Comparação dos procedimentos de "imprint " e escarificação no diagnóstico da Leishmaniose Tegumentar Americana

American Tegumentary Leishmaniasis (ATL) is an infectious disease caused by parasites of the genus Leishmania, which has complex characteristics in different aspects. The diagnosis, whenever possible, should be based on epidemiological evidence, clinical aspect and laboratory tests. Imprint and scraping procedures are used for direct detection of the parasite. Scraping is the quickest, low-cost and easy to conduct. Based on the characteristics of direct examination for the confirmation of ATL cases, the Brazilian Ministry of Health has encouraged the implementation of the scraping procedure in all Central public health laboratories. Thus the knowledge of the accuracy parameters of this procedure and the standardization of collection and reading methods are important for its application in a uniform manner throughout Brazil. In this study, we aimed to evaluate the sensitivity of direct methods (imprint and scraping), compared with the reference standard test (culture). Besides, we sought to establish collection and reading criteria with the purpose of standardizing the method to propose its application in different Brazilian regions. The study population comprised 110 patients with clinical suspicion of ATL who were treated at the Laboratory of Leishmaniasis Surveillance (VigiLeish/IPEC/Fiocruz) for clinical evaluation and sample collection. Among the 110 patients studied, 40 were confirmed with ATL. The imprint was positive in 28 patients granting sensitivity of 70%, scraping conducted in the outer edge was positive in 17 patients and in the inner edge in 25, reaching sensitivity of 42.5% and 62.5% respectively. The material obtained from the inner edge of the lesion was more sensitive and presented a larger amount of white cells and lesser red cells, favoring slide reading. Accuracy parameters found for the direct methods were satisfactory showing that they may be implemented in all Brazilian regions for the diagnosis of American tegumentary leishmaniasis.