A review of the leishmanin skin test: A neglected test for a neglected disease.

The leishmanin skin test (LST) has been used for decades to detect exposure and immunity to the parasite Leishmania, the causative agent of the neglected tropical disease leishmaniasis. In the LST, Leishmania antigen (leishmanin) is intradermally injected into the forearm. In an individual who has b...

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Autores principales:	Jessica Carstens-Kass, Kayla Paulini, Patrick Lypaczewski, Greg Matlashewski
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/6071b3b1746343eb8ef2d24994d75e10
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spelling	oai:doaj.org-article:6071b3b1746343eb8ef2d24994d75e102021-12-02T20:23:44ZA review of the leishmanin skin test: A neglected test for a neglected disease.1935-27271935-273510.1371/journal.pntd.0009531https://doaj.org/article/6071b3b1746343eb8ef2d24994d75e102021-07-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009531https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735The leishmanin skin test (LST) has been used for decades to detect exposure and immunity to the parasite Leishmania, the causative agent of the neglected tropical disease leishmaniasis. In the LST, Leishmania antigen (leishmanin) is intradermally injected into the forearm. In an individual who has been previously infected, a delayed-type hypersensitivity (DTH) reaction results in a measurable induration at the site of the injection, indicating that previous exposure to Leishmania has resulted in the development of cell-mediated immunity. LST positivity is associated with long-lasting protective immunity against reinfection, most notably as reported for visceral leishmaniasis (VL). Despite efforts over the past few decades, leishmanin antigen is no longer produced under good manufacturing practice (GMP) conditions anywhere in the world. Consequently, the use of the LST in epidemiological studies has declined in favor of serological and molecular tests. In this review, we provide a historical overview of the LST and justification for the reintroduction of leishmanin. A GMP-grade leishmanin can be used to detect immunity in vivo by the LST and can be investigated for use in an interferon-γ release assay (IGRA), which may serve as an in vitro version of the LST. The LST will be a valuable tool for surveillance and epidemiological studies in support of the VL elimination programs and as a surrogate marker of immunity in vaccine clinical trials.<h4>Methods</h4>A review of the literature was conducted using PubMed as the primary database, with MeSH terms "leishmanin skin test" OR "Montenegro test" OR "Montenegro skin test." Articles written in English that describe the history or standardization of leishmanin, the use of leishmanin in an IGRA, or the use of the LST in epidemiological studies or vaccine trials were prioritized in our appraisal of the literature.Jessica Carstens-KassKayla PauliniPatrick LypaczewskiGreg MatlashewskiPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 7, p e0009531 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Jessica Carstens-Kass Kayla Paulini Patrick Lypaczewski Greg Matlashewski A review of the leishmanin skin test: A neglected test for a neglected disease.
description	The leishmanin skin test (LST) has been used for decades to detect exposure and immunity to the parasite Leishmania, the causative agent of the neglected tropical disease leishmaniasis. In the LST, Leishmania antigen (leishmanin) is intradermally injected into the forearm. In an individual who has been previously infected, a delayed-type hypersensitivity (DTH) reaction results in a measurable induration at the site of the injection, indicating that previous exposure to Leishmania has resulted in the development of cell-mediated immunity. LST positivity is associated with long-lasting protective immunity against reinfection, most notably as reported for visceral leishmaniasis (VL). Despite efforts over the past few decades, leishmanin antigen is no longer produced under good manufacturing practice (GMP) conditions anywhere in the world. Consequently, the use of the LST in epidemiological studies has declined in favor of serological and molecular tests. In this review, we provide a historical overview of the LST and justification for the reintroduction of leishmanin. A GMP-grade leishmanin can be used to detect immunity in vivo by the LST and can be investigated for use in an interferon-γ release assay (IGRA), which may serve as an in vitro version of the LST. The LST will be a valuable tool for surveillance and epidemiological studies in support of the VL elimination programs and as a surrogate marker of immunity in vaccine clinical trials.<h4>Methods</h4>A review of the literature was conducted using PubMed as the primary database, with MeSH terms "leishmanin skin test" OR "Montenegro test" OR "Montenegro skin test." Articles written in English that describe the history or standardization of leishmanin, the use of leishmanin in an IGRA, or the use of the LST in epidemiological studies or vaccine trials were prioritized in our appraisal of the literature.
format	article
author	Jessica Carstens-Kass Kayla Paulini Patrick Lypaczewski Greg Matlashewski
author_facet	Jessica Carstens-Kass Kayla Paulini Patrick Lypaczewski Greg Matlashewski
author_sort	Jessica Carstens-Kass
title	A review of the leishmanin skin test: A neglected test for a neglected disease.
title_short	A review of the leishmanin skin test: A neglected test for a neglected disease.
title_full	A review of the leishmanin skin test: A neglected test for a neglected disease.
title_fullStr	A review of the leishmanin skin test: A neglected test for a neglected disease.
title_full_unstemmed	A review of the leishmanin skin test: A neglected test for a neglected disease.
title_sort	review of the leishmanin skin test: a neglected test for a neglected disease.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/6071b3b1746343eb8ef2d24994d75e10
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A review of the leishmanin skin test: A neglected test for a neglected disease.

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