Diagnosis of \u3ci\u3eSchistosoma mansoni\u3c/i\u3e Infections: What are the Choices in Brazilian Low-Endemic Areas?

The population of Brazil is currently characterised by many individuals harbouring low-intensity Schistosoma mansoni infections. The Kato-Katz technique is the diagnostic method recommended by the World Health Organization (WHO) to assess these infections, but this method is not sensitive enough in the context of low egg excretion. In this regard, potential alternatives are being employed to overcome the limits of the Kato-Katz technique. In the present review, we evaluated the performance of parasitological and immunological approaches adopted in Brazilian areas. Currently, the diagnostic choices involve a combination of strategies, including the utilisation of antibody methods to screen individuals and then subsequent confirmation of positive cases by intensive parasitological investigations

Serological Proteomic Screening and Evaluation of a Recombinant Egg Antigen for the Diagnosis of Low-Intensity \u3ci\u3eSchistosoma mansoni\u3c/i\u3e infections in endemic area in Brazil

Background Despite decades of use of control programs, schistosomiasis remains a global public health problem. To further reduce prevalence and intensity of infection, or to achieve the goal of elimination in low-endemic areas, there needs to be better diagnostic tools to detect low-intensity infections in low-endemic areas in Brazil. The rationale for development of new diagnostic tools is that the current standard test Kato-Katz (KK) is not sensitive enough to detect low-intensity infections in low-endemic areas. In order to develop new diagnostic tools, we employed a proteomics approach to identify biomarkers associated with schistosome-specific immune responses in hopes of developing sensitive and specific new methods for immunodiagnosis. Methods and findings Immunoproteomic analyses were performed on egg extracts of Schistosoma mansoni using pooled sera from infected or non-infected individuals from a low-endemic area of Brazil. Cross reactivity with other soil-transmitted helminths (STH) was determined using pooled sera from individuals uniquely infected with different helminths. Using this approach, we identified 23 targets recognized by schistosome acute and chronic sera samples. To identify immunoreactive targets that were likely glycan epitopes, we compared these targets to the immunoreactivity of spots treated with sodium metaperiodate oxidation of egg extract. This treatment yielded 12/23 spots maintaining immunoreactivity, suggesting that they were protein epitopes. From these 12 spots, 11 spots cross-reacted with sera from individuals infected with other STH and 10 spots cross-reacted with the negative control group. Spot number 5 was exclusively immunoreactive with sera from S. mansoni-infected groups in native and deglycosylated conditions and corresponds to Major Egg Antigen (MEA). We expressed MEA as a recombinant protein and showed a similar recognition pattern to that of the native protein via western blot. IgG-ELISA gave a sensitivity of 87.10% and specificity of 89.09% represented by area under the ROC curve of 0.95. IgG-ELISA performed better than the conventional KK (2 slides), identifying 56/64 cases harboring 1–10 eggs per gram of feces that were undiagnosed by KK parasitological technique. Conclusions The serological proteome approach was able to identify a new diagnostic candidate. The recombinant egg antigen provided good performance in IgG-ELISA to detect individuals with extreme low-intensity infections (1 egg per gram of feces). Therefore, the IgG-ELISA using this newly identified recombinant MEA can be a useful tool combined with other techniques in low-endemic areas to determine the true prevalence of schistosome infection that is underestimated by the KK method. Further, to overcome the complexity of ELISA in the field, a second generation of antibody-based rapid diagnostic tests (RDT) can be developed

Diagnosing schistosomiasis: where are we?

Submitted by Nuzia Santos ([email protected]) on 2015-02-02T16:33:57Z No. of bitstreams: 1 2014_024.pdf: 741827 bytes, checksum: 2ac4c380c92047b5e7c3f60f36364205 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-02-02T16:34:07Z (GMT) No. of bitstreams: 1 2014_024.pdf: 741827 bytes, checksum: 2ac4c380c92047b5e7c3f60f36364205 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-02-02T16:36:38Z (GMT) No. of bitstreams: 1 2014_024.pdf: 741827 bytes, checksum: 2ac4c380c92047b5e7c3f60f36364205 (MD5)Made available in DSpace on 2015-02-02T16:36:38Z (GMT). No. of bitstreams: 1 2014_024.pdf: 741827 bytes, checksum: 2ac4c380c92047b5e7c3f60f36364205 (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisas Clínicas. Belo Horizonte, MG, BrasilLaboratório de Parasitoses Intestinais e Malacologia. Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisas Clínicas. Belo Horizonte, MG, BrasilIn light of the World Health Organization’s initiative to extend schistosomiasis morbidity and mortality control programs by including a disease elimination strategy in low endemic settings, this paper reviews diagnostic tools described during the last decades and provide an overview of ongoing efforts in making an efficient diagnostic tool available worldwide. A literature search on PubMed using the search criteria schistosomiasis and diagnosis within the period from 1978 to 2013 was carried out. Articles with abstract in English and that used laboratory techniques specifically developed for the detection of schistosomiasis in humans were included. Publications were categorized according to the methodology applied (parasitological, immunological, or molecular) and stage of development (in house development, limited field, or large scale field testing). The initial research generated 4,535 publications, of which only 643 met the inclusion criteria. The vast majority (537) of the publications focused on immunological techniques; 81 focused on parasitological diagnosis, and 25 focused on molecular diagnostic methods. Regarding the stage of development, 307 papers referred to in-house development, 202 referred to limited field tests, and 134 referred to large scale field testing. The data obtained show that promising new diagnostic tools, especially for Schistosoma antigen and deoxyribonucleic acid (DNA) detection, which are characterized by high sensitivity and specificity, are being developed. In combination with international funding initiatives these tools may result in a significant step forward in successful disease elimination and surveillance, which is to make efficient tests accessible and its large use self-sustainable for control programs in endemic countries

Development and Clinical Evaluation of Loop-Mediated Isothermal Amplification (LAMP) Assay for the Diagnosis of Human Visceral Leishmaniasis in Brazil

Submitted by Nuzia Santos ([email protected]) on 2020-02-07T17:09:59Z No. of bitstreams: 1 Development_and_Clinical_Evaluation_of_Loop-Mediat.pdf: 2250805 bytes, checksum: ce0d44382fff6ea78478cd40f2f41843 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2020-02-07T17:11:50Z (GMT) No. of bitstreams: 1 Development_and_Clinical_Evaluation_of_Loop-Mediat.pdf: 2250805 bytes, checksum: ce0d44382fff6ea78478cd40f2f41843 (MD5)Made available in DSpace on 2020-02-07T17:11:50Z (GMT). No. of bitstreams: 1 Development_and_Clinical_Evaluation_of_Loop-Mediat.pdf: 2250805 bytes, checksum: ce0d44382fff6ea78478cd40f2f41843 (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Visceral leishmaniasis (VL) is considered a major public health concern in Brazil and several regions of the world. A recent advance in the diagnosis of infectious diseases was the development of loop-mediated isothermal amplification (LAMP). The aim of this study was to develop and evaluate a new LAMP assay for detection of K26 antigen-coding gene of L. donovani complex. A total of 219 blood samples of immunocompetent patients, including 114 VL cases and 105 non-VL cases, were analyzed for the diagnosis of VL in the present study. Diagnostic accuracy was calculated against a combination of parasitological and/or serological tests as a reference standard. The results were compared to those of kDNA Leishmania-PCR. The detection limit for the K26-Lamp assay was 1fg L. infantum purified DNA and 100 parasites/mL within 60 min of amplification time with visual detection for turbidity. The assay was specific for L. donovani complex. Sensitivity, specificity, and accuracy were 98.2%, 98.1%, and 98.2%, respectively, for K26-LAMP and 100%, 100%, and 100%, respectively, for kDNA Leishmania-PCR. Excellent agreement was observed between K26-LAMP and kDNA Leishmania-PCR assays (K = 0.96). A highly sensitive and specific LAMP assay targeting K26 antigen-coding gene of L. donovani complex was developed for diagnosis in peripheral blood samples of VL patients

Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison

Submitted by Nuzia Santos ([email protected]) on 2018-12-07T18:17:25Z No. of bitstreams: 1 Efficacy of Anti-Leishmania Therapy in Visceral Leishmaniasis .pdf: 6977310 bytes, checksum: 707f055984679efb9e035128adfd6c6f (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2018-12-07T18:19:47Z (GMT) No. of bitstreams: 1 Efficacy of Anti-Leishmania Therapy in Visceral Leishmaniasis .pdf: 6977310 bytes, checksum: 707f055984679efb9e035128adfd6c6f (MD5)Made available in DSpace on 2018-12-07T18:19:47Z (GMT). No. of bitstreams: 1 Efficacy of Anti-Leishmania Therapy in Visceral Leishmaniasis .pdf: 6977310 bytes, checksum: 707f055984679efb9e035128adfd6c6f (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisa Clínica. Belo Horizonte, MG, Brazil/Fundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, BrazilUniversidade Federal de Minas Gerais. Programa de Pós-Graduação em Ciências da Saúde do Adulto. Belo Horizonte, MG, BrazilFundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, BrazilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Pesquisa Clínica. Belo Horizonte, MG, BrazilOBJECTIVE: We conducted a systematic literature review with indirect comparison of studies evaluating therapeutic efficacy and toxicity associated to visceral leishmaniasis (VL) therapy among HIV infected individuals. MAIN OUTCOME MEASUREMENTS: The outcomes of interest were clinical and parasitological cure, mortality, and adverse events. METHODS: PRISMA guidelines for systematic reviews and Cochrane manual were followed. Sources were MEDLINE, LILACS, EMBASE, Web of Knowledge databases and manual search of references from evaluated studies. We included all studies reporting outcomes after VL treatment, regardless of their design. Study quality was evaluated systematically by using the Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Comprehensive Meta-Analysis software v.2.2.048 was used to perform one-group meta-analysis of study arms with the same drug to estimate global rates of success and adverse events with each drug. These estimates were used, when possible, to indirectly compare treatment options, adjusted for CD4 count. Direct comparison was pooled when available. RESULTS: Seventeen studies reporting five treatment regimens and outcome of 920 VL episodes occurring in HIV infected individuals were included. The main outstanding difference in outcome among the treatment regimens was observed in mortality rate: it was around 3 times higher with high-dose antimony use (18.4%, CI 95% 13.3-25%), indirectly compared to lipid formulations of amphotericin B treatment (6.1%, CI 95% 3.9-9.4%). It was observed, also by indirect comparison, higher rates of clinical improvement in study arms using amphotericin B than in study arms using pentavalent antimonial therapy (Sb(v)). The parasitological cure, an outcome that presented some degree of risk of selection and verification bias, had rates that varied widely within the same treatment arm, with high heterogeneity, hampering any formal comparison among drugs. One direct comparison of amphotericin and antimoniate was possible combining results of two studies and confirming the superiority of amphotericin. CONCLUSIONS: Available evidence suggests that amphotericin is superior to antimony treatment. Death rate using antimoniate high dose is unacceptably high. Randomized controlled trials are necessary to compare different formulations and doses of amphotericin, alternative therapies and drug combinations

The Cure Rate after Placebo or No Therapy in American Cutaneous Leishmaniasis: A Systematic Review and Meta-Analysis

Submitted by Nuzia Santos ([email protected]) on 2016-07-20T19:17:56Z No. of bitstreams: 1 ve_Cota_Gláucia_The Cure_CPqRR_2016.PDF: 902544 bytes, checksum: 0d158ae179ad44c321f00ac633ee15d0 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2016-07-20T19:20:34Z (GMT) No. of bitstreams: 1 ve_Cota_Gláucia_The Cure_CPqRR_2016.PDF: 902544 bytes, checksum: 0d158ae179ad44c321f00ac633ee15d0 (MD5)Made available in DSpace on 2016-07-20T19:20:34Z (GMT). No. of bitstreams: 1 ve_Cota_Gláucia_The Cure_CPqRR_2016.PDF: 902544 bytes, checksum: 0d158ae179ad44c321f00ac633ee15d0 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Investigação Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, BrasilUniversidade Federal de Minas Gerais. Programa de Pos –Graduação em Ciencias da Saude Adulta. Belo Horizonte, MG, BrasilFundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, BrasilFundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, BrasilFundação Hospitalar do Estado de Minas Gerais. Hospital Eduardo de Menezes. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Investigação Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, BrasilINTRODUCTION: There are few drugs with proven efficacy in cutaneous leishmaniasis (CL), and pentavalent antimonial derivatives are still the main first-line therapeutic agents worldwide, despite their recognized high toxicities. Randomized controlled clinical trials assessing the efficacy and safety of new therapeutic modalities are of high priority, and the definition of the design of such trials raises debate about the use of placebo as a comparator. To support the use of placebo as a comparator, two main points need to be addressed: 1--the cure rate without any therapeutic intervention and 2--the damage caused by CL and its impact on patients. OBJECTIVE The aim of this study was to systematically assess the spontaneous cure rate for American CL and to broaden the discussion about placebo use in CL trials. METHODS: The PRISMA guidelines for systematic reviews and the Cochrane manual were followed. The sources used were the PubMed and LILACS databases. Studies were included if they reported cure rates using placebo or no treatment in American CL. RESULTS: Thirteen studies of a total of 352 patients were ultimately included in this review. The summarized global cure rates for all Leishmania species according to the intention-to-treat analyses performed at approximately three ("initial cure") and nine ("definitive cure") months after "no treatment" or placebo use were 26% (CI95%: 16 to 40%) and 26% (CI95%:16 to 38%), respectively. Notably, a significantly lower cure rate was observed for L. braziliensis infection (6.4%, CI95%:0.2 to 20%) than for L. mexicana infection (44%, CI95%:19 to 72%), p = 0.002. Of note, relapse occurred in 20% of patients with initial healing (CI95%:9.2 to 38.9%). CONCLUSION: These results clearly demonstrate a low spontaneous cure rate following no-treatment or placebo use, confirming that this strategy for the control group in CL studies expose patients to greater morbidity, especially for CL caused by L. braziliensis. Therefore, from this point, the crucial question to consider regarding placebo use is the seriousness of the suffering caused by this disease

Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis: a retrospective review of a Brazilian referral centre

Submitted by Nuzia Santos ([email protected]) on 2017-07-10T17:37:27Z No. of bitstreams: 1 Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis.pdf: 4166264 bytes, checksum: 52790bbad09ef518d09eac5e6652be14 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2017-07-10T17:42:17Z (GMT) No. of bitstreams: 1 Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis.pdf: 4166264 bytes, checksum: 52790bbad09ef518d09eac5e6652be14 (MD5)Made available in DSpace on 2017-07-10T17:42:17Z (GMT). No. of bitstreams: 1 Intralesional meglumine antimoniate for the treatment of localised cutaneous leishmaniasis.pdf: 4166264 bytes, checksum: 52790bbad09ef518d09eac5e6652be14 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Centro de Referência em Leishmanioses. Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias. Belo Horizonte, MG, Brasil.Universidade José do Rosário Vellano. Faculdade de Medicina. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Centro de Referência em Leishmanioses. Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Centro de Referência em Leishmanioses. Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Centro de Referência em Leishmanioses. Pesquisas Clínicas e Políticas Públicas em Doenças Infecto-Parasitárias. Belo Horizonte, MG, Brasil.Although intralesional meglumine antimoniate (MA) infiltration is considered an option for cutaneous leishmaniasis (CL) therapy and is widely used in the Old World, there have been few studies supporting this therapeutic approach in the Americas. This study aims to describe outcomes and adverse events associated with intralesional therapy for CL. This retrospective study reviewed the experience of a Brazilian leishmaniasis reference centre using intralesional MA to treat 31 patients over five years (2008 and 2013). The median age was 63 years (22-86) and the median duration time of the lesions up to treatment was 16 weeks. In 22 patients (71%), intralesional therapy was indicated due to the presence of contraindications or previous serious adverse events with systemic MA. Other indications were failure of systemic therapy or ease of administration. Intralesional treatment consisted of one-six infiltrations (median three) for a period of up to 12 weeks. The initial (three months) and definitive (six months) cure rates were 70.9% and 67.7%, respectively. Most patients reported mild discomfort during infiltration and no serious adverse events were observed. In conclusion, these results show that the intralesional MA efficacy rate was very similar to that of systemic MA treatment, and reinforce the need for further studies with adequate design to establish the efficacy and safety of this therapeutic approach

Cost-effectiveness analysis of diagnostic-therapeutic strategies for visceral leishmaniasis in Brazil

Submitted by Nuzia Santos ([email protected]) on 2019-09-03T12:37:34Z No. of bitstreams: 1 Cost-effectiveness analysis.pdf: 3912324 bytes, checksum: 22baa609ea909687962f980d59e4970d (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2019-09-03T12:42:27Z (GMT) No. of bitstreams: 1 Cost-effectiveness analysis.pdf: 3912324 bytes, checksum: 22baa609ea909687962f980d59e4970d (MD5)Made available in DSpace on 2019-09-03T12:42:27Z (GMT). No. of bitstreams: 1 Cost-effectiveness analysis.pdf: 3912324 bytes, checksum: 22baa609ea909687962f980d59e4970d (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto Rene Rachou. Grupo de Pesquisa Clínica e Políticas Públicas sobre Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Instituto Rene Rachou. Grupo de Pesquisa Clínica e Políticas Públicas sobre Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, BrasilFundação Oswaldo Cruz. Instituto Rene Rachou. Grupo de Pesquisa Clínica e Políticas Públicas sobre Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, BrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.Instituto de Avaliação de Tecnologia em Saúde. Porto Alegre, RS, Brasil/Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, BrasilIntroduction: Visceral leishmaniasis (VL) is fatal if not diagnosed and treated. This study aimed to estimate the cost–effectiveness of diagnostic–therapeutic alternatives for VL in Brazil. Methods: A decision model estimated the life expectancy and costs of six diagnostic–therapeutic strategies. Results: IT LEISH + liposomal amphotericin B emerged the best option, presenting lower costs and higher effectiveness. DAT-LPC + liposomal amphotericin B showed an incremental cost–effectiveness ratio of US$ 326.31 per life year. Conclusions: These findings indicate the feasibility of incorporating DAT and designating liposomal amphotericin B as the first-line drug for VL in Brazil

Estudio de la implementación y el costo directo estimado de pruebas de diagnóstico de la leishmaniasis visceral humana en una zona urbana en Brasil

Submitted by Nuzia Santos ([email protected]) on 2016-07-07T12:48:26Z No. of bitstreams: 1 ve_Tália _ Assis_Study_CPqRR_2015.pdf: 134267 bytes, checksum: 560f63bf8cd63a2bfa9a7e58f1adbff7 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2016-07-07T12:52:27Z (GMT) No. of bitstreams: 1 ve_Tália _ Assis_Study_CPqRR_2015.pdf: 134267 bytes, checksum: 560f63bf8cd63a2bfa9a7e58f1adbff7 (MD5)Made available in DSpace on 2016-07-07T12:52:27Z (GMT). No. of bitstreams: 1 ve_Tália _ Assis_Study_CPqRR_2015.pdf: 134267 bytes, checksum: 560f63bf8cd63a2bfa9a7e58f1adbff7 (MD5) Previous issue date: 2015Made available in DSpace on 2016-07-08T18:43:28Z (GMT). No. of bitstreams: 3 ve_T?lia _ Assis_Study_CPqRR_2015.pdf.txt: 41436 bytes, checksum: 079dd5acb1ee2ccfa10885ea9f5ae2a5 (MD5) ve_T?lia _ Assis_Study_CPqRR_2015.pdf: 134267 bytes, checksum: 560f63bf8cd63a2bfa9a7e58f1adbff7 (MD5) license.txt: 2991 bytes, checksum: 5a560609d32a3863062d77ff32785d58 (MD5) Previous issue date: 2015Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil / Centro Federal de Educação Tecnológica de Minas Gerais. Contagem, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Belo Horizonte, MG, Brasil.Este trabalho relata o processo e os custos da implantação de dois testes para descentralizar o diagnóstico da leishmaniose visceral (LV) em um município endêmico no Brasil: um teste rápido (IT LEISH) e um teste de aglutinação direta (DAT-LPC). A implantação iniciou com o treinamento dos profissionais de saúde do município na realização dos testes diagnósticos. Os itens incluídos nas estimativas de custo das capacitações foram a remuneração proporcional de todos os profissionais envolvidos e os custos diretos dos testes usados. O estudo foi conduzido entre novembro de 2011 e novembro de 2013. Durante esse período, 17 capacitações foram realizadas e 175 profissionais treinados. O custo relacionado a cada profissional de saúde capacitado na realização do IT LEISH foi de US$7,13 e na realização do DAT-LPC, de US$ 9,93. O custo direto do IT LEISH e do DAT-LPC foi estimado em US$6,62 e US$ 5,44, respectivamente. Esta primeira avaliação da implantação desses dois testes aponta para a viabilidade da descentralização de ambos os métodos, que aumentam o acesso ao diagnóstico da LV no Brasil.This work reports the process and costs of comprehensively implementing two tests to decentralize the diagnosis of visceral leishmaniasis (VL) in an endemic city in Brazil: a rapid test (IT LEISH) and a direct agglutination test (DAT-LPC). The implementation began by training health professionals to perform the tests. Estimation of the training costs considered the proportional remuneration of all professionals involved and the direct costs of the tests used for training. The study was conducted between November 2011 and November 2013. During that time, 17 training sessions were held, and 175 professionals were trained. The training cost for each professional was US$7.13 for the IT LEISH and US$ 9.93 for the DAT-LPC. The direct costs of the IT LEISH and DAT-LPC were estimated to be US$6.62 and US$ 5.44, respectively. This first evaluation of the implementation of these diagnostic tests indicates the feasibility of decentralizing both methods to extend access to VL diagnosis in Brazil