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VALUE OF CULTURE AND NESTED POLYMERASE CHAIN REACTION OF BLOOD IN THE PREDICTION OF RELAPSES IN PATIENTS CO-INFECTED WITH LEISHMANIA AND HUMAN IMMUNODEFICIENCY VIRUS

The use of culture and a nested polymerase chain reaction (PCR) of blood in predicting the probability of relapse was evaluated in 20 patients co-infected with Leishmania and human immunodeficiency virus (HIV). Fourteen of 20 patients relapsed, with 24 clinical relapses diagnosed. During clinical relapse, the parasite was detected by culture in 21 of 24 blood samples and by nested PCR in 23 of 24 blood samples. After treatment and during asymptomatic periods, the parasite was detected by culture in 18 (19.1%) of 94 blood samples and by nested PCR in 58 (61.7%) of 94 blood samples. For positive blood cultures, the Kaplan-Meier probability estimates for relapse at 6, 12, 18, and 24 months were 44%, 68%, 76%, and 76%, respectively, while for positive nested PCRs, the estimates were 20%, 33%, 45%, and 50%, respectively. For negative blood cultures, relapse probabilities for the same time points were 7%, 12%, 12%, and 12%, while for negative nested PCRs, these probabilities were 8%, 14%, 21%, and 26%. Nested PCR-positive results in asymptomatic periods indicated presence of the parasite, but not necessarily relapse. However, the presence of viable parasites during post-treatment follow-up increased the probability of relapse and showed that culture positivity could be a good relapse marker.

Received March 11, 2005. Accepted for publication May 24, 2005.

Acknowledgments: We thank Dr. Adil M. Allahverdiyev (Tropical Diseases Research Center, School of Medicine, Cukurova University, Adana, Turkey) and Dr. R. Ortiz de Lejarazu (Servicio de Microbiología, Hospital Universitario de Valladolid, Spain) for useful suggestions and comments. We also thank Dr. I. Gasser (Laboratorio de Microbiología, Hospital Universitari Vall d’Hebron, Barcelona, Spain) and R. Angrill and F. Corcoll (Laboratorio de Microbiología, Hospital Residencia Sant Camil, St. Pere de Ribes, Barcelona, Spain) for providing biological samples, R. Rycroft for correcting the manuscript, and S. Tebar for excellent technical assistance.

Financial support: This work was supported by the Comissionat per Universitats i Recerca, Generalitat de Catalunya (exp. 1997 SGR 00341; exp. 2001 SGR 00136).

^* Address correspondence to Cristina Riera, Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Avenida Joan XXIII s.n., E-08028 Barcelona, Spain. E-mail: mcriera{at}ub.edu

Authors’ addresses: Cristina Riera, Roser Fisa, Jaume Carrió, Montserrat Gállego, and Montserrat Portús, Laboratori de Parasitologia, Facultat de Farmàcia, Universitat de Barcelona, Avenida Joan XXIII s.n., E-08028 Barcelona, Spain, Telephone: 34-93-402-4500, Fax: 34-93-402-4504, E-mails: mcriera{at}ub.edu, rfisa{at}ub.edu, jcarrio{at}ub.edu, mgallego{at}ub.edu, and mportus{at}ub.edu. Esteban Ribera, Vicenç Falcó, and Israel Molina, Servicio de Enfermedades Infecciosas, Hospital General Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035, Barcelona, Spain, Telephone: 34-93-274-6090, Fax: 34-93-274-6057, E-mail: eribera{at}vhebron.net, vfalco{at}vhebron.net, and imolro{at}yahoo.es. Lluis Moner, Servicio de Medicina Interna, Hospital Residencia Sant Camil, Sant Pere de Ribes, Carreter Puigmoltó Km 0.8, Sant Pere de Ribes 08810, Barcelona, Spain, Telephone: 34-93-896-0025, Fax: 34-93-896-1287, E-mail: llmoner{at}terra.es.

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