Laboratory profile in patients of cutaneous leishmaniasis from various regions of Pakistan.

Abstract

To delineate the different laboratory findings in patients of cutaneous leishmaniasis and to see the efficacy of some recent immunodiagnostic tools in the diagnosis of disease. Descriptive case-control study. The study was conducted over a period of two years in Military Hospital (MH) and Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan. Fifty patients with clinical diagnosis of cutaneous leishmaniasis(CL), were included in the study from western, south-western and northern regions of the country (Quetta, Multan, Chakwal, Kohat, Northern areas and Islamabad). Complete blood picture, blood groups, skin slit smears, impression smears and skin biopsies and serological tests including Enzyme-linked immunosorbent assay (ELISA), indirect fluorescent antibody test (IFAT), and indirect hemagglutination assay (IHA) were done in all cases. Immunohistochemistry with IFAT was performed in 20 patients and kDNA (kinetoplast DNA) probes in 16 patients. These tests were then evaluated to see their efficacy in diagnosis of CL. Blood CP was normal except for low hemoglobin levels. Most prevalent blood group was B-positive. Skin slit smear and impression smears were positive in 30% and 36% cases respectively. On histopathology four distinct histological patterns emerged. Results with H&E, Giemsa and Leishman stains were similar (36%) and PAS failed to stain parasite. On tissue section IFAT yielded 36%, peroxidase-antiperoxidase (PAP) 45% and kDNA probes 25% positive results. Serology was positive in 56% with ELISA, in 50% each with IFAT and IHA tests. Routine blood tests have no role in diagnosis of CL. Skin slit smear and touch impression smears are rapid means of diagnosis. Modern immunodiagnostic methods can produce better results but these are costly and availability is limited. In our setup slit skin smear/impression smear and light microscopy with routine H and E staining are probably the most co-effective accurate diagnostic methods.