What laboratory investigations are essential for confirming a diagnosis of leishmaniasis in primary care?

In primary care, confirming a diagnosis of leishmaniasis primarily relies on laboratory investigations that detect the parasite directly or identify its genetic material. Essential investigations include microscopic examination of tissue samples obtained from skin lesions or mucosal sites, where the presence of Leishmania amastigotes within macrophages can be visualised after appropriate staining. Additionally, polymerase chain reaction (PCR) testing on lesion samples is highly sensitive and specific for detecting Leishmania DNA, making it a valuable diagnostic tool. Serological tests are generally less useful in cutaneous leishmaniasis due to variable antibody responses but may support diagnosis in visceral forms. Culture of the parasite from lesion aspirates or biopsies can be performed but is less commonly available in primary care settings. Therefore, the key laboratory investigations in primary care are microscopy and PCR of lesion samples to confirm leishmaniasis NICE NG95 Vega-López 2003Bailey & Lockwood 2007.