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Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population.
Am J Dermatopathol. 2021 08 01; 43(8):567-573.AJ

Abstract

BACKGROUND

A definite diagnosis of infectious granulomatous dermatitis (IGD) is difficult for both practicing dermatologists and dermatopathologists due to overlapping clinical and histomorphological features. We aimed to explore the role of multiplex polymerase chain reaction (PCR) for identifying a definite etiological agent for diagnosis and appropriate treatment in IGD in formalin-fixed paraffin-embedded tissue.

MATERIALS AND METHODS

Sixty-two cases of IGD were included, excluding leprosy. The histochemical stains including Ziehl-Neelsen, periodic acid-Schiff, and Giemsa were performed in all cases. A multiplex PCR was designed for detection of tuberculosis (TB) (IS6110 and mpt64), fungal infections (ITS1, ITS2; ZM1, and ZM3), and leishmaniasis (kDNA). The results of histomorphology, histochemical stains, and multiplex PCR were compared.

RESULTS

Among 62 cases, the sensitivity rate of PCR detection for organisms was 16.7%, 0%, 100%, 72%, 75%, and 66.7% in patients with TB, suggestive of TB, leishmaniasis, fungal infections, and granulomatous dermatitis not otherwise specified and granulomatous dermatitis suggestive of fungus, respectively. The TB PCR using IS6110 primers was negative in all cases; however, PCR using mpt64 primers was positive in 33.33% cases of scrofuloderma. The histochemical stains including Ziehl-Neelsen for acid-fast bacilli, periodic acid-Schiff for fungus, and Giemsa for Leishman-Donovan bodies showed positivity in 11.3%, 43.5%, and 3.2%, respectively.

CONCLUSION

A multiplex PCR (Mycobacterium tuberculosis, Leishmania, and panfungal) is highly recommended in all cases of IGD where an etiological agent is difficult to establish by skin biopsy and histochemical stains along with a clinicopathological correlation. This will augment in appropriate treatment and will reduce empirical treatment and morbidity in such patients.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Parkhi M
Departments of Histopathology.
Kumar S M
Departments of Histopathology.
De D
Dermatology. Venereology. Leprology, and.
Yadav R
Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Sethi S
Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Radotra BD
Departments of Histopathology.
Saikia UN
Departments of Histopathology.

MeSH

AdolescentAdultAgedAged, 80 and overChildChild, PreschoolColoring AgentsDNADermatomycosesFemaleFungiGranulomaHumansIndiaInfantLeishmaniaLeishmaniasis, CutaneousMaleMiddle AgedMycobacterium tuberculosisPolymerase Chain ReactionSkin Diseases, InfectiousStaining and LabelingTuberculosis, CutaneousYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33395043

Citation

Parkhi, Mayur, et al. "Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population." The American Journal of Dermatopathology, vol. 43, no. 8, 2021, pp. 567-573.
Parkhi M, Kumar S M, De D, et al. Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population. Am J Dermatopathol. 2021;43(8):567-573.
Parkhi, M., Kumar S, M., De, D., Yadav, R., Sethi, S., Radotra, B. D., & Saikia, U. N. (2021). Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population. The American Journal of Dermatopathology, 43(8), 567-573. https://doi.org/10.1097/DAD.0000000000001878
Parkhi M, et al. Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population. Am J Dermatopathol. 2021 08 1;43(8):567-573. PubMed PMID: 33395043.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population. AU - Parkhi,Mayur, AU - Kumar S,Mukin, AU - De,Dipankar, AU - Yadav,Rakesh, AU - Sethi,Sunil, AU - Radotra,Bishan Dass, AU - Saikia,Uma Nahar, PY - 2021/1/5/pubmed PY - 2021/12/21/medline PY - 2021/1/4/entrez SP - 567 EP - 573 JF - The American Journal of dermatopathology JO - Am J Dermatopathol VL - 43 IS - 8 N2 - BACKGROUND: A definite diagnosis of infectious granulomatous dermatitis (IGD) is difficult for both practicing dermatologists and dermatopathologists due to overlapping clinical and histomorphological features. We aimed to explore the role of multiplex polymerase chain reaction (PCR) for identifying a definite etiological agent for diagnosis and appropriate treatment in IGD in formalin-fixed paraffin-embedded tissue. MATERIALS AND METHODS: Sixty-two cases of IGD were included, excluding leprosy. The histochemical stains including Ziehl-Neelsen, periodic acid-Schiff, and Giemsa were performed in all cases. A multiplex PCR was designed for detection of tuberculosis (TB) (IS6110 and mpt64), fungal infections (ITS1, ITS2; ZM1, and ZM3), and leishmaniasis (kDNA). The results of histomorphology, histochemical stains, and multiplex PCR were compared. RESULTS: Among 62 cases, the sensitivity rate of PCR detection for organisms was 16.7%, 0%, 100%, 72%, 75%, and 66.7% in patients with TB, suggestive of TB, leishmaniasis, fungal infections, and granulomatous dermatitis not otherwise specified and granulomatous dermatitis suggestive of fungus, respectively. The TB PCR using IS6110 primers was negative in all cases; however, PCR using mpt64 primers was positive in 33.33% cases of scrofuloderma. The histochemical stains including Ziehl-Neelsen for acid-fast bacilli, periodic acid-Schiff for fungus, and Giemsa for Leishman-Donovan bodies showed positivity in 11.3%, 43.5%, and 3.2%, respectively. CONCLUSION: A multiplex PCR (Mycobacterium tuberculosis, Leishmania, and panfungal) is highly recommended in all cases of IGD where an etiological agent is difficult to establish by skin biopsy and histochemical stains along with a clinicopathological correlation. This will augment in appropriate treatment and will reduce empirical treatment and morbidity in such patients. SN - 1533-0311 UR - https://www.unboundmedicine.com/medline/citation/33395043/Diagnostic_Utility_of_Biplex/Multiplex_Polymerase_Chain_Reaction_in_Infectious_Granulomatous_Dermatitis_in_North_Indian_Population_ DB - PRIME DP - Unbound Medicine ER -