Noninvasive Diagnosis of Visceral Leishmaniasis:Development and Evaluation of Two Urine-Based Immunoassays for Detection of Leishmania donovani Infection in India

Visceral leishmaniasis (VL), one of the most prevalent parasitic diseasesin the developing world causes serious health concerns. Post kala-azar dermal leishmaniasis (PKDL) is a skin disease which occurs after treatment as a sequel to VL. Parasitological diagnosis involves invasive tissue aspiration which is tedious and painful. Commercially available immunochromatographic rapid diagnostic test such as rK39-RDT is used for field diagnosis of VL, detects antibodiesin serum samples. Urine sample is however, much easier in collection,storage and handling than serum and would be a better alternative where collection of tissue aspirate or blood is impractical. In this study, we have developed and evaluated the performance of two urine-based diagnostic assays, ELISA and dipstick test, and compared the results with serologicalrK39-RDT. Our study shows the capability of urinebased tests in detecting anti-Leishmania antibodies effectively for both VL and PKDL diagnosis. The ability of dipstick test to demonstrate negative results after six months in 90% of the VL cases after treatment could be useful as a test of clinical cure. Urine-based tests can therefore replace the need for invasive practices and ensure better diagnosi

Appendicular Duplication – Variations in Anatomy and Associations: Appendicular Duplication

Background: Although Duplication anomalies are common in the Gastro-intestinal tract, appendicular anomalies are rare with variable anatomy. Objectives: To describe the series of appendicular duplication cases managed at a tertiary care center. Methods: Data regarding the clinical features, associated anomalies and management of cases of appendicular duplication at a tertiary care center from January, 2019 to December, 2020 were collected retrospectively and analyzed. Results: Four children with appendicular duplication were managed during this period; three neonates presented with high anorectal malformation and type two pouch colons with a large colovesical fistula. They had a single caecum with two separate appendices symmetrically on either side (type B1). They were managed by division of colo-vesical fistula, mobilization of colonic pouch after limited pouchoplasty and anoplasty as a single stage procedure. None of the appendix was removed. In one of these cases, bilateral ureters were dilated. The fourth case presented as a 3 year-old with pain abdomen and during surgery for suspected appendicitis, partial duplication of inflamed appendix was found (type A). Appendicectomy relieved this child of his symptoms. All patients are doing well on follow-up. Conclusion: The position, anatomy and associated anomalies of appendicular duplication can be variable complicating its presentation and management

Comparison of urine antibody absorbances between VL patients and healthy controls using four leishmanial antigens.

<p>Reactivity of urine (undiluted) from visceral leishmaniasis (VL) patients (n = 5) and healthy controls (HC) (n = 6) against 2.5 μg/well of leishmanial membrane antigen, LAg; recombinant glycoprotein 63, rGP63; recombinant cysteine protease A, rCPA and soluble leishmanial antigen, SLA. The standard error of mean for each group is shown as a solid line.</p

Receiver operator characteristics (ROC) curve for urine ELISA.

<p>ROC curve obtained from the ELISA values for the detection of anti-<i>Leishmania</i> IgG antibodies in urine samples. Cut-off value (0.1875), sensitivity (97.94%), specificity (100%) and AUC (0.9984) were determined by this curve using GraphPad Prism software (version 5.0).</p