Histopathological spectrum in acute and chronic cutaneous leishmaniasis in Sri Lanka

Abstract

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.