Comparison of an indirect hemagglutination test and bone marrow aspiration for the diagnosis of visceral leishmaniasis in Aseer area, Saudi Arabia

Background: In the Aseer area, in the southern western region of Saudi Arabia, visceral leishmaniasis or Kala-azar is an endemic and serious disease that mainly affects children. Objectives: In this study, an anti-leishmania antibody diagnostic test, the indirect hemagglutination (IHA) test, was compared with the gold standard microscopic detection of Leishmania donovani bodies in bone marrow aspiration (LDB/BMA) smears. Factors such as sensitivity, specificity as well as reliability will govern whether health authorities should continue the use of the IHA assay or replace it with more specific and sensitive as well as reliable techniques. Patients and methods: A total of 582 patient samples were included in this study. All were tested by IHA and by microscopic examination for LDB/BMA smears. Results of the tests are statistically analyzed and tabulated. Results: The comparison showed a poor correlation between the microscopic detection of parasite forms in the gold standard bone marrow smear examination (LDB/BMA) and the serological antibody screening of patient samples by IHA (Pr0.05). This type of results and correlation poses serious questions relatingto the sensitivity, specificity, and ultimately, the reliability of the IHA test in the diagnosis of visceral leishmaniasis. Conclusion: A better alternative for IHA test might be the introduction of methods that detect the parasite it self or its antigens that can be used in conjunction with microscopic examination for LDB/BMA. In this respect, PCR–ELISA and KATEX agglutination tests represent obvious candidates.