Histological spectrum of cutaneous leishmaniasis due to Leishmania tropica

Abstract

Skin biopsies from 117 cases of acute and 23 cases of lupoid leishmaniasis were studied. Of the 117 acute cases, anergic macrophage response were seen in 44, diffuse necrosis in 9 and focalized necrosis in 11 biopsies; the remaining 53 biopsies showed scanty or no parasites with a few to abundant epithelioid cells probably representing post necrotic changes before complete healing of the lesions. The 23 biopsies of lupoid leishmaniasis showed rather well organized epithelioid granulomata surrounded by lymphocytes, inconspicuous plasma cells, no amastigotes and no necrosis. Lupoid cases showed strong delayed hypersensitivity with leishmanin and low serum antibody titres. It appears that the lesions of urban cutaneous leishmaniasis spend a long time in the anergic phase. Partial destruction of parasites by activated macrophages together with gradual elevation of antibody levels prepares the appropriate antigen-antibody ratio for optimum development of necrosis at PI3 leading to effective elimination of parasites. Plasma cells appear to be important in the induction of necrosis and inhibition of epithelioid granulomata. A significant inverse relationship has been found between plasma cells and epitheloid cells. The delayed hypersensitivity observed in lupoid leishmaniasis is probably the result of a poor humoral response evidenced by inconspicuous plasma cells and low serum antibody titres.

Successful Treatment of Lupoid Cutaneous Leishmaniasis with Glucantime and Topical Trichloroacetic Acid (A Case Report)

“…Treatment options include intraregional pentavalent antimony [11], a combination therapy with intramuscular injection of meglumine antimoniate (MA) and allopurinol [12], local injection of amphothericin B [13], levamisole [14], dapsone [15], cryotherapy [16], and triple therapy with paromomycin, cryotherapy, and intralesional meglumine antimoniate [5]. …”

Polymerase Chain Reaction for Diagnosis of Cutaneous Leishmaniasis in Histologically Positive, Suspicious and Negative Skin Biopsies

“…Presence of granuloma, lymphocytes and plasma cells may be produced by other infective and noninfective etiologies. Granuloma may also be caused by an immunologic reaction to the antigenic stimulation of the parasite rather than the live parasite itself, the process that is suggested to be present in some cases of chronic lupoid leishmaniasis [2]. When pathologists observe these histopathologic features but cannot see the parasite, they report the biopsy as ‘consistent with CL’.…”

Clinicopathological presentation of cutaneous leishmaniasis and its diagnostic algorithm

“…This encompasses a range of immunological reaction varying from complete lack of immune response in diffuse cutaneous leishmaniasis to exaggerated immune response in the lupoid type [8].…”

“…The histological picture of cutaneous leishmaniasis in some endemic areas can be classified into variable presentation as in leprosy [8]. Several histological classifications have been described consisting of 4-6 categories which differs from one endemic area to another [8,9].…”

“…Several histological classifications have been described consisting of 4-6 categories which differs from one endemic area to another [8,9]. Ridley classification is widely followed which was later modified 10 as described in Table 1.…”