A histological classification of mucocutaneous leishmaniasis in Brazil and its clinical evaluation

Abstract

Biopsies of skin and mucosal lesions were made on 60 well documented Brazilian patients with untreated cutaneous or mucocutaneous leishmaniasis, whose response to treatment was subsequently evaluated in 38 cases. The biopsies were examined with a view to classification after correlation with clinical and immunological findings. Although there was no simple or unified spectrum, five histological groups were defined and found to have some clinico-prognostic significance. In two groups the cases were all cutaneous with a relatively good prognosis. In another two groups they were evolving as mucocutaneous with a poor prognosis. The fifth group showed mixed characteristics with a tendency to relapse. There was no strong correlation with serum antibodies or Montenegro skin test, which were usually positive, or with parasite load, which was always low. The tissue response was distinguished from that in oriental sore by the degree of connective tissue involvement in all groups. It was the primary response in two groups, and subsidiary to a mono-nuclear response in the others. It suggested damage due to extra-cellular parasites or immune complexes. It did not correlate with the distinction between cutaneous and mucocutaneous disease. The single, most favourable, prognostic feature in either the cellular or connective tissue component was necrosis with a reactive response.

Molecular and biologic characterization of Leishmania parasites implicated in an epidemic outbreak in northwestern Argentina

“…As in Colombia (Weigle et al 1993), direct examination was the most sensitive method, followed by in vitro culture and histopathology. All lesions showed nonspeci®c in¯ammation, in accordance with features described in persons infected with L. (V.) braziliensis (Ridley et al 1980), and sparse nests of Leishmania amastigotes (Magalhaes et al 1986). The limited eectiveness of parasitologic methods in the detection and isolation of parasites was likely related to the characteristic poor growth of L. (V.) braziliensis in arti®cial media (Walton et al 1977;Lainson and Shaw 1979;Rey et al 1990).…”

Immunohistochemical analysis of the mucosal lesion in mucocutaneous leishmaniasis

“…T cells have a potential role in the early LCL lesions (Esterre, 1991), where a non-specific inflammatory reaction occurs, but not in more chronic stage such as old LCL and MCL lesions (Pirmez, 1990). As far as this hypothesis is true, the MCL lesion can be considered as a "delayed" (Ridley, 1989) In contrast to the observations made in New World LCL (Iiuaman, 1990;Esterre, 1991) and MCL (Ridley, 1980;Ridley, 1983;Ridley, 1989), the involvement of a connective tissue reaction is considered to be insi gnificant in Old World LCL (Ridley, 1979). The fibro tic process has been linked to a good prognosis (Ridley, 1980;Ridley, 1989;Huaman, 1990;Gutierrez, 1991), in contrast to the macrophage lysis and the associated tissue necrosis (Ridley, 1989).…”

“…1991 ) and MCL (Ridley, 1980;Marsden, 1986;Ridley, 1989;Huaman, 1990) documented in LCL (Castes, 1983;Carvalho, 1985;Magalhaes, 1986;Modlin, 1989;Pirmez, 1990;Esterre, 1992), but less in MCL. In this last pathology, the immune response has been characterized in the peripheral blood (Carvalho, 1985) and at the T lym phocyte level (Pirmez, 1990).…”

Étude anatomoclinique de la forme lupoïde de la leishmaniose cutanée (16 cas)

“…Les corps de Leishman sont souvent difficiles à mettre en évidence. Cet aspect histologique avec réaction granulomateuse et corps de Leishman rares ou absents correspond au stade E de la classification de Ridley et al [11] et Gaafar et al [12].…”