Abstract
Following antigen preparation procedures similar to those of the direct agglutination test (DAT), an IgG ELISA employing intact beta-mercaptoethanol (beta-ME)-treated Leishmania donovani promastigotes was developed. The performance of the beta-ME ELISA thus developed was assessed in patients with confirmed visceral leishmaniasis (VL), revealing slightly lower sensitivity (39/40=97.5%) than that of the DAT (40/40=100%). When challenged with sera of individuals with non-VL conditions, including leukaemia and African trypanosomiasis, the specificity of the beta-ME ELISA was 100% (158/158), compared to 98.8% (156/158) for DAT. In an endemic population (n=145) manifesting a clinical suspicion of VL, results obtained with the beta-ME ELISA were highly concordant with those of DAT, both in the seropositive (65/68=95.6%) and seronegative (77/80=96.3%) groups. Furthermore, the incorporated intact antigen demonstrated higher sensitivity in ELISA (16/18=88.9%) than the water-soluble equivalent (13/18=72.2%). The stability of the formaldehyde-fixed antigen (2 months at 4 degrees C) in beta-ME ELISA, as well as the option for direct testing of whole-blood samples and visual reading of results (within 2 h, compared to 18 h for DAT), advocate the simultaneous application of the technique with DAT for confirmation of VL in laboratories with limited facilities.