Leishmaniasis, Cutaneous Clinical Trial
Official title:
Evaluation of a Diagnostic Device, CL Detect™ Rapid Test, for the Diagnosis of Cutaneous Leishmaniasis in Peru
Determine the sensitivity and specificity of the FDA-cleared CL Detect™ Rapid Test in Peru, using a test procedure that was modified from that described in the device instructions to optimize these parameters for the detection of Leishmania species identified in Peru.
Observational study of a FDA cleared device, the CL Detect™ Rapid Test. Data for the 510(K)
was supported by a sensitivity study conducted in Tunisia, Old world Leishamania major and a
specificity study conducted in the United Sates. Sensitivity and specificity data collected
recently in Peru (2014-2015), by the Instituto de Medicina Tropical Alexander von Humbolt,
supports the idea that the sensitivity of the CL Detect™ Rapid Test can be drastically
increased for New World Leishmania species. The study is a single trial, with two clinical
sites, NAMRU-6, Puerto Maldonado and the Alexander von Humboldt Tropical Medicine Institute
in Lima. The objective of the study is to determine the sensitivity and specificity of the
FDA-cleared CL Detect™ Rapid Test, using an optimized test procedure determined from a pilot
study conducted in Peru. Two modifications to the test procedure (marketed device
instructions) are included in this study: 1) increase in extraction time in lysis buffer from
5 to 10 minutes to 20 to 30 minutes and 2) a 20 μl increase in the volume of the sample to
add to the test strip, from 20 μl to 40 μl. The gold standard for Leishmania diagnosis, which
is microscopic identification of amastigotes in stained lesion sample, will be used as a
control.
Participants will be patients who present for medical consultation due to a suspected CL
lesion. After obtaining informed consent and screening the participant for eligibility, we
will collect and test at most 4 samples from the index lesion in the following order:
1. one sample obtained with a dental broach for use with the CL Detect™ Rapid Test;
2. one sample obtained by scraping for microscopic identification of amastigotes; and
3. one sample obtained by scraping for Leishmania speciation by PCR; and
4. when possible, (depending on the size of the lesion), one sample from a different site
of the same lesion, obtained by scraping for use with the CL Detect™ Rapid Test. PCR
analysis will be performed by NAMRU-6 for possible exploratory analyses including
species identification. If the etiologies of the lesions that are negative for
Leishmania are known, they will be reported. Participants with a positive diagnosis of
leishmaniasis by microscopy or other methods will be referred for standard of care
treatment in Peru by the attending physician of the Peruvian Ministry of Health.
Treatment is not part of this study. If a participant's lesions are negative for
Leishmania, standard of care follow-up testing will be performed, either at the study
site, or (when indicated) in another hospital.
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