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Cutaneous Leishmaniasis: Contribution of Routine Histopathology in Unexpected Encounters.

Jerome B Taxy1, Harry M Goldin2, Sara Dickie3

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Cutaneous leishmaniasis, a sandfly-transmitted protozoan disease, presents as ulcerated papules. Diagnosis in non-endemic areas relies on travel history, morphology, and molecular techniques when organisms are not visible.

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Area of Science:

  • Dermatology
  • Infectious Diseases
  • Parasitology

Background:

  • Cutaneous leishmaniasis is caused by Leishmania protozoa, transmitted by sandflies.
  • It presents as ulcerated papules, a form of granulomatous dermatitis.
  • Diagnosis in non-endemic regions like North America often requires a travel history.

Purpose of the Study:

  • To highlight diagnostic challenges and methods for cutaneous leishmaniasis.
  • To emphasize the role of morphology and molecular techniques in diagnosis.
  • To raise awareness of this unusual infection in a global context.

Main Methods:

  • Histopathological examination of skin biopsies.
  • Giemsa and CD1a immunostaining for organism identification.
  • Polymerase chain reaction (PCR) and DNA sequencing for speciation.

Main Results:

  • Four cases of cutaneous leishmaniasis were analyzed.
  • Leishmania organisms were identified morphologically in 3 cases.
  • PCR and DNA sequencing confirmed the diagnosis in 3 cases, including one without identifiable organisms.

Conclusions:

  • Morphology and special stains are crucial but can be challenging.
  • Molecular techniques like PCR are vital for confirming diagnosis, especially when organisms are not visible.
  • Increased global travel and climate change necessitate heightened awareness of leishmaniasis in non-endemic areas.