Browsing by Author "Pathirana, K.P.N."

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Clinicopathological Profile of Cutaneous Leishmaniasis in Army Personnel in the Kilinochchi and Mulllativu Districts of Sri Lanka
(Sri Lanka Medical Association, 2020) Wijesinghe, H.D.; Gunathilaka, N.; Semege, S.; Pathirana, K.P.N.; Manamperi, N.; de Silva, M.V.C.; Fernando, S.D.
INTRODUCTION AND OBJECTIVES: Leishmaniasis is caused by an intra cellular protozoan of the genus Leishmania. The clinicopathological profile of cutaneous leishmaniasis (CL) varies according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This study describes the clinicopathological features of cutaneous leishmaniasis among army personnel serving in two Northern districts of the country. METHODS: In this collaborative cross-sectional study, the histopathology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression and histology) were reviewed. The parasitic load was assessed semi-quantitatively. The histological features were correlated with the clinical presentation and organism load. RESULTS: The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%, n=34). The lesion types included papule (34.7%, n=17), nodule (32.7%, n=16) and ulcer (30.6%, n=15). Evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 and included hyperkeratosis (90.0%; n=45), acanthosis (44.0%; n=22), atrophy (34.0%; n=17) and interface change (66%; n=33). Dermal changes were seen in all cases and characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20 % (n=10). Leishmania amastigote forms were observed in 88% (n=44). Transepidermal elimination (P=0.025), granuloma (P=0.027) formation and type of lesion (P=0.034) were significantly associated with organism load with granuloma formation being associated with reduction in organism load. CONCLUSION: Histopathological changes were characterised by a diffuse lymphohistioplasmacytic infiltrate, ill-defined granuloma or well-formed granuloma. Well-formed granulomata were associated with a reduction in organism load.
Histopathological spectrum in acute and chronic Cutaneous Leishmaniasis in Sri Lanka
(Sri lanka Medical Association, 2015) Manamperi, N.H.; Fernando, C.; Pathirana, K.P.N.; Karunaweera, N.D.; Abeyewickreme, W.; de Silva, M.V.C.
INTRODUCTION AND OBJECTIVES: Histological spectrum in cutaneous leishmaniasis (CL) is wide and varied. The objective of this study is to describe the histological spectrum of acute and chronic CL. METHOD: Skin biopsies of 35 patients with smear positive for Leishmania amastigotes were processed routinely for histopathology, examined at a conference microscope and classified into 4 groups using modified Ridley criteria for Leishmaniasis as: I- parasitized macrophages with variable lymphocytes and plasma ceils; 1! - parasitized macrophages with lymphocytes, plasma cells and ill formed histiocytic granulomata; 111 - a mixture of macrophages (with or without parasites), lymphocytes, plasma cells and epithelioid granulomata; IV - epithelioid granulomatous response with a few lymphocytes and plasma cells but no amastigotes. Lesions were categorized as acute (< 6 months) or chronic (> 6 months). RESULTS: Study group composed of all males with a mean age of 32.6 years (range 22 - 47) and lesion duration of 5.6 months (range 1-24). Twenty nine (82.9%) were also positive by histopathology. Twenty two (62.9%) were acute and 13 (37.1%) chronic. Group I, II, Ml and IV patterns were seen in 14 (40%), 12 (34.3%), 5 (14.3%) and 4 (11.4%) respectively and 9 (40.9%), 9 (40.9%), 2 (9.1%) and 2 (9.1%) of acute lesions and 5 (38.5%), 3 (23.1%), 3 (23.1%) and 2 (15.4%) of chronic lesions respectively. CONCLUSION: Histology of CL shows marked inflammatory cell infiltrate with or without granuloma formation. Majority of patients presenting with either acute or chronic CL belong to histological groups I or II.
Histopathological spectrum in acute and chronic cutaneous leishmaniasis in Sri Lanka
(Sri Lanka College of Microbiologists, 2015) Manamperi, N.H.; de Silva, M.V.C.; Fernando, C.; Pathirana, K.P.N.; Abeyewickreme, W.; Karunaweera, N.D.
OBJECTIVES: To describe the histological spectrum of acute and chronic cutaneous leishmaniasis. METHOD: Patients from Sri Lanka army were recruited by active and passive case detection methods and punch biopsies were obtained. Skin biopsies of 35 patients with smear positive for Leishmania amastigotes were processed routinely for histopathology, examined at a conference microscope and classified into 4 groups using modified Ridley criteria for Leishmaniasis as: I - parasitized macrophages with variable lymphocytes and plasma cells; II - parasitized macrophages with lymphocytes, plasma cells and ill formed histiocytic granulomata; III -a mixture of macrophages (with or without parasites), lymphocytes, plasma cells and epithelioid granulomata; IV - epithelioid granulomatous response with a few lymphocytes and plasma cells but no amasigotes. Lesions were categorized as acute (<6 months) or chronic (> 6 months). RESULTS: Study group composed of males with a mean age of 32.6 years (range 22-47) and lesion duration of 5.6 months (range 1-24). Twenty nine (82.9%) were also positive by histopathology. Twenty two (62.9%) were acute and 13 (37.1%) chronic. Group I, II, III and IV patterns were seen in 14 (40%), 12 (34.3%), 5 (14.3%) and 4 (11.4%) respectively and 9 (40.9%), 9 (40.9%), 2 (9.1%) and 2 (9.1 %) of acute lesions and 5 (38.5%), 3 (23.1 %), 3 (23.1 %) and 2 (15.4%) of chronic lesions respectively. CONCLUSION: Histology of cutaneous leishmaniasis shows marked inflammatory cell infiltrate with or without granuloma formation. Majority of patients presenting with either acute or chronic cutaneous leishmaniasis belong to histological groups I or II. ACKNOWLEDGEMENTS: Financial assistance from the University Grants Commission, Sri Lanka (UGC/VC/DRIC/PG/2013/KLN/ 03) and University of Kelaniya (RP/03/04/06/01/2014) are acknowledged. An abstract based on similar work was presented at the 128"1 Anniversary International Medical Congress of the Sri Lanka Medical Association, 5th to 8th July 2015.
Pathogenesis of Leishmania donovani induced cutaneous leishmaniasis: role of Tumor Necrosis Factor α
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Manamperi, N.H.; Oghumu, S.; Pathirana, K.P.N.; Munidasa, U.A.D.D.; Somaratne, K.K.V.N.; Rathnayake, R.M.D.I.; Thilakaratne, S.M.; de Silva, M.V.C.; Pathmeswaran, A.; Abeyewickreme, W.; Satoskar, A.R.; Karunaweera, N.D.
BACKGROUND: Cutaneous leishmaniasis (CL) in Sri Lanka is caused by the usually visceralizing Leishmania donovani. Host immune response plays a key role in the clinical presentation of leishmaniasis. Role of cytokines in pathogenesis of local lesions has not been studied. OBJECTIVE: To describe tissue cytokine expression with lesion progression with time in CL due to Leishmania donovani. METHODS: Skin biopsies from fifty eight patients with parasitologically or histopathologically confirmed CL and 30 healthy controls were analyzed for local tissue expression of Interleukin (IL)-12A, IL-4, IL-10, Interferon-gamma (IFNg) and Tumor Necrosis Factor-alpha (TNF-α). Cytokine mRNA was quantified by real-time RT- PCR using SYBR green. Relative copy numbers were calculated for each gene by 2-ΔΔCt method using β-actin as the reference gene and healthy controls as the calibrator. Spearman correlation was used to determine the correlation between cytokines and duration of active skin lesions. RESULTS: The study group consisted of 37 males (63.8%) and 21 females (36.2%) with a mean age of 35 (SD=12.05) years which ranged between 18-66 years. Mean duration of lesions was 6.8 (SD=9.10) months with a range of 1-48 months. The Spearman correlation coefficient for relative copy numbers and lesion duration was 0.220, 0.077, 0.073, 0.235 and 0.295 for IL-12A, IL-4, IL-10, IFNg and TNF-α respectively. There was a significant positive correlation between expression of TNF-α and lesion duration (p= 0.024). CONCLUSIONS: Localized expression of TNF-α increases with time in CL due to L. donovani in Sri Lanka, which indicates development of a pro-inflammatory immune response at the site of infection as the disease progresses.