Herath C H P, Ratnatunga N V I, Waduge R, Ratnayake P, Ratnatunga C N, Ramadasa S
Department of Pathology, Teaching Hospital, Peradeniya, Sri Lanka.
Ceylon Med J. 2010 Dec;55(4):106-11. doi: 10.4038/cmj.v55i4.2626.
INTRODUCTION; Cutaneous leishmaniasis is endemic in Sri Lanka. The immunopathogenesis of these lesions in Sri Lankans has not been documented.
To classify skin lesions into histological groups, to assess parasitic load, density of each inflammatory cell type and necrosis and to characterise the lymphocytic reaction in cutaneous leishmaniasis in comparison to leprosy.
Skin biopsies from 31 patients with demonstrable amastigotes in smears or tissue sections were studied. The lesions were classified by two independent observers into four distinct histological groups based on different cell types in the inflammatory infiltrate and formation of granulomata. Parasitic load and the presence of necrosis were recorded. Immunohistochemical staining for CD45RO and CD20 for counting T and B cells respectively was done.
Histological groups of cutaneous leishmaniasis ranging from group I-IV were similar to that of the spectrum in leprosy ranging from lepromatous to tuberculoid leprosy. The histological groups from I-IV showed a significant inverse relationship with the mean parasitic index. Necrosis was not a prominent feature. The mean percentage of T cells in the histological spectrum from group I-IV in leishmaniasis was similar to the spectrum from lepromatous to tuberculoid leprosy. Mean percentage of T cells were 20.1% in group I, 20.5% in group II, 33.8% in group III and 47.8% in group IV. Lepromatous, borderline tuberculoid and tuberculoid leprosy had 21.3%, 33.4% and 48.0% T cells respectively.
Cutaneous leishmaniasis is a spectral disease similar to leprosy. The mean percentage T cells from group I-IV were similar to those in the spectrum of leprosy and mean percentage B cells varied in a narrow range.
引言；皮肤利什曼病在斯里兰卡呈地方性流行。斯里兰卡人这些病变的免疫发病机制尚未见文献报道。
将皮肤病变分为组织学类型，评估寄生虫负荷、每种炎症细胞类型的密度和坏死情况，并与麻风病相比，对皮肤利什曼病中的淋巴细胞反应进行特征描述。
对31例涂片或组织切片中可证实有前鞭毛体的患者的皮肤活检标本进行研究。两名独立观察者根据炎症浸润中的不同细胞类型和肉芽肿形成情况，将病变分为四个不同的组织学类型。记录寄生虫负荷和坏死情况。分别进行CD45RO和CD20的免疫组化染色以计数T细胞和B细胞。
皮肤利什曼病的组织学类型从I组到IV组与麻风病从瘤型到结核样型的谱系相似。I组到IV组的组织学类型与平均寄生虫指数呈显著负相关。坏死不是突出特征。利什曼病中I组到IV组组织学谱系中T细胞的平均百分比与瘤型到结核样型麻风病的谱系相似。I组T细胞平均百分比为20.1%，II组为20.5%，III组为33.8%，IV组为47.8%。瘤型、界线类偏结核样型和结核样型麻风病的T细胞分别为21.3%、33.4%和48.0%。
皮肤利什曼病是一种与麻风病相似的谱系疾病。I组到IV组T细胞的平均百分比与麻风病谱系中的相似，B细胞平均百分比在较窄范围内变化。
