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Histopathological Patterns of Cutaneous and Mucocutaneous Leishmaniasis Due to L. aethiopica
Abay Atnafu1, Zewditu Chanyalew2, Sofia Yimam1
1Department of Communicable and Non Communicable Disease, Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
Insights
This study details the histopathological features of cutaneous leishmaniasis (CL) in Ethiopia caused by Leishmania aethiopica. Findings reveal diffused inflammatory cell infiltrate, predominantly macrophages and lymphocytes, in CL skin lesions.
Area of Science:
- Dermatology
- Infectious Diseases
- Pathology
Background:
- Cutaneous leishmaniasis (CL) is endemic in Ethiopia, primarily caused by Leishmania aethiopica.
- Limited histopathological data exists for CL lesions caused by L. aethiopica.
Purpose of the Study:
- To analyze the histopathological features of CL caused by L. aethiopica.
- To correlate histopathological findings with CL clinical forms.
Main Methods:
- Analysis of skin biopsies from PCR-confirmed CL patients.
- Hematoxylin and eosin (H&E) staining for histopathological examination.
- Descriptive statistics using SPSS version 26.0.
Main Results:
- Amastigotes found in 29% of MCL and 58% of LCL cases.
- Diffused inflammatory cell infiltrate (macrophages, lymphocytes) observed in 77% of samples.
- Significant correlations noted between necrosis, granuloma types, eosinophils, giant cells, and CL forms.
Conclusions:
- CL in Ethiopia caused by L. aethiopica exhibits dermal changes dominated by diffused inflammatory cell infiltrate.
- Macrophages and lymphocytes are the primary inflammatory cells.
- Amastigotes are present in histiocytes, with varying granuloma patterns observed.
Abstract:
Background: Cutaneous leishmaniasis (CL) is an endemic disease in Ethiopia, mainly caused by L. aethiopica. Limited reports are available related to histopathological features of the skin lesion caused by L. aethiopica. This study aimed to analyze the histopathological features of CL due to L. aethiopica. Materials and Methods: A similar cohort polymerase chain reaction (PCR) confirmed CL patients from a previous own study, who were prospectively enrolled from All Africa Leprosy, Tuberculosis and Rehabilitation Training (ALERT) Hospital Addis Ababa, Kela Health Center in Gurage Zone, Siliti Health Center in Silit zone of southern nations and nationalities, as well as Ankober Health Center in Amhara region was used for data analysis. The histopathology was analyzed by performing hematoxylin and eosin (H&E) staining to look for the presence of general and specific histopathology patterns of the disease. Descriptive statistics was utilized using SPSS version 26.0 (SPSS, Inc., Chicago, United States of America). Results: Amastigotes were observed in skin biopsies of 29% (n = 2) mucocutaneous leishmaniasis (MCL) and 58% (n = 6) localized cutaneous leishmaniasis (LCL) patients. Diffused inflammatory cell infiltrate was observed in the dermal compartment of 77% (n = 20) samples while the remaining 23% (n = 6) had patchy or nodular inflammatory cell infiltrate. The dominant type of inflammatory cell infiltrate in the dermal compartments is macrophages and lymphocytes with a similar proportion, 23/26 (88.5%), followed by plasma cells, 21/26 (80.8%). Among all cases, 38.5% (n = 10) of them were categorized under the Type I pattern while Types IV and V patterns were reported in 26.9% (n = 7) and 34.6% (n = 9) of the remaining samples, respectively. The study found statistically significant correlations between necrosis and MCL (p=0.01), unorganized granulomas and LCL (p=0.04), and the presence of eosinophils and giant cell Langerhans with MCL (p=0.002 and p < 0.001, respectively). Conclusion: In our study, the histopathological patterns of the CL caused by L. aethiopica were shown to have a dermal change that was characterized by a domination of diffused inflammatory cell infiltrate. Most of the cell types in the infiltrate were macrophages and lymphocytes. In addition, amastigote resided in the histiocyte with a varying degree of intensity, and both the organized and unorganized granulomas were shown with a considerable proportion.
