Clinicopathological Profile of Cutaneous Leishmaniasis in Army Personnel in the Kilinochchi and Mulllativu Districts of Sri Lanka

Abstract

INTRODUCTION AND OBJECTIVES: Leishmaniasis is caused by an intra cellular protozoan of the genus Leishmania. The clinicopathological profile of cutaneous leishmaniasis (CL) varies according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This study describes the clinicopathological features of cutaneous leishmaniasis among army personnel serving in two Northern districts of the country. METHODS: In this collaborative cross-sectional study, the histopathology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression and histology) were reviewed. The parasitic load was assessed semi-quantitatively. The histological features were correlated with the clinical presentation and organism load. RESULTS: The majority (89.8%; n=44) presented with a single lesion mostly located in the upper limb (69.4%, n=34). The lesion types included papule (34.7%, n=17), nodule (32.7%, n=16) and ulcer (30.6%, n=15). Evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 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 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 organism load with granuloma formation being associated with reduction in organism load. CONCLUSION: Histopathological changes were characterised by a diffuse lymphohistioplasmacytic infiltrate, ill-defined granuloma or well-formed granuloma. Well-formed granulomata were associated with a reduction in organism load.