Resumo

BARBOSA, Raimundo Nonato Pires et al. New evidences on the diagnostic value of indirect immunofluorescence test and delayed hypersensitivity skin test in human infection by Leishmania (L.) infantum chagasi in the Amazon, Brazil. Rev Pan-Amaz Saude [online]. 2010, vol.1, n.1, pp.33-44. ISSN 2176-6215.  http://dx.doi.org/10.5123/S2176-62232010000100006.

This is a prospective study on a cohort of 1099 individuals of both genders, aged 1-84 years (mean 24.4 years), living in an endemic area of American visceral leishmaniasis (AVL) in the municipality of Cametá, Brazil, from May 2006 to September 2008. It aimed to analyze the prevalence and incidence rates of human infection by Leishmania (L.) infantum chagasi, as well as the evolutional process of its previously defined clinical and immunological profiles: 1. Asymptomatic infection (AI); 2. Symptomatic infection (SI = AVL); 3. Subclinical oligosymptomatic infection (SOI); 4. Subclinical resistant infection (SRI); and 5. Indeterminate initial infection (III). The diagnosis was based on the simultaneous use of indirect immunofluorescence assay (IFA) and delayed hypersensitivity skin test. A total of 304 cases of infection were diagnosed during the period studied (187 for prevalence and 117 for incidence), generating an accumulated prevalence rate of 27.6%. The distribution regarding their clinical and immunological profiles presented the following order: AI 51.6%; III 22.4 %; SRI 20.1%; SOI 4.3%; and SI (= AVL) 1.6%. Based on the dynamics of the infection, the main discovery was about the III profile, which had an instrumental role in its evolution, directing it either to the resistant immunological pole - SRI (21 cases - 30.8%) and AI (30 cases - 44.1 %) profiles - or to the susceptible immunological pole - SI (1 case - 1.5%) profile. In addition, 16 cases remained within the III profile until the end of the study. It was concluded that this diagnostic approach can help monitor the infection in endemic areas, aiming mainly at preventing morbidity caused by AVL, and reducing the treatment time and expenses.

Palavras-chave : Leishmania (L.) infantum chagasi; Infection; Immunologic Tests; Hypersensitivity; Delayed; Fluorescent Antibody Technique; Indirect.

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