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Published on: April 21, 2012
A histopathological study of cutaneous leishmaniasis in Sri Lanka
C H P Herath1, N V I Ratnatunga, R Waduge
1Department of Pathology, Teaching Hospital, Peradeniya, Sri Lanka. chaturika_herath@yahoo.com
Insights
Cutaneous leishmaniasis in Sri Lanka presents a spectrum of skin lesions similar to leprosy. T-cell responses varied across these groups, mirroring patterns seen in leprosy patients.
Area of Science:
- Immunology
- Dermatology
- Infectious Diseases
Background:
- Cutaneous leishmaniasis (CL) is endemic in Sri Lanka, but its immunopathogenesis remains understudied.
- Understanding the immune response in CL is crucial for effective treatment and management.
Purpose of the Study:
- To histologically classify CL skin lesions in Sri Lankan patients.
- To assess parasitic load, inflammatory cell density, necrosis, and lymphocytic reactions.
- To compare the lymphocytic profile of CL with that of leprosy.
Main Methods:
- Skin biopsies from 31 CL patients with confirmed amastigotes were analyzed.
- Lesions were classified into four histological groups by two independent observers.
- Immunohistochemistry was used to quantify T and B cells (CD45RO and CD20).
Main Results:
- CL lesions exhibited a histological spectrum (Groups I-IV) analogous to the leprosy spectrum (lepromatous to tuberculoid).
- A significant inverse relationship was observed between histological group and parasitic load.
- T-cell percentages in CL groups I-IV (20.1% to 47.8%) closely mirrored those in leprosy spectrum (21.3% to 48.0%).
Conclusions:
- Cutaneous leishmaniasis exhibits a spectral disease pattern comparable to leprosy.
- The T-cell distribution across the CL spectrum aligns with that observed in leprosy.
- B-cell percentages showed minimal variation across the CL spectrum.
Unlabelled:
INTRODUCTION; Cutaneous leishmaniasis is endemic in Sri Lanka. The immunopathogenesis of these lesions in Sri Lankans has not been documented.
Objectives:
To classify skin lesions into histological groups, to assess parasitic load, density of each inflammatory cell type and necrosis and to characterise the lymphocytic reaction in cutaneous leishmaniasis in comparison to leprosy.
Methods:
Skin biopsies from 31 patients with demonstrable amastigotes in smears or tissue sections were studied. The lesions were classified by two independent observers into four distinct histological groups based on different cell types in the inflammatory infiltrate and formation of granulomata. Parasitic load and the presence of necrosis were recorded. Immunohistochemical staining for CD45RO and CD20 for counting T and B cells respectively was done.
Results:
Histological groups of cutaneous leishmaniasis ranging from group I-IV were similar to that of the spectrum in leprosy ranging from lepromatous to tuberculoid leprosy. The histological groups from I-IV showed a significant inverse relationship with the mean parasitic index. Necrosis was not a prominent feature. The mean percentage of T cells in the histological spectrum from group I-IV in leishmaniasis was similar to the spectrum from lepromatous to tuberculoid leprosy. Mean percentage of T cells were 20.1% in group I, 20.5% in group II, 33.8% in group III and 47.8% in group IV. Lepromatous, borderline tuberculoid and tuberculoid leprosy had 21.3%, 33.4% and 48.0% T cells respectively.
Conclusion:
Cutaneous leishmaniasis is a spectral disease similar to leprosy. The mean percentage T cells from group I-IV were similar to those in the spectrum of leprosy and mean percentage B cells varied in a narrow range.
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