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Cutaneous leishmaniasis: a pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis.
J Cutan Pathol. 2020 Jun 23 [Online ahead of print]JC

Abstract

BACKGROUND

Traditional methods for the diagnosis of leishmaniasis yield poor sensitivity, which limits its effectiveness in lesions with a low parasite burden.

METHODS

Retrospective pathologic study of 360 cases of cutaneous leishmaniasis and analysis of the different diagnostic methods used.

RESULTS

In 93% of the lesions, histopathology showed a dense and diffuse inflammatory infiltrate, consisting of lymphocytes, histiocytes and plasma cells, which occupied the superficial and mid dermis and variably extended to deep dermis and superficial subcutis (standard pattern). The remaining cases exhibited atypical features, such as perivascular, interstitial or perifollicular inflammatory patterns, folliculitis or panniculitis. Granulomas were identified in 84% of biopsies, most of them as small, poorly formed, non-necrotizing histiocytic aggregates. Amastigotes were visualized by routine histopathologic exam in 36% of biopsies. Immunohistochemistry stained 17/26 lesions (65%) negative by conventional stains. PCR provided the correct diagnosis in 218 cases (58% of the series) negative for Leishmania by other techniques.

CONCLUSIONS

Biopsies negative for Leishmania by traditional diagnostic methods that show the histopathologic standard pattern or those with atypical features from patients with clinical suspicion of cutaneous leishmaniasis in endemic areas should be studied by immunohistochemistry and/or PCR for Leishmania in order to reach the definitive diagnosis. This article is protected by copyright. All rights reserved.

Authors+Show Affiliations

Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain.Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain.Leishmaniasis and Chagas Disease Unit, Reference and Research Laboratory in Parasitology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain.Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain. Department of Basic Medical Sciences, Universidad Rey Juan Carlos, Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32578232

Citation

Cardozo, Rocío S., et al. "Cutaneous Leishmaniasis: a Pathological Study of 360 Cases With Special Emphasis On the Contribution of Immunohistochemistry and Polymerase Chain Reaction to Diagnosis." Journal of Cutaneous Pathology, 2020.
Cardozo RS, García-Montero PP, Chicharro C, et al. Cutaneous leishmaniasis: a pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis. J Cutan Pathol. 2020.
Cardozo, R. S., García-Montero, P. P., Chicharro, C., & Tardío, J. C. (2020). Cutaneous leishmaniasis: a pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis. Journal of Cutaneous Pathology. https://doi.org/10.1111/cup.13785
Cardozo RS, et al. Cutaneous Leishmaniasis: a Pathological Study of 360 Cases With Special Emphasis On the Contribution of Immunohistochemistry and Polymerase Chain Reaction to Diagnosis. J Cutan Pathol. 2020 Jun 23; PubMed PMID: 32578232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cutaneous leishmaniasis: a pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis. AU - Cardozo,Rocío S, AU - García-Montero,Pedro P, AU - Chicharro,Carmen, AU - Tardío,Juan C, Y1 - 2020/06/23/ PY - 2019/11/03/received PY - 2020/05/23/revised PY - 2020/06/18/accepted PY - 2020/6/25/entrez JF - Journal of cutaneous pathology JO - J. Cutan. Pathol. N2 - BACKGROUND: Traditional methods for the diagnosis of leishmaniasis yield poor sensitivity, which limits its effectiveness in lesions with a low parasite burden. METHODS: Retrospective pathologic study of 360 cases of cutaneous leishmaniasis and analysis of the different diagnostic methods used. RESULTS: In 93% of the lesions, histopathology showed a dense and diffuse inflammatory infiltrate, consisting of lymphocytes, histiocytes and plasma cells, which occupied the superficial and mid dermis and variably extended to deep dermis and superficial subcutis (standard pattern). The remaining cases exhibited atypical features, such as perivascular, interstitial or perifollicular inflammatory patterns, folliculitis or panniculitis. Granulomas were identified in 84% of biopsies, most of them as small, poorly formed, non-necrotizing histiocytic aggregates. Amastigotes were visualized by routine histopathologic exam in 36% of biopsies. Immunohistochemistry stained 17/26 lesions (65%) negative by conventional stains. PCR provided the correct diagnosis in 218 cases (58% of the series) negative for Leishmania by other techniques. CONCLUSIONS: Biopsies negative for Leishmania by traditional diagnostic methods that show the histopathologic standard pattern or those with atypical features from patients with clinical suspicion of cutaneous leishmaniasis in endemic areas should be studied by immunohistochemistry and/or PCR for Leishmania in order to reach the definitive diagnosis. This article is protected by copyright. All rights reserved. SN - 1600-0560 UR - https://www.unboundmedicine.com/medline/citation/32578232/Cutaneous_leishmaniasis:_a_pathological_study_of_360_cases_with_special_emphasis_on_the_contribution_of_immunohistochemistry_and_polymerase_chain_reaction_to_diagnosis L2 - https://doi.org/10.1111/cup.13785 DB - PRIME DP - Unbound Medicine ER -
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