Histopathology of human American cutaneous leishmaniasis before and after treatment

Abstract

Chemical therapy for the treatment of leishmaniasis is still inadequate, and a number of drugs and therapeutic programs are being tested. Besides treatment, the ultimate goal is an effective cure, and histopathological analyses of the lesion cicatrices constitute an important measure of treatment success, or otherwise, in this respect. In this paper, we describe histopathological patterns in cases of American cutaneous leishmaniasis in 32 patients from the municipality of Caratinga, Minas Gerais, Brazil, before and after treatment with the following therapeutic methods: 1) leishvacin + glucantime; 2) leishvacin + BCG associated with glucantime; 3) glucantime; 4) leishvacin + BCG. Lesion fragments were collected from all patients by biopsy prior to, and approximately 30 days after, each treatment which resulted in a clinical diagnosis of cure. Following the analysis of slides, the preparations were described from a histopathological point of view and grouped taking into account the prevalence or significance of the characteristic elements. This process resulted in the following classification: 1. exudative reaction (ER); 2. exudative giant cell reaction (EGCR); 3. exudative productive reaction (EPR); 4. exudative productive giant cell reaction (EPGCR); 5. exudative productive necrotic reaction (EPNR); 6. necrotic exudative reaction (NER); 7. productive exudative reaction (PER), 8. productive giant cell reaction (PGCR); 9. productive exudative giant cell reaction (PEGCR); 10. productive exudative giant cell granulomatous reaction (PEGCGR); 11. productive reaction (PR) and 12. productive cicatricial (cure) reaction (PCR). After this analysis, it was noted that clinical cure did not always coincide with histopathological cure.

Histopathological and immunohistochemical aspects of American cutaneous leishmaniasis before and after different treatments*

“…Therefore, a criterion of cure ideal should consider aspects of clinical, histopathological, and parasitological analyses. 16 The immune response before treatment showed an increased expression of Th1 cytokines, and after treatment there was a reduction in inflammatory response and a mix of cytokines of Th1 and Th2 responses. We also report that there was no statistically significant difference in the evolution of healing amongst the three treatments, indicating the equivalence in clinical cure for the three treatments, showing that ACL can be effectively treated by a combination of immunotherapy and immunochemotherapy, decreasing the amount of Glucantime required.…”

“…16 In this systematic study the authors found that evaluation of the histopathological scar is important for analyzing the healing process because by following the analysis of fragments from lesions and scars, obtained from patients diagnosed with ACL, it was observed that the histopathological samples submitted both before and after treatment did not always correlate with the indications of a clinical cure. Besides, even after treatment, when the patients were considered clinically cured in some cases, an inflammatory process still persisted in skin lesions, despite complete healing of the lesion.…”

American Tegumentary Leishmaniasis: Effectiveness of an Immunohistochemical Protocol for the Detection of Leishmania in Skin

“…Lesions of patients with LCL are prone to heal after some months with or without treatment, resulting in smooth, shiny scars described as atrophic, hairless, and depressed, with hypo- or hyper-pigmented areas [31], [35], [36]. In the search for parasites in ATL lesions, the percent positivity is inversely proportional to the duration of infection [36], [37].…”

Cutaneous Hematopathology

“…The epidermal changes are nonspecifi c and consist of hyperkeratosis, parakeratosis, and epidermal atrophy or hyperplasia. Ulceration can be seen in some cases (Kurban et al 1966 ;Gutierrez et al 1991 ;Peltier et al 1996 ;Botelho et al 1998 ;Mehregan et al 1999 ).…”