Elsevier

Clinics in Dermatology

Volume 17, Issue 3, May–June 1999, Pages 297-304
Clinics in Dermatology

Original Articles
Histologic diagnosis of cutaneous leishmaniasis

https://doi.org/10.1016/S0738-081X(99)00048-6Get rights and content

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Histopathology of acute cutaneous leishmaniasis

Acute lesions of cutaneous leishmaniasis may present as papules, nodules, or plaques which are crusted or ulcerated (Fig 1). There is histologic similarity between the acute lesions of Old World leishmaniasis (oriental sore, Baghdad boil) and the New World lesions of acute leishmaniasis (uta, chiclero’s ulcer), with some differences seen in mucocutaneous leishmaniasis. Early in the course of disease, there is mixed inflammation (Fig 2).15 The inflammation is dense and diffuse throughout the

Histopathology of chronic cutaneous Leishmania

Some early authors differentiated Leishmania recidivans from chronic lupoid leishmaniasis, in that the former develops only after apparent healing of the primary lesion and is limited to its scar.22 Most authors, ourselves included, consider these entities to be identical.23 Single or sometimes multiple papular lesions develop at the edge of scars from previously healed acute lesions of leishmaniasis and progress gradually into an infiltrated scaly plaque which may show yellowish discoloration

Histopathology of disseminated cutaneous leishmaniasis

Disseminated cutaneous leishmaniasis (DCL) occurs in individuals with an anergic response to the Leishmania organism.27 This is most commonly caused by Leishmania aethiopica in the Old World and Leishmania mexicana amazonensis in the New World. Reports of DCL caused by Leishmania Venezuelensis have been reported from Venezuela.28 Clinically and histologically this form of leishmaniasis is similar to lepromatous leprosy. There is an infiltrate of monomorphous vacuolated appearing macrophages in

Histopathology of post Kala-Azar dermal leishmaniasis

Post Kala-Azar dermal leishmaniasis (PKDL) is most commonly secondary to visceral infection by Leishmania donovani. Lesions may appear from months up to 5 years after apparent successful treatment of visceral Kala-Azar. The clinical lesions may appear as hyperpigmented and hypopigmented macules, papules, and nodules. The hypopigmented macules show a decreased amount of epidermal pigment. The epidermis may be atrophic with keratotic follicular plugging.33 There may be a variable number of

Unusual presentations of cutaneous leishmaniasis

Several unusual and rare clinical presentations of cutaneous leishmaniasis have been described. Erysipeloid leishmaniasis has been described in Iranian women presenting clinically as erythematous indurative patches and plaques over the face and nose resembling erysipelas.35 Histologically, there are macrophages containing large numbers of amastigotes filling the upper dermis and extending into the deeper dermis along adnexal structures.35 A variable number of lymphocytes and plasma cells are

Histologic differential diagnosis of leishmaniasis

The differential diagnosis of acute cutaneous leishmaniasis includes other infectious granulomas. The histologic differential diagnosis would include sporotrichosis, blastomycosis histoplasmosis, yaws, syphilitic gumma, tuberculosis cutis, anthrax, granuloma inguinale, rhinoscleroma, and furunculosis. Identification of the organisms in the acute lesion should help to differentiate cutaneous leishmaniasis from these other infections. Rhinoscleroma, histoplasmosis, granuloma inguinale, and

Immunopathology of leishmaniasis

A great deal of work is underway concerning the immunopathology of many granulomatous processes. Much of this recent work is helpful in correlating the clinical and immunologic status of the patient to the histologic findings. For a more in-depth study, we encourage the reader to obtain the original references, however, we will attempt to summarize some of what is known and correlate this with the histologic findings.

The immunopathology of leishmaniasis is predominantly that of a T-cell

New techniques for diagnosis

Many new methods of diagnosis are available using immulogic and molecular biologic methods. Many of these methods are not commercially available yet, but may prove to be useful in the near future. Impression smear (touch preparations) of skin biopsy specimens has been shown to be an effective method for detecting organisms. Touch preps prepared by Giemsa stain have been shown to detect organisms in specimens which failed to show organisms by histologic examination.48 This is a relatively simple

Conclusions

The tropism of the infectious Leishmania organism, the size of the inoculum, and the underlying immune status of the patient will determine the clinical and histologic findings. The histopathology of cutaneous leishmaniasis is marked by a T-cell mediated immune response ranging from a mixed lymphohistologic infiltrate with many intracellular organisms in acute lesions to a well-defined epithelioid granuloma formation with few organisms in patients with chronic lesion and an intact immune

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      Late stages of CL may be accompanied by a large number of plasma cells. Epidermal alterations, such as atrophy, acanthosis, ulceration, or pseudoepitheliomatous hyperplasia, may be seen.59,83,84 The cicatricial stage is characterized by flattened and hyperpigmented epidermis accompanied by dermal fibrosis.46

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