Haemoculture as a tool for diagnosing visceral leishmaniasis in HIV-negative and HIV-positive patients: interest for parasite identification.

Between May 1993 and June 1996, 65 adults infected with human immunodeficiency virus (HIV) and 30 HIV-negative patients (8 children and 22 adults) from the Mediterranean region with symptoms that included at least fever were examined for Leishmania. A total of 128 bone marrow and 128 peripheral venous blood samples were taken and cultured on NNN medium. At the initial diagnosis, 14 (6 HIV-positive and 8 HIV-negative) of 15 patients with a positive blood culture also had a positive bone marrow culture. Two patients (1 HIV-positive and the other HIV-negative) had a positive bone marrow culture but a negative blood culture. During post-therapeutic check-ups, 7 out of 8 patients with a positive blood culture (6 HIV-positive and 1 HIV-negative) also had a positive bone marrow culture. On the other hand, three patients (2 HIV-positive and 1 HIV-negative) had a positive bone marrow but a negative blood culture. Relapses were more frequent (9/65 vs. 3/30) and the demonstration of Leishmania in the blood was commoner (6/65 vs. 2/30) in the HIV-positive than the HIV-negative patients. Stocks were identified by their isoenzymes: MON-1 from four HIV-positive and eight HIV-negative patients, MON-28 from one HIV-positive patient and MON-29 from another. For each patient, the same zymodeme was found in bone marrow and blood cultures, both at initial diagnosis and at follow-up.