Histopathology of Cutaneous Leishmaniasis Caused by Leishmania donovani in Sri Lanka

Harshima Wijesinghe,Nayana Gunathilaka,Saveen Semege,Deepika Fernando,Nuwani Manamperi,Chandu De Silva,Nishantha Pathirana

doi:10.1155/2020/4926819

Harshima Wijesinghe, Nayana Gunathilaka + Show 5 more

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https://doi.org/10.1155/2020/4926819

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Abstract

Cutaneous leishmaniasis (CL) is a neglected tropical disease that is gaining importance in Sri Lanka and internationally. The clinical presentation, pathology, and method of parasite elimination in CL vary according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This collaborative cross-sectional study describes the clinicopathological features of cutaneous leishmaniasis among personnel of the tri-forces serving in the North and East of the country. The histology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression, and histology) was reviewed. The parasitic load was assessed semiquantitatively. The histological features were correlated with the clinical presentation and organism load. The majority (89.8%; n = 44) presented with a single lesion mostly located in the upper limb (69.4%). The lesion types included papule (34.7%), nodule (32.7%), and an ulcer (30.6%). The evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 of the biopsies and included hyperkeratosis (90.0%; n = 45), acanthosis (44.0%; n = 22), atrophy (34.0%; n = 17), and interface change (66%; n = 33). Dermal changes were seen in all cases and were characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20% (n = 10). Leishmania amastigote forms were observed in 88% (n = 44). Transepidermal elimination (P = 0.025), granuloma (P = 0.027) formation, and type of lesion (P = 0.034) were significantly associated with the organism load. Granuloma formation was associated with a reduction in organism load, indicating that the macrophage activation played an important role in the control of the organism.

Highlights

Leishmaniasis, a neglected tropical disease, is caused by the intracellular protozoan of the genus Leishmania
Of the three main forms of clinical presentations seen with leishmaniasis, cutaneous leishmaniasis (CL) is the most common with an estimated 600,000 to one million new cases occurring worldwide annually [1]
Clinical material collected from skin lesions of personnel of the tri-forces serving in the North and East of the country with features suspicious for CL was evaluated for the presence of Leishmania organisms by slit skin smear, lesion aspirate, tissue impression, and histology

Summary

Introduction

Leishmaniasis, a neglected tropical disease, is caused by the intracellular protozoan of the genus Leishmania. Of the three main forms of clinical presentations seen with leishmaniasis, cutaneous leishmaniasis (CL) is the most common with an estimated 600,000 to one million new cases occurring worldwide annually [1]. The estimated global burden of this disease is believed to be higher than the reported numbers due to underreporting, under surveillance, and inadequate case detection techniques [2]. Since 1993, the geographical distribution of leishmaniasis is reported to have expanded significantly in the world, with a concomitant sharp increase in the number of cases [3] and emerging new disease foci [4]. Leishmania donovani MON-37 has been reported to be the causative organism of both cutaneous

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