Histopathological spectrum in acute and chronic Cutaneous Leishmaniasis in Sri Lanka

Abstract

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.