Department of Dermatology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Department of Pathology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain.
Histol Histopathol. 2021 May;36(5):567-576. doi: 10.14670/HH-18-324. Epub 2021 Mar 4.
Different immunohistochemical markers to detect amastigotes in cutaneous leishmaniasis have been proposed with variable diagnostic usefulness.
To evaluate the diagnostic usefulness of immunohistochemical amastigotes identification by specific polyclonal anti-Leishmania antibodies and CD1a expression (clone EP3622) in a series of PCR confirmed cutaneous leishmaniasis.
Thirty-three skin samples corresponding to PCR confirmed cutaneous leishmaniasis were included in the study. All samples were stained with Hematoxylin-eosin and Giemsa. Moreover, immunohistochemical studies with anti-CD1a and anti-Leishmania antibodies were performed. The patients clinical features and the observed histopathological features were also recorded.
From the selected 33 biopsies, Leishmania spp. amastigotes were detected in 48.4% of cases with conventional Hematoxylin-eosin stain and in 57.5% of cases by Giemsa staining. In 31/33 cases, anti-CD1a allowed us to identify parasitic structures, and in 33/33 cases amastigotes were detected with anti-Leishmania antibodies. Concordance between both techniques, anti-CD1a and anti-Leishmania, was 94% [CI 95%: (79,8%-99,3%)] ; p value <0.05. The sensitivity of anti-CD1a in comparison with the PCR was 94%, with a positive predictive value of 100%. Two cases of low parasitic index were negative for CD1a immunostaining. In cases with high parasitic index, anti-CD1a stained amastigotes in superficial and deep dermis. Only a few cases were originally diagnosed with the available histological techniques, needing PCR for Leishmania spp.
Anti-CD1a antibody seems to be a useful technique to identify amastigotes when PCR and anti-Leishmania antibodies are not available. The sensitivity to detect amastigotes is increased when the CD1a immunostaining is added to the classical Haematoxylin - eosin and Giemsa staining.
已经提出了不同的免疫组织化学标记物来检测皮肤利什曼病中的无鞭毛体，其诊断有用性各不相同。
评估特异性多克隆抗利什曼抗体和 CD1a 表达（克隆 EP3622）对一系列经 PCR 证实的皮肤利什曼病中无鞭毛体鉴定的诊断有用性。
纳入本研究的 33 个皮肤样本均经 PCR 证实为皮肤利什曼病。所有样本均行苏木精-伊红和吉姆萨染色。此外，还进行了抗 CD1a 和抗利什曼抗体的免疫组织化学研究。记录了患者的临床特征和观察到的组织病理学特征。
在所选择的 33 个活检中，常规苏木精-伊红染色和吉姆萨染色分别在 48.4%和 57.5%的病例中检测到利什曼原虫无鞭毛体。在 31/33 例中，抗 CD1a 允许我们识别寄生虫结构，而在 33/33 例中均检测到抗利什曼抗体。两种技术（抗 CD1a 和抗利什曼抗体）之间的一致性为 94%[95%CI（79，8%-99.3%）]；p 值<0.05。与 PCR 相比，抗 CD1a 的敏感性为 94%，阳性预测值为 100%。两个寄生虫指数较低的病例抗 CD1a 免疫染色为阴性。在寄生虫指数较高的病例中，抗 CD1a 染色了真皮浅层和深层的无鞭毛体。最初仅用现有的组织学技术诊断的少数病例需要进行 PCR 检测利什曼原虫。
当 PCR 和抗利什曼抗体不可用时，抗 CD1a 抗体似乎是一种识别无鞭毛体的有用技术。当将 CD1a 免疫染色添加到经典的苏木精-伊红和吉姆萨染色中时，检测无鞭毛体的敏感性增加。
