Table 4 Diagnostic methods .

Diagnostic test	Comments
Visceral leishmaniasis
Microscopic detection of amastigotes in smears of tissue aspirates or biopsy samples	Bone marrow aspirates or biopsy: sensitivity 55–97%
	Lymph node aspirate smears (sensitivity 60%) or biopsy
	Splenic aspirates (sensitivity >97%): risk of life-threatening haemorrhage
Tissue culture	On special media like Novy, McNeal, Nicolle (NNN) medium or inoculated into animals such as hamsters
Leishmania antibody (DAT)	Sensitivity 72%, specificity 94%
	Some cross-reactions in leprosy, Chagas disease, malaria, and schistosomiasis
	In HIV, may be falsely negative
Anti-K39 antibody in blood droplet	Sensitivity 90–100% in symptomatic patients
	Useful in clinical management in resource-poor areas
Leishmania DNA detection in tissue aspirates and peripheral blood by PCR	Sensitivity 70–93% in peripheral blood
Detection of Leishmania antigen and antibody in the urine	High sensitivity and specificity
Cutaneous leishmaniasis
Microscopic examination of skin scrapings or biopsy specimens taken from the edge of lesions	Rapid and low-cost
	Limited sensitivity, especially in chronic lesions
	A practical guide to diagnostic techniques in cutaneous leishmaniasis can be found at: http://www.thelancet.com/journals/lancet/article/PIIS0140673698101782/fulltext#abstract
Cultures of the lesions	More sensitive than microscopy
	May become contaminated
	Different species have different growth requirements
Antibody detection	Poorly sensitive
	In American cutaneous leishmaniasis there have been reports of cross-reactivity
Montenegro (leishmanin) skin test	Unable to distinguish between current and past infection
	Reports of false positivity in other skin infections

DAT, direct agglutination test; PCR, polymerase chain reaction.