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Published on: April 21, 2012
Transepidermal elimination in cutaneous leishmaniasis: a multiregional study
Sarah Karram1, Asif Loya, Hadi Hamam
1Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Journal of Cutaneous Pathology
|March 27, 2012
Summary
Transepidermal elimination, a skin reaction, was found in 28.3% of cutaneous leishmaniasis cases, particularly with Leishmania major infection. This finding may indicate a unique way parasites exit the skin.
Area of Science:
- Dermatology
- Infectious Diseases
- Parasitology
Background:
- Transepidermal elimination (TEE) is observed in various infectious diseases.
- Its role in cutaneous leishmaniasis (CL) has not been previously evaluated.
Purpose of the Study:
- To investigate the occurrence and characteristics of TEE in CL patients.
- To identify factors associated with TEE in CL.
Main Methods:
- Histopathological analysis of 212 skin biopsies from CL patients across four countries.
- Evaluation of TEE, parasitic index, interface changes, ulceration, and necrosis.
- Confirmation and subtyping of Leishmania species using PCR and RFLP.
Main Results:
- Leishmania tropica (88.2%) and Leishmania major (11.8%) were identified.
- TEE was observed in 28.3% of cases, with a higher prevalence in L. major infections (35% vs. 2%).
- TEE correlated with interface changes and higher parasitic index, but not increased ulceration.
Conclusions:
- This study documents TEE in 28.3% of CL cases, with 48% showing a perforating plug.
- A significant association was found between TEE, L. major, interface changes, and higher parasitic index.
- TEE may represent a mechanism for parasite extrusion through the epidermis in CL.
