Role of Leishmania spp. infestation in nondiagnostic cutaneous granulomatous lesions: Report of a series of patients from a Western Mediterranean area

Department of Dermatology, Hospital del Mar-IMAS, Barcelona, Spain.
British Journal of Dermatology (Impact Factor: 4.28). 07/2009; 161(2):320-5. DOI: 10.1111/j.1365-2133.2009.09282.x
Source: PubMed


Leishmaniasis is a parasitic disease prevalent in countries of the Mediterranean area.
The potential role of Leishmania as the aetiological factor for cutaneous granulomatous lesions in a series of patients from a Western Mediterranean area was evaluated. The practical usefulness of Leishmania-specific polymerase chain reaction (PCR) amplification and immunohistochemical techniques in skin biopsy specimens was assessed.
Twenty-five skin biopsies diagnosed as nonspecific granulomatous dermatoses were included in the study. A panel of histopathological features was blindly evaluated by two independent observers. Only those cases showing nondiagnostic clinicopathological features and lacking demonstrable microorganisms after bacteriological, mycological or mycobacteriological cultures and specific stains (Ziehl-Neelsen, Giemsa, Gram, periodic acid-Schiff stains) were finally selected. Quantitative real-time PCR was performed in all selected samples. In available samples, immunohistochemical detection of specific Leishmania spp. antigens was also performed.
From the selected 25 biopsies, Leishmania spp. DNA was detected by real-time PCR in 13 cases. In seven of eight PCR-positive cases the presence of a varying density of amastigotes could also be demonstrated immunohistochemically.
Leishmania infection seems to be an important aetiological factor in cutaneous granulomatous lesions showing nondiagnostic features in endemic areas. In such areas, Leishmania-specific PCR amplification and/or immunohistochemical studies may be useful diagnostic tools. These techniques may be specifically indicated in the evaluation of patients showing nonspecific granulomatous inflammatory infiltrates of unknown aetiology lacking the histopathological evidence of parasites.

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    • "Leishmania spp. DNA was initially investigated with a TaqMan probe rtPCR targeting highly repeated kinetoplast sequences (Mary et al., 2004; Martín-Ezquerra et al., 2009). A subset of DNA from rtPCR-positive samples was further tested with a conventional PCR test amplifying the Leishmania spp. "
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    • "Leishmaniasis has been found to create varying degrees of diagnostic dilemmas in different parts of the world: in Canada, leishmaniasis was found to present as cutaneous myiasis caused by Dermatobia hominis [34] ; in Tunisia, erythema nodosum was the presenting feature [35] ; while in Brazil, pyrexia of unknown origin (PUO) were found to be common presentations [36] . Also in USA, cutaneous leishmaniasis was found to present as sebaceous cysts Table 1 Clinical presentations of cutaneous leishmaniasis in 778 literature reviews on 6 689 cases [n(%)]. "
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