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Comparison between Colorimetric In Situ Hybridization, Histopathology, and Immunohistochemistry for the Diagnosis of New World Cutaneous Leishmaniasis in Human Skin Samples. Trop Med Infect Dis 2022; 7:tropicalmed7110344. [DOI: 10.3390/tropicalmed7110344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
New world cutaneous leishmaniasis (NWCL) is an anthropozoonosis caused by different species of the protozoan Leishmania. Colorimetric in situ hybridization (CISH) was shown to satisfactorily detect amastigote forms of Leishmania spp. in animal tissues, yet it was not tested for the diagnosis of human NWCL. The aim of this study was to compare CISH, histopathology (HP), and immunohistochemistry (IHC) techniques to diagnose NWCL in human cutaneous lesions. The sample comprised fifty formalin-fixed, paraffin-embedded skin biopsy specimens from patients with NWCL caused by L. (V.) braziliensis. These specimens were analyzed by CISH, using a generic probe for Leishmania, IHC, and HP to assess the sensitivity of these methods by using a parasitological culture as a standard reference. Additional specimens from three patients diagnosed with cutaneous mycoses were also included to evaluate cross-reactions between CISH and IHC. The sensitivities of IHC, CISH, and HP for detecting amastigotes was 66%, 54%, and 50%, respectively. IHC, unlike CISH, cross-reacted with different species of fungi. Together, these results demonstrate that CISH may be a complementary assay for the detection of amastigote in the laboratorial diagnosis routine of human NWCL caused by L. (V.) braziliensis.
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Diagnostic Utility of Biplex/Multiplex Polymerase Chain Reaction in Infectious Granulomatous Dermatitis in North Indian Population. Am J Dermatopathol 2021; 43:567-573. [PMID: 33395043 DOI: 10.1097/dad.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A definite diagnosis of infectious granulomatous dermatitis (IGD) is difficult for both practicing dermatologists and dermatopathologists due to overlapping clinical and histomorphological features. We aimed to explore the role of multiplex polymerase chain reaction (PCR) for identifying a definite etiological agent for diagnosis and appropriate treatment in IGD in formalin-fixed paraffin-embedded tissue. MATERIALS AND METHODS Sixty-two cases of IGD were included, excluding leprosy. The histochemical stains including Ziehl-Neelsen, periodic acid-Schiff, and Giemsa were performed in all cases. A multiplex PCR was designed for detection of tuberculosis (TB) (IS6110 and mpt64), fungal infections (ITS1, ITS2; ZM1, and ZM3), and leishmaniasis (kDNA). The results of histomorphology, histochemical stains, and multiplex PCR were compared. RESULTS Among 62 cases, the sensitivity rate of PCR detection for organisms was 16.7%, 0%, 100%, 72%, 75%, and 66.7% in patients with TB, suggestive of TB, leishmaniasis, fungal infections, and granulomatous dermatitis not otherwise specified and granulomatous dermatitis suggestive of fungus, respectively. The TB PCR using IS6110 primers was negative in all cases; however, PCR using mpt64 primers was positive in 33.33% cases of scrofuloderma. The histochemical stains including Ziehl-Neelsen for acid-fast bacilli, periodic acid-Schiff for fungus, and Giemsa for Leishman-Donovan bodies showed positivity in 11.3%, 43.5%, and 3.2%, respectively. CONCLUSION A multiplex PCR (Mycobacterium tuberculosis, Leishmania, and panfungal) is highly recommended in all cases of IGD where an etiological agent is difficult to establish by skin biopsy and histochemical stains along with a clinicopathological correlation. This will augment in appropriate treatment and will reduce empirical treatment and morbidity in such patients.
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Reemergence of zoonotic cutaneous leishmaniasis in an endemic focus, northeastern Iran. Parasite Epidemiol Control 2021; 13:e00206. [PMID: 33889761 PMCID: PMC8048008 DOI: 10.1016/j.parepi.2021.e00206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 01/04/2021] [Accepted: 01/29/2021] [Indexed: 11/24/2022] Open
Abstract
Zoonotic cutaneous leishmaniasis (ZCL) is a form of disease, which is mostly caused by Leishmania major (L.major) in the Old World with high incidence through early life. Recently, the high incidence of CL has been reported in Jajarm County, northeastern Iran. The aim of the present study was to investigate the epidemiological aspects of CL and to identify Leishmania spp. in the area. Between 2012 and 2018, patients with active lesions suspected of CL were examined. Diagnosis was performed by methods of clinical examination and direct smears. Conventional kDNA polymerase chain reaction (PCR) was used to identify species of Leishmania. During the seven-year study period, 629 subjects were diagnosed as CL cases by clinical and microscopic examination. Considering the population of the study area, the average incidence rate was 237.8 per 100,000 population. Most (29.4%) of the subjects with ZCL were aged <10 years. Most of the patients (58.7%) were male and the rest were female. Most ulcers were observed on the face (32.2%) and hands (23.7%), respectively. Most patients (90%) had two or more ulcers on their body. The highest incidence was in the autumn in October (32%). Our data revealed that an ongoing reemergence of ZCL focus caused by L.major has arisen in the study area. Moreover, direct PCR on the smears for identifying Leishmania showed 100% specificity, and the species was identified as L. major using species -specific kDNA PCR. The use of conventional PCR on skin smears seems to provide a valuable method for confirming the clinical diagnosis of ZCL, which is very specific and sensitive particularly for clinical correlative studies. Further investigations are needed to improve planning strategies of vectors and reservoirs populations.
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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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Veasey JV, Zampieri RA, Lellis RF, Freitas THPD, Winter LMF. Identification of Leishmania species by high-resolution DNA dissociation in cases of American cutaneous leishmaniasis. An Bras Dermatol 2020; 95:459-468. [PMID: 32518010 PMCID: PMC7335872 DOI: 10.1016/j.abd.2020.02.003] [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: 09/08/2019] [Accepted: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
Background American cutaneous leishmaniasis is an infectious dermatosis caused by protozoa of the genus Leishmania, which comprises a broad spectrum of clinical manifestations depending on the parasite species involved in the infections and the immunogenetic response of the host. The use of techniques for amplification of the parasites DNA based on polymerase chain reaction polymerase chain reaction and the recent application of combined techniques, such as high-resolution DNA dissociation, have been described as a viable alternative for the detection and identification of Leishmania spp. in biological samples. Objectives To identify the Leishmania species using the polymerase chain reaction high-resolution DNA dissociation technique in skin biopsies of hospital-treated patients, and compare with results obtained by other molecular identification techniques. Methods A retrospective study assessing patients with suspected American cutaneous leishmaniasis seen at a hospital in São Paulo/Brazil was conducted. The paraffin blocks of 22 patients were analyzed by polymerase chain reaction high-resolution DNA dissociation to confirm the diagnosis and identify the species. Results Of the 22 patients with suspected American cutaneous leishmaniasis, the parasite was identified in 14, comprising five cases (35.6%) of infection by L. amazonensis, four (28.5%) by L. braziliensis, two (14.4%) by L. amazonensis + L. infantum chagasi, two (14.4%) by L. guyanensis, and one (7.1%) by Leishmania infantum chagasi. In one of the samples, in which the presence of amastigotes was confirmed on histopathological examination, the polymerase chain reaction high-resolution DNA dissociation technique failed to detect the DNA of the parasite. Study limitations The retrospective nature of the study and small number of patients. Conclusions The method detected and identified Leishmania species in paraffin-embedded skin biopsies with a sensitivity of 96.4% and could be routinely used in the public health system.
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Affiliation(s)
- John Verrinder Veasey
- Dermatology Clinic, Faculdade de Ciências Médicas, Hospital da Santa Casa de Misericórdia de São Paulo, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil.
| | - Ricardo Andrade Zampieri
- Department of Physiology, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rute Facchini Lellis
- Department of Pathological Anatomy, Hospital da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Thaís Helena Proença de Freitas
- Dermatology Clinic, Faculdade de Ciências Médicas, Hospital da Santa Casa de Misericórdia de São Paulo, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
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Rojas-Jaimes J, Frischtak HL, Arenas J, Lescano AG. Case Report: Mucosal Leishmaniasis Presenting with Nasal Septum Perforation after Almost Thirty Years. Am J Trop Med Hyg 2018; 99:327-330. [PMID: 29869609 PMCID: PMC6090329 DOI: 10.4269/ajtmh.17-0831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/13/2018] [Indexed: 01/09/2023] Open
Abstract
Mucosal leishmaniasis (ML) is associated with progressive tissue destruction and granuloma formation, often after a considerable period of latency from an initial cutaneous infection. We report a case of recurrent epistaxis of 3 years duration and nasopharyngeal obstruction in a woman with treated cutaneous leishmaniasis nearly 30 years before and with no further exposure to Leishmania. Computed tomography revealed nasal septal perforation and histopathology demonstrated chronic inflammation. Microscopy was negative for amastigotes, but molecular testing of nasal mucosa biopsy detected Leishmania (Viannia) braziliensis. The patient underwent 28 days of treatment with IV sodium stibogluconate and her symptoms improved significantly. Sixteen months after treatment, she continues to have episodic epistaxis and detectable parasite load in her nasal lesion. Although ML is known to take years to decades to develop, there are few reported cases in the literature of such a long latency period. This report highlights the importance of considering ML in the differential diagnosis of chronic epistaxis in countries where leishmaniasis is endemic or in immigrants from these countries, even when presentation occurs decades after leaving an endemic region.
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Affiliation(s)
- Jesùs Rojas-Jaimes
- Department of Medicine, Universidad Cientifica del Sur, Lima, Peru
- Department of Sciences, Universidad Continental, Lima, Peru
| | | | - Jose Arenas
- Hospital Nacional Guillermo Almenara Irigoyen ESSalud, Lima, Peru
| | - Andres G. Lescano
- Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Cayetano Heredia, Lima, Peru
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The Role of Histopathology and Immunohistochemistry in the Diagnosis of Cutaneous Leishmaniasis Without "Discernible" Leishman-Donovan Bodies. Am J Dermatopathol 2018; 39:890-895. [PMID: 29190217 DOI: 10.1097/dad.0000000000000861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Histopathology plays an important role in the diagnosis of cutaneous leishmaniasis (CL) but Leishman-Donovan (LD) bodies may not always be discernible. Recently, anti-CD1a antibody (Ab), clone MTB1, was found to decorate LD bodies immunohistochemically. OBJECTIVE Can histopathology without discernible LD bodies be used to diagnose CL, and can immunohistochemistry using anti-CD1a Ab, clone MTB1, detect LD bodies in these cases. METHODS Suspected CL lesions were studied histopathologically and immunohistochemically, and the patients' clinical files were reviewed. RESULTS Of the 196 patients with suspected CL, direct smear demonstrated LD bodies in 50 (25.5%). Of the remaining 146 patients, 118 underwent biopsy. In 56 (47.5%) patients, the hematoxylin-eosin-stained sections revealed LD bodies. In 47 (39.8%) patients, LD bodies were not discerned but the histopathology demonstrated histiocytic infiltrates with varying numbers of plasma cells along with other inflammatory cells, and negative Ziehl-Neelsen and periodic acid-Schiff stains. This pattern was termed "histopathology consistent with leishmaniasis." The history, clinical findings, and response to anti-leishmania therapy supported the diagnosis of CL in all of them, and immunostains for CD1a, clone MTB1, detected LD bodies in 11 (23.4%) of these 47 patients. CONCLUSIONS "Histopathology consistent with CL" along with appropriate clinical findings supports the diagnosis of CL in an endemic area, and immunostains with CD1a Ab, clone MTB1, may help in the minority of the cases.
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Tomasini C, Moneghini L, Barbui AM. Chronic amastigote-negative cutaneous leishmaniasis: A clinical, histopathologic and molecular study of 27 cases with emphasis on atypical and pseudolymphomatous presentations. J Cutan Pathol 2017; 44:530-537. [DOI: 10.1111/cup.12927] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Carlo Tomasini
- Dermatopathology Unit; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza; Turin Italy
| | - Laura Moneghini
- Division of Pathology, Department of Health Sciences; University of Milan, Hospital San Paolo; Milan Italy
| | - Anna M. Barbui
- Microbiology and Virology Unit; Azienda Ospedaliero Universitaria Città della Salute e della Scienza; Turin Italy
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Lupoid leishmaniasis among the known cases of cutaneous leishmaniasis in Herat Province, western Afghanistan. J Infect Public Health 2016; 9:557-63. [DOI: 10.1016/j.jiph.2015.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/20/2015] [Accepted: 12/11/2015] [Indexed: 11/23/2022] Open
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Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz RA. Cutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management. J Am Acad Dermatol 2016; 73:911-26; 927-8. [PMID: 26568336 DOI: 10.1016/j.jaad.2014.09.014] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/03/2014] [Accepted: 09/05/2014] [Indexed: 12/25/2022]
Abstract
The diagnosis of leishmaniasis can be challenging because it mimics both infectious and malignant conditions. A misdiagnosis may lead to an unfavorable outcome. Using culture, histologic, and/or polymerase chain reaction study results, a diagnosis of leishmaniasis can be established and treatment initiated. Appropriate management requires an accurate diagnosis, which often includes identification of the specific etiologic species. Different endemic areas have varying sensitivities to the same medication, even within individual species. Species identification may be of practical value, because infections with select species have a substantial risk of visceral involvement. In addition, HIV and otherwise immunocompromised patients with leishmaniasis have a propensity for diffuse cutaneous leishmaniasis. For most New World Leishmania species, parenteral antimonial drugs remain the first line of therapy, while Old World species are easily treated with physical modalities. Historically, live organism vaccination has been used and is effective in preventing leishmaniasis, but results in an inoculation scar and an incubation period that may last for years. A more effective method of vaccination would be welcome.
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Affiliation(s)
- Marc Z Handler
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Parimal A Patel
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Rajendra Kapila
- Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Robert A Schwartz
- Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey; Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Preventive Medicine and Community Health, Rutgers New Jersey Medical School, Newark, New Jersey; Rutgers School of Public Affairs and Administration, Newark, New Jersey.
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Cunha MA, Leão ACQ, de Cassia Soler R, Lindoso JAL. Efficacy and Safety of Liposomal Amphotericin B for the Treatment of Mucosal Leishmaniasis from the New World: A Retrospective Study. Am J Trop Med Hyg 2015; 93:1214-8. [PMID: 26483120 DOI: 10.4269/ajtmh.15-0033] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/20/2015] [Indexed: 11/07/2022] Open
Abstract
The standard treatment of mucosal leishmaniasis (ML) is pentavalent antimonials, agents with serious adverse effects. Alternative agents include amphotericin B deoxycholate and liposomal amphotericin B. We performed a retrospective study including 29 patients treated with liposomal amphotericin B, most of whom had comorbidities, history of previous treatment of ML, and contraindications to the use of antimonial pentavalent or amphotericin B deoxycholate. We observed a cure rate of 93.1%. Kidney failure was the most important side effect, reported in five patients (17.2%). This study showed a good efficacy and safety profile of liposomal amphotericin B in patients with ML and contraindications to the use of other agents.
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Affiliation(s)
- Mirella A Cunha
- Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; Laboratório de Soroepidemiologia (LIM-38 HC-FMUSP), Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
| | - Aline C Q Leão
- Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; Laboratório de Soroepidemiologia (LIM-38 HC-FMUSP), Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
| | - Rita de Cassia Soler
- Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; Laboratório de Soroepidemiologia (LIM-38 HC-FMUSP), Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
| | - José Angelo L Lindoso
- Instituto de Infectologia Emílio Ribas, São Paulo, Brazil; Laboratório de Soroepidemiologia (LIM-38 HC-FMUSP), Instituto de Medicina Tropical da Universidade de São Paulo, São Paulo, Brazil
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Montalvo AM, De Armas Y, Fraga J, Blanco O, Menéndez R, Montoto V, Capó de Paz V. Molecular and histological tools to diagnose an imported case of American cutaneous leishmaniasis in Cuba. Int J Dermatol 2015; 54:1175-9. [DOI: 10.1111/ijd.12915] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/29/2014] [Accepted: 11/23/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ana M. Montalvo
- Department of Parasitology; Pedro Kourí Institute for Tropical Medicine; Havana Cuba
| | - Yaxsier De Armas
- Department of Epidemiology; Pedro Kourí Institute for Tropical Medicine; Havana Cuba
| | - Jorge Fraga
- Department of Parasitology; Pedro Kourí Institute for Tropical Medicine; Havana Cuba
| | - Orestes Blanco
- Hospital of the Pedro Kourí Institute for Tropical Medicine; Havana Cuba
| | - Reinaldo Menéndez
- Hospital of the Pedro Kourí Institute for Tropical Medicine; Havana Cuba
| | - Vicente Montoto
- Provincial Center for Hygiene, Epidemiology and Microbiology; Santiago de Cuba Cuba
| | - Virginia Capó de Paz
- Department of Pathology; Pedro Kourí Institute for Tropical Medicine; Havana Cuba
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Pontello Junior R, Gon ADS, Ogama A. American cutaneous leishmaniasis: epidemiological profile of patients treated in Londrina from 1998 to 2009. An Bras Dermatol 2014; 88:748-53. [PMID: 24173180 PMCID: PMC3798351 DOI: 10.1590/abd1806-4841.20132168] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/27/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND American cutaneous leishmaniasis is a dermatozoonosis of compulsory notification with relevant morbidity. The disease is considered endemic in northern Paraná. OBJECTIVES To evaluate the clinical, laboratory and epidemiological aspects of patients with American cutaneous leishmaniasis treated at Clinics Hospital, State University of Londrina, Brazil (Paraná). METHODS This was an observational, cross-sectional, retrospective and descriptive study. The medical records of patients with American cutaneous leishmaniasis treated at the University Hospital of Londrina - Paraná, from 1998 to 2009 were evaluated. RESULTS A total of 470 patients, with prevalence of 8.72 cases / 100,000 inhabitants, participated in the study. Most patients were male, aged 21-40 years, with a single ulcerated lesion as the most common clinical presentation, located mainly in an exposed area of the body. With regard to immunological tests, the Montenegro intradermal reaction was positive in 84.4% of cases. Treatment with pentavalent antimony was well tolerated, and patient follow-up for a year occurred in 59% of cases. CONCLUSION American cutaneous leishmaniasis is still an endemic disease in the region, with a high potential for morbidity, but with a cure rate of around 95% after treatment. The use of immunological techniques facilitates the diagnosis of clinically suspicious cases.
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Satow MM, Yamashiro-Kanashiro EH, Rocha MC, Oyafuso LK, Soler RC, Cotrim PC, Lindoso JAL. Applicability of kDNA-PCR for routine diagnosis of American tegumentary leishmaniasis in a tertiary reference hospital. Rev Inst Med Trop Sao Paulo 2014; 55:393-9. [PMID: 24213191 PMCID: PMC4105086 DOI: 10.1590/s0036-46652013000600004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022] Open
Abstract
SUMMARY This study evaluated the applicability of kDNA-PCR as a prospective
routine diagnosis method for American tegumentary leishmaniasis (ATL) in patients
from the Instituto de Infectologia Emílio Ribas (IIER), a reference center for
infectious diseases in São Paulo - SP, Brazil. The kDNA-PCR method detected
Leishmania DNA in 87.5% (112/128) of the clinically suspected
ATL patients, while the traditional methods demonstrated the following percentages
of positivity: 62.8% (49/78) for the Montenegro skin test, 61.8% (47/76) for
direct investigation, and 19.3% (22/114) for in vitro culture.
The molecular method was able to confirm the disease in samples considered
negative or inconclusive by traditional laboratory methods, contributing to the
final clinical diagnosis and therapy of ATL in this hospital. Thus, we strongly
recommend the inclusion of kDNA-PCR amplification as an alternative diagnostic
method for ATL, suggesting a new algorithm routine to be followed to help the
diagnosis and treatment of ATL in IIER.
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Affiliation(s)
- Marcela M Satow
- Instituto de Medicina Tropical de São Paulo, São PauloSP, Brazil, , , , , , , , , ,
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Guarner J. Detection of microorganisms in granulomas that have been formalin-fixed: review of the literature regarding use of molecular methods. SCIENTIFICA 2012; 2012:494571. [PMID: 24278704 PMCID: PMC3820445 DOI: 10.6064/2012/494571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 06/02/2023]
Abstract
Granuloma is an organized aggregate of immune cells that under the microscope appear as epithelioid macrophages. A granuloma can only be diagnosed when a pathologist observes this type of inflammation under the microscope. If a foreign body or a parasite is not observed inside the granuloma, stains for acid-fast bacilli and fungi are ordered since mycobacteria and fungi are frequently the cause of this type of inflammation. It is calculated that 12 to 36% of granulomas do not have a specific etiology and many have wondered if with new molecular methods we could reduce this number. This paper will summarize the frequently known causes of granulomas and will present the recent literature regarding the use of molecular techniques on tissue specimens and how these have helped in defining causative agents. We will also briefly describe new research regarding formation and function of granulomas and how this impacts our ability to find an etiologic agent.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA 30322, USA
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