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Karabulut YY, Bozkurt FK, Türsen Ü, Bayram G, Temel GÖ, Erdal ME. The role of CD1a expression in the diagnosis of cutaneous leishmaniasis, its relationship with leishmania species and clinicopathological features. Dermatol Ther 2021; 34:e14977. [PMID: 33991375 DOI: 10.1111/dth.14977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
Abstract
Cutaneous leishmaniasis is caused by a flagellated protozoan transmitted by the bite of a female sandfly. The clinical and demographic details of this disease, predominantly affecting immunocompetent individuals, are recognized by the WHO as a Neglected Tropical Disease. We sought to determine the usability of CD1a immunohistochemical staining to detect amastigotes especially in cases where leishmaniasis is suspected but evident amastigotes could not observed. We also evaluated the relationship between CD1a expression and leishmania subtypes. A total of 84 cases diagnosed with leishmaniasis or suspected leishmania on histo-morphological evaluation of skin biopsies were included in the study. Amastigotes were easily detected in hematoxylin eosin in 18 of 84 cases. In 23 cases, amastigotes could not detect in hematoxylin eosin sections. The immunostains for CD1a are demonstrated amastigotes in 60 of 84 cases. However, a small number of amastigotes became visible by positive staining with CD1a in 43.4% of the cases in that amastigotes could not detected in hematoxylin eosin. A statistically significant correlation was found between amastigote amount in hematoxylin eosin and CD1a expression. In addition, a significant correlation was observed between CD1a expression, age and clinical pre-diagnosis of the cases. It was observed that amastigotes were easily detected in hematoxylin eosin in Leishmania Infantum / donovani positive cases in polymerase chain reaction (PCR), and at the same time, it was found that CD1a expression was significantly higher. Using histopathology examination with CD1a staining and/or PCR methods, a diagnosis of leishmaniasis can be established and early treatment initiated. This contributes to reduce transmission and prevalence.
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Affiliation(s)
| | - Funda Kuş Bozkurt
- Department of Pathology, Mersin University, School of Medicine, Mersin, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University, School of Medicine, Mersin, Turkey
| | - Gül Bayram
- Department of Medical Services and Techniques, Vocational School of Health Services, Mersin University, Mersin, Turkey
| | - Gülhan Örekeci Temel
- Department of Biostatistics, Mersin University, School of Medicine, Mersin, Turkey
| | - Mehmet Emin Erdal
- Department of Medical Biology and Genetics, Mersin University, School of Medicine, Mersin, Turkey
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Hammond AM, Kallis PJ, Sokumbi O, Auerbach J, Vincek V, Motaparthi K. The EP3662 clone of CD1a supports the diagnosis of New World cutaneous leishmaniasis. J Cutan Pathol 2021; 48:1317-1320. [PMID: 33675546 DOI: 10.1111/cup.14001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Alexander M Hammond
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Penelope J Kallis
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Olayemi Sokumbi
- Department of Dermatology and Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jena Auerbach
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Vladimir Vincek
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
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Lopez-Trujillo E, Gonzàlez-Farré M, Pujol RM, Bellosillo B, Fisa R, Riera C, Alcover M, Barranco C, Martin-Ezquerra G. Diagnostic usefulness of immunohistochemical evaluation of CD1a antigen and polyclonal anti-leishmania antibodies in cutaneous leishmaniasis. Histol Histopathol 2021; 36:567-576. [PMID: 33665791 DOI: 10.14670/hh-18-324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Different immunohistochemical markers to detect amastigotes in cutaneous leishmaniasis have been proposed with variable diagnostic usefulness. OBJECTIVES To evaluate the diagnostic usefulness of immunohistochemical amastigotes identification by specific polyclonal anti-Leishmania antibodies and CD1a expression (clone EP3622) in a series of PCR confirmed cutaneous leishmaniasis. MATERIALS AND METHODS Thirty-three skin samples corresponding to PCR confirmed cutaneous leishmaniasis were included in the study. All samples were stained with Hematoxylin-eosin and Giemsa. Moreover, immunohistochemical studies with anti-CD1a and anti-Leishmania antibodies were performed. The patients clinical features and the observed histopathological features were also recorded. RESULTS From the selected 33 biopsies, Leishmania spp. amastigotes were detected in 48.4% of cases with conventional Hematoxylin-eosin stain and in 57.5% of cases by Giemsa staining. In 31/33 cases, anti-CD1a allowed us to identify parasitic structures, and in 33/33 cases amastigotes were detected with anti-Leishmania antibodies. Concordance between both techniques, anti-CD1a and anti-Leishmania, was 94% [CI 95%: (79,8%-99,3%)] ; p value <0.05. The sensitivity of anti-CD1a in comparison with the PCR was 94%, with a positive predictive value of 100%. Two cases of low parasitic index were negative for CD1a immunostaining. In cases with high parasitic index, anti-CD1a stained amastigotes in superficial and deep dermis. Only a few cases were originally diagnosed with the available histological techniques, needing PCR for Leishmania spp. CONCLUSIONS Anti-CD1a antibody seems to be a useful technique to identify amastigotes when PCR and anti-Leishmania antibodies are not available. The sensitivity to detect amastigotes is increased when the CD1a immunostaining is added to the classical Haematoxylin - eosin and Giemsa staining.
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Affiliation(s)
| | | | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Beatriz Bellosillo
- Department of Pathology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Roser Fisa
- Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Riera
- Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
| | - Magdalena Alcover
- Department of Biology, Healthcare and the Environment, Faculty of Pharmacy and Food Science, Universitat de Barcelona, Barcelona, Spain
| | - Carlos Barranco
- Department of Pathology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
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Ródenas-Herranz T, Linares-González L, Carpena-Martínez I, Pérez-Ramos M, Ruiz-Villaverde R. Cutaneous leishmaniasis induced by TNF-α blockers: a diagnostic challenge. Int J Dermatol 2020; 60:e101-e103. [PMID: 32989744 DOI: 10.1111/ijd.15222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/14/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Miguel Pérez-Ramos
- Pathology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
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Cardozo RS, García-Montero PP, Chicharro C, Tardío JC. Cutaneous leishmaniasis: A pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis. J Cutan Pathol 2020; 47:1018-1025. [PMID: 32578232 DOI: 10.1111/cup.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 05/23/2020] [Accepted: 06/18/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Traditional methods for the diagnosis of leishmaniasis yield poor sensitivity, which limits its effectiveness in lesions with a low parasite burden. METHODS Retrospective pathologic study of 360 cases of cutaneous leishmaniasis and analysis of the different diagnostic methods used. RESULTS In 93% of the lesions, histopathology showed a dense and diffuse inflammatory infiltrate, consisting of lymphocytes, histiocytes and plasma cells, which occupied the superficial and mid dermis and variably extended to deep dermis and superficial subcutis (standard pattern). The remaining cases exhibited atypical features, such as perivascular, interstitial or perifollicular inflammatory patterns, folliculitis or panniculitis. Granulomas were identified in 84% of biopsies, most of them as small, poorly formed, non-necrotizing histiocytic aggregates. Amastigotes were visualized by routine histopathologic exam in 36% of biopsies. Immunohistochemistry stained 17 of 26 lesions (65%) negative by conventional stains. PCR provided the correct diagnosis in 218 cases (58% of the series) negative for Leishmania by other techniques. CONCLUSIONS Biopsies negative for Leishmania by traditional diagnostic methods that show the histopathologic standard pattern, those with atypical features from patients with clinical suspicion of cutaneous leishmaniasis in endemic areas, should be studied by immunohistochemistry and/or PCR for Leishmania in order to reach the definitive diagnosis.
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Affiliation(s)
- Rocío S Cardozo
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | | | - Carmen Chicharro
- Leishmaniasis and Chagas Disease Unit, Reference and Research Laboratory in Parasitology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan C Tardío
- Department of Pathology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Basic Medical Sciences, Universidad Rey Juan Carlos, Madrid, Spain
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Autochthonous Cases of Mucosal Leishmaniasis in Northeastern Italy: Clinical Management and Novel Treatment Approaches. Microorganisms 2020; 8:microorganisms8040588. [PMID: 32325735 PMCID: PMC7232153 DOI: 10.3390/microorganisms8040588] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022] Open
Abstract
Mucosal leishmaniasis (ML) is a rare clinical variant of tegumentary leishmaniasis in Mediterranean Europe. Here we report on three autochthonous cases of head and neck ML in patients living in Northeastern Italy. Patients presented with non-specific, long-standing symptoms of upper respiratory tract involvement, mimicking other diseases. Parasitological diagnosis was reached by histopathology, immunohistochemistry and molecular biology on tissue specimens. Leishmania infantum was identified by molecular typing in all three cases. All patients reached a complete remission with protracted multivalent antileishmanial drugs; in one case, a novel approach of combined medical and endoscopic surgical treatment was carried out. High clinical suspicion led to a prompt diagnosis and deployment of a multivalent treatment. ML should be considered in the differential diagnosis of nasal, oral, and pharyngolaryngeal lesions in endemic areas. A prompt diagnosis is mandatory to establish a correct management; different antileishmanial medications as well as endoscopic surgical options may be required to reach a complete remission.
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DeCoste R, Walsh NM, Pasternak S. The EP3622 clone of CD1a in the diagnosis of cutaneous leishmaniasis. J Cutan Pathol 2020; 47:666-667. [PMID: 32144788 DOI: 10.1111/cup.13679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Ryan DeCoste
- Division of Anatomical Pathology, Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Noreen M Walsh
- Division of Anatomical Pathology, Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sylvia Pasternak
- Division of Anatomical Pathology, Department of Pathology, Queen Elizabeth II Health Sciences Centre, Nova Scotia Health Authority, Central Zone, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Thilakarathne IK, Ratnayake P, Vithanage A, Sugathadasa DP. Role of Histopathology in the Diagnosis of Cutaneous Leishmaniasis: A Case-Control Study in Sri Lanka. Am J Dermatopathol 2019; 41:566-570. [PMID: 31335408 DOI: 10.1097/dad.0000000000001367] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cutaneous leishmaniasis (CL) displays a spectrum of manifestations clinically and histologically. Then, it becomes a diagnostic challenge and must discern from the other clinical and histological mimics, especially when the Leishman-Donovan bodies are inattentive. In this study, we compared the distinguishing histomorphological characteristics of CL against the other skin diseases with similar clinical and histological features. Skin biopsies of 181 patients, which suspect CL clinically, are evaluated histologically. Pertaining to the first case-control comparison, which performed between skin lesions of CL with or without discernible organisms and the other granulomatous dermatitis, highlighted that the ill-formed coalescent granulomata (OR = 14.83) and diffuse dense dermal plasma cell infiltrate (OR = 74.25) are significantly associated with the skin lesions of CL. The second case-control analysis was between CL without discernible organisms and the other granulomatous dermatitis, and identified a significant association in the presence of ill-formed coalescent granulomata (OR = 16.94) and diffuse dense (>50/HPF) dermal plasma cell infiltrate (OR = 74.5) in the skin lesions of CL. Pertaining to epidermal changes, acanthosis (OR = 2.38), spongiosis (OR = 9.13), and the presence of ulceration (OR = 20.26) are among the major concerns in CL. In conclusion, in the presence of clinical suspicion, dermal granulomata in ill-formed coalescent morphology with high plasma cell density in a diffuse arrangement are positive factors for the diagnosis of CL, especially when the discernible Leishmania amastigotes are absent. Resource utilization such as polymerase chain reaction and other ancillary techniques during the diagnosis of CL can be minimized by using a range of histopathological features and special attention should be focused on this in the future.
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