Diagnosis, detection and surveillance

© J.A Ruiz Postigo/wHO
Active screening for cutaneous leihmaniasis, Alepo, Syrian Arab Republic, 2011

Diagnosis of visceral leishmaniasis is made by combining clinical signs with parasitological or serological tests (mainly rapid diagnostic tests). In cutaneous and mucocutaneous leishmaniasis, clinical manifestation with parasitological tests confirm the diagnosis but serological tests have limited value.

A robust surveillance system is an essential component of control or elimination programmes. Two forms of surveillance – passive and active case-detection or searches – are mainly applied in disease control programmes.

‘Passive case detection’ is detection triggered by patients seeking care for their illness from clinicians working in static health facilities. Clinicians who manage a case should notify it to the appropriate epidemiological surveillance system, even in low or non-endemic countries, to obtain a more accurate information of the leishmaniasis burden worldwide. WHO recommends the use of the standard case definitions to detect the cases.

‘Active case detection’ or search means that health staff reach out to the community and systematically screen the population to find cases of leishmaniasis. Active case search is an essential component of the visceral leishmaniasis elimination strategy on the Indian subcontinent. It helps to reduce disease transmission by shortening the infectious period of patients; and earlier diagnosis and treatment improves treatment outcomes of patients.