Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Department of Pathology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Int J Dermatol. 2023 Oct;62(10):1237-1247. doi: 10.1111/ijd.16826.
Treatment responses to cutaneous leishmaniasis (CL) observed in Sri Lanka show variability, ranging from quick healing to delayed or failed responses to routine medication. The determinants of these differences in treatment response are not well defined. This study aimed to identify predictive features of treatment response and outcome in localized CL caused by Leishmania donovani, focusing on both clinical and histopathological findings in the patients.
Tissue sections (n = 103) derived from 3 mm punch biopsies of parasitologically confirmed patients were assessed. Patients were followed up weekly until complete healing of skin lesions and were reviewed at the end of 6 months and 1 year.
Healing required 7-21 weekly doses of intralesional sodium stibogluconate (IL-SSG) (mean = 12.2 ± 0.622). Twenty-nine (28.1%) patients were identified as delayed responders. None had recurred at the end of 1 year. The demographic or clinical features (age, gender, lesion type, size, location, and lesion duration) did not significantly influence the treatment response. A heavy parasite load and acanthosis were significant predictors of a delayed response to treatment (P < 0.001). Higher parasite loads were associated with inflammation of the entire dermis (P = 0.008), more intense infiltration of macrophages (p = 0.001), and epidermal atrophy (P = 0.033). Well-formed granulomas were inversely proportional to parasite loads.
Histology findings proved to be better prognostic markers than clinical features for delayed responders to treatment and will aid in targeted patient management when tissue biopsies are performed in the initial diagnosis of CL.
斯里兰卡观察到的皮肤利什曼病（CL）的治疗反应存在差异，从快速愈合到常规药物治疗延迟或失败不等。这些治疗反应差异的决定因素尚未明确。本研究旨在确定利什曼原虫引起的局限性 CL 治疗反应和结局的预测特征，重点关注患者的临床和组织病理学发现。
对寄生虫学确诊患者的 3mm 打孔活检获得的组织切片（n=103）进行评估。患者每周随访一次，直至皮肤病变完全愈合，并在 6 个月和 1 年时进行复查。
治愈需要接受 7-21 次每周剂量的病灶内注射葡萄糖酸锑钠（IL-SSG）（平均 12.2±0.622）。29 名（28.1%）患者被确定为延迟反应者。在 1 年末均未复发。人口统计学或临床特征（年龄、性别、病变类型、大小、位置和病变持续时间）并未显著影响治疗反应。寄生虫负荷量高和棘皮症是治疗反应延迟的显著预测因素（P<0.001）。较高的寄生虫负荷与整个真皮炎症（P=0.008）、巨噬细胞浸润更强烈（p=0.001）和表皮萎缩（P=0.033）相关。形成良好的肉芽肿与寄生虫负荷呈反比。
组织学发现被证明是治疗延迟反应者比临床特征更好的预后标志物，当在 CL 的初始诊断中进行组织活检时，将有助于有针对性的患者管理。
