Accuracy of mucocutaneous leishmaniasis diagnosis using polymerase chain reaction: systematic literature review and meta-analysis

• Published in: Memórias do Instituto Oswaldo Cruz Vol. 110; no. 2; pp. 157 - 165
• Main Authors: Gomes, Ciro Martins, Mazin, Suleimy Cristina, Santos, Elisa Raphael dos, Cesetti, Mariana Vicente, Bächtold, Guilherme Albergaria Brízida, Cordeiro, João Henrique de Freitas, Theodoro, Fabrício Claudino Estrela Terra, Damasco, Fabiana dos Santos, Carranza, Sebastián Andrés Vernal, Santos, Adriana de Oliveira
• Format: Journal Article
• Language: English
• Published: Brazil Fundação Oswaldo Cruz, Fiocruz 01-04-2015; Instituto Oswaldo Cruz, Ministério da Saúde; Fundação Oswaldo Cruz (FIOCRUZ)
• Subjects: Biopsy; Clinical Trials as Topic; Confidence Intervals; diagnosis; DNA, Protozoan - isolation & purification; Humans; leishmaniasis; leishmaniasis, mucocutaneous; Leishmaniasis, Mucocutaneous - blood; Leishmaniasis, Mucocutaneous - diagnosis; Leishmaniasis, Mucocutaneous - urine; mucocutaneous - diagnosis - polymerase chain reaction; PARASITOLOGY; polymerase chain reaction; Polymerase Chain Reaction - standards; Qualitative Research; ROC Curve; Sensitivity and Specificity; TROPICAL MEDICINE; leishmaniasis, mucocutaneous; diagnosis; polymerase chain reaction
• ISSN: 1678-8060; 0074-0276; 1678-8060; 0074-0276
• DOI: 10.1590/0074-02760140280

The diagnosis of mucocutaneous leishmaniasis (MCL) is hampered by the
absence of a gold standard. An accurate diagnosis is essential because
of the high toxicity of the medications for the disease. This study
aimed to assess the ability of polymerase chain reaction (PCR) to
identify MCL and to compare these results with clinical research
recently published by the authors. A systematic literature review based
on the Preferred Reporting Items for Systematic Reviews and
Meta-Analyses: the PRISMA Statement was performed using comprehensive
search criteria and communication with the authors. A meta-analysis
considering the estimates of the univariate and bivariate models was
performed. Specificity near 100% was common among the papers. The
primary reason for accuracy differences was sensitivity. The
meta-analysis, which was only possible for PCR samples of lesion
fragments, revealed a sensitivity of 71% [95% confidence interval (CI)
= 0.59; 0.81] and a specificity of 93% (95% CI = 0.83; 0.98) in the
bivariate model. The search for measures that could increase the
sensitivity of PCR should be encouraged. The quality of the collected
material and the optimisation of the amplification of genetic material
should be prioritised.