A clinico-pathological study of cutaneous leishmaniasis in British troops from Belize

Abstract

Thirty-four cases of cutaneous leishmaniasis contracted by British soldiers in Belize were studied. Pre- and post-treatment biopsies were taken from all patients. The range of histological appearances is described and the value of histological examination (including Giemsa staining and immunohistochemistry), cytological preparations and microbiological culture in diagnosis and clinical management assessed. Histology and culture were found to be complementary techniques in reaching a positive diagnosis, whilst cytological preparations were of no additional value. Histological examination of post-treatment biopsies merely confirmed the clinical impression of healing or non-healing whilst culture identified viable organisms in apparently healed lesions, which were subsequently re-treated.

Cutaneous leishmaniasis

“…Monoclonal antibodies can demonstrate parasites in paraffin sections but are often species specific. 23 PCR methods are useful for confirming the diagnosis and offer improved sensitivity over microscopy and culture; 24 however, problems exist with the identification of individual species, particularly those of the New World.…”

Infection-induced respiratory burst in BALB/c macrophages kills Leishmania guyanensis amastigotes through apoptosis: possible involvement in resistance to cutaneous leishmaniasis

“…guyanensis is the causative agent of a cutaneous form of leishmaniasis in humans, in which a papule with vacuoled macrophages containing amastigotes and a lymphocytic infiltrate develops into an ulcer [19][20][21]. This lesion can either heal spontaneously [22,23] or become chronic, increasing morbidity in patients [24].…”

Diffuse cutaneous leishmaniasis associated with the immune reconstitution inflammatory syndrome

“…Alteration of dermal connective tissue with collagen degeneration or palisading around areas of necrosis may occur 53 . Epithelioid cell granulomas, typified by giant cells with a rim of lymphocytes, are present in about 30% of cases; they are associated with a favorable response to treatment and healing 53,55 . In DCL, the vacuolated pattern of macrophages is more distinct in patients who are totally anergic to leishmanin skin testing 56 .…”

“…DCL can be clinically indistinguishable from lepromatous leprosy or Jorge Lobo's disease (a chronic deep mycotic infection caused by Lacazia loboi ): 46 cultures and histologic staining differentiate the two, and nerve involvement is not seen. The lesions of DCL may also resemble cutaneous lymphoma 55 . DCL and post kala‐azar dermal leishmaniasis may present similarly, but the former is not associated with visceral disease.…”