iran J Med Sci 21:119–124

    Google Scholar 

  • el Harith A, Slappendel RJ, Reiter I, van Knapen F, de Korte P, Huigen E, Kolk AH (1989) Application of a direct agglutination test for detection of specific anti-Leishmania antibodies in the canine reservoir. J Clin Microbiol 27(10):2252–2257

    PubMed  PubMed Central  Google Scholar 

  • Harith AE, Kolk AHJ, Kager PA (1986) A simple and economical direct agglutination test for sero-diagnosis and sero-epidemiological studies of visceral leishmaniasis. Trans R Soc Trop Med Hyg 80(4):583–587

    CAS  Article  PubMed  Google Scholar 

  • Mohebali M (2013) Visceral leishmaniasis in Iran: review of the epidemiological and clinical features. Iran J Parasitol 8(3):348–358

    PubMed  PubMed Central  Google Scholar 

  • Mohebali M, Javadian E, Yagobi-ershadi Akhavan AA, Hajjaran H, Abai MR (2004) Characterization of Leishmania infection in rodents from endemic areas of the Islamic Republic of Iran. East Meditterr Health J 19:591–599

    Google Scholar 

  • Mohebali M, Hajjaran H, Hamzavi Y, Mobedi I (2005) Epidemiological aspects of canine visceral leishmaniosis in the Islamic Republic of Iran. Vet Parasitol 129(3–4):243–251

    Article  PubMed  Google Scholar 

  • Mohebali M, Edrissian GH, Nadim A, Hajjaran H, Akhoundi B, Hooshmand B, Zarei Z, Arshi S, Mirsamadi N, Manouchehri Naeini K, Mamishi S, Sanati AA, Moshfe AA, Charehdar S, Fakhar M (2006) Application of direct agglutination test (DAT) for the diagnosis and sero-epidemiological studies of visceral leishmaniasis in Iran. Iran J Parasitol 1(1):15–25

    Google Scholar 

  • Mohebali M, Edrissian GH, Shirzadi MR, Akhoundi B, Hajjaran H, Zarei Z, Molaei S, Sharifi I, Mamishi S, Mahmoudvand H, Torabi V, Moshfe A, Malmasi A, Motazedian MH, Fakhar M (2011) An observational study on the current distribution of visceral leishmaniasis in different geographical zones of Iran and implication to health policy. Travel Med Infect Dis 9(2):67–74

    Article  PubMed  Google Scholar 

  • Oshaghi MA, Ravasan NM, Javadian E, Mohebali M, Hajjaran H, Zare Z, Mohtarami F, Rassi Y (2009) Vector incrimination of sand flies in the most important visceral leishmaniasis focus in Iran. Am J Trop Med Hyg 81(4):572–577

    CAS  Article  PubMed  Google Scholar 

  • Pittalis S, Nicastri E, Spinazzola F, Ghirga P, De Marco M, Paglia MG, Narciso P (2006) Leishmania infantum leishmaniasis in corticosteroid-treated patients. BMC Infect Dis 6:177–181

    Article  PubMed  PubMed Central  Google Scholar 

  • Rassi Y, Abai MR, Oshaghi MA, Javadian E, Sanei A, Rafidzadeh S, Arzamani K (2012a) First detection of Leishmania infantum in Phlebotomus kandelakii using molecular methods in north-eastern Islamic Republic of Iran. East Mediterr Health J 18:387–392

    CAS  PubMed  Google Scholar 

  • Rassi Y, Sanei Dehkordi A, Oshaghi MA, Abai MR, Mohtarami F, Enayati A, Zarei Z, Javadian E (2012b) First report on natural infection of the Phlebotomus tobbi by Leishmania infantum in northwestern Iran. Exp Parasitol 131:344–349

    Article  PubMed  Google Scholar 

  • Tuon FF, Sabbaga Amato V, Floeter-Winter LM, de Andrade Zampieri R, Amato Neto V, Siqueira Franca FO, Shikanai-Yasuda MA (2007) Cutaneous leishmaniasis reactivation 2 years after treatment caused by systemic corticosteroids—first report. Int J Dermatol 46(5):628–630

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to the colleagues of the Reference Leishmaniasis Laboratory, School of Public Health, Tehran University of Medical Sciences for their technical advices and supports.

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Affiliations

  1. Kala-Azar Laboratory, Health Center, Ardabil University of Medical Scince, P.O. Box 56617-45378, Meshkinshahr, Iran

    Soheila Molaie

  2. Department of Medical Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Mehdi Mohebali & Behnaz Akhoundi

  3. Department of Medical Entomology and Vector Control, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Mohamad-Reza Abai

  4. Shahid Madani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Akbar Molaie

  5. Health Care Center of Meshkinshahr, Ardabil University of Medical Sciences, Meshkin-shahr, Iran

    Eslam Moradi Asl

Authors
  1. Soheila Molaie
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  2. Mehdi Mohebali
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  3. Mohamad-Reza Abai
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  4. Akbar Molaie
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  5. Behnaz Akhoundi
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  6. Eslam Moradi Asl
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Correspondence to Soheila Molaie.

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Molaie, S., Mohebali, M., Abai, MR. et al. Alteration of Direct Agglutination Test (DAT) results in Iranian Kala-Azar patients: a case series. J Parasit Dis 41, 446–449 (2017). https://doi.org/10.1007/s12639-016-0825-y

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  • DOI: https://doi.org/10.1007/s12639-016-0825-y

Keywords

  • Visceral leishmaniasis
  • Direct Agglutination Test
  • False negative
  • Corticosteroid