Demonstration of agglutinating anti-Leishmania antibodies in lymph node aspirate for confirmation of kala-azar serodiagnosis

Despite poor sensitivity for the diagnosis of visceral leishmaniasis (VL), demonstration of amastigotes in Giemsa-stained organ aspirate is still considered the ‘gold standard’ (WHO, 2004). As it is less risky and easily applicable in rural health settings compared with bone-marrow or spleen aspiration, lymph node aspiration is routinely carried out in many VL endemic areas. However, even with the incorporation of highly sensitive techniques such as PCR, the reliability of lymph-node aspiration for VL diagnosis, although improved in advanced disease, nevertheless remains below the desired level in early and mild infections (Osman et al., 1997).