Comparison of skin smears and biopsy specimens for demonstration of Leishmania tropica bodies in cutaneous leishmaniasis.

OBJECTIVE

To determine and compare the diagnostic value of skin biopsy, saline aspirate smears, skin slit smears and skin biopsy impression smears to demonstrate Leishmania tropica (LT) bodies in cutaneous leishmaniasis and to determine any association within the applied diagnostic tests.

DESIGN

An analytical study.

PLACE AND DURATION OF STUDY

Department of Dermatology, PNS Shifa, Karachi from January to December 2003.

PATIENTS AND METHODS

Seventyeight patients of cutaneous leishmaniasis were subjected to saline aspirate smears, skin slit smears, skin biopsy impression smears and skin biopsy and looked for LT bodies. The percentage positivity of all methods was calculated. McNemar test was applied to determine the association between percentage positivities of methods.

RESULTS

Skin biopsy showed LT bodies in 70 (89.74%) patients, saline aspirate smears in 24 (30.76%), skin slit smears in 25 (32.05%) and skin biopsy impression smears in 27 (34.61%) patients. Smears demonstrated LT bodies in 10.25% cases in which biopsy was negative. Skin biopsy impression smears showed concordant results with skin biopsy in 20.51%, skin slit smears in 16.66% and saline aspirate smears in 19.25% of cases. Saline aspirate smears were positive in 48.1% of cases in which biopsy impression smears were negative, slit smears were positive in 50.9 % of cases in which biopsy impression smears were negative and slit smears were positive in 37% of cases in which saline aspirate smears were negative.

CONCLUSION

Skin biopsy for histopathology is the most useful method in the demonstration of Leishmania parasite. Sensitivity of smears can be increased by a combination of various skin smears.