2010
DOI: 10.4038/cmj.v55i4.2626
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A histopathological study of cutaneous leishmaniasis in Sri Lanka

Abstract: 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 classi… Show more

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Cited by 13 publications
(12 citation statements)
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“…Its organization ranged from diffuse inflammatory infiltrate with parasitized macrophages to varying degrees of granuloma formation that extended from ill‐formed histiocytic to epithelioid granulomata. Similar histological changes have been observed in previous studies carried out on CL due to L. major and L. donovani in the local setting . Varying degrees of necrosis have been described in American tegumentary leishmaniasis as well as in CL in the old world .…”
Section: Discussionsupporting
confidence: 84%
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“…Its organization ranged from diffuse inflammatory infiltrate with parasitized macrophages to varying degrees of granuloma formation that extended from ill‐formed histiocytic to epithelioid granulomata. Similar histological changes have been observed in previous studies carried out on CL due to L. major and L. donovani in the local setting . Varying degrees of necrosis have been described in American tegumentary leishmaniasis as well as in CL in the old world .…”
Section: Discussionsupporting
confidence: 84%
“…Varying degrees of necrosis have been described in American tegumentary leishmaniasis as well as in CL in the old world . However, necrosis was not a prominent feature in this study, and therefore parasite elimination in CL due to L. donovani appears to depend on activation of macrophages to form epithelioid granulomas, rather than through a necrotizing process, as previously suggested . Interestingly, up‐regulation of IFN‐γ seen in this study provide further support for this assumption, as IFN‐γ is a potent activator of macrophages .…”
Section: Discussionmentioning
confidence: 99%
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“…The cutaneous reaction to leishmaniasis amastigotes has typically been classified into five groups and range from almost normal skin to an intense cellular infiltration, granuloma formation and necrosis; of these, necrosis has been considered the most effective means for elimination of amastigotes 51 . In addition, the presence of amastigotes in all epidermal layers suggesting transepidermal elimination has been shown in a limited number of cases in humans and animal models; however, these findings were not comprehensively evaluated 52–55 . In our series, cases with transepidermal elimination were thoroughly evaluated and were found to be associated with a decreased incidence of necrosis and ulceration, as well as a notably higher rate of interface changes.…”
Section: Discussionmentioning
confidence: 99%