Azadeh B, Samad A, Ardehali S
Trans R Soc Trop Med Hyg. 1985;79(5):631-6. doi: 10.1016/0035-9203(85)90174-9.
Skin biopsies from 117 cases of acute and 23 cases of lupoid leishmaniasis were studied. Of the 117 acute cases, anergic macrophage response were seen in 44, diffuse necrosis in 9 and focalized necrosis in 11 biopsies; the remaining 53 biopsies showed scanty or no parasites with a few to abundant epithelioid cells probably representing post necrotic changes before complete healing of the lesions. The 23 biopsies of lupoid leishmaniasis showed rather well organized epithelioid granulomata surrounded by lymphocytes, inconspicuous plasma cells, no amastigotes and no necrosis. Lupoid cases showed strong delayed hypersensitivity with leishmanin and low serum antibody titres. It appears that the lesions of urban cutaneous leishmaniasis spend a long time in the anergic phase. Partial destruction of parasites by activated macrophages together with gradual elevation of antibody levels prepares the appropriate antigen-antibody ratio for optimum development of necrosis at PI3 leading to effective elimination of parasites. Plasma cells appear to be important in the induction of necrosis and inhibition of epithelioid granulomata. A significant inverse relationship has been found between plasma cells and epitheloid cells. The delayed hypersensitivity observed in lupoid leishmaniasis is probably the result of a poor humoral response evidenced by inconspicuous plasma cells and low serum antibody titres.
对117例急性皮肤利什曼病和23例类狼疮性皮肤利什曼病患者的皮肤活检样本进行了研究。在117例急性病例中，44例可见无反应性巨噬细胞反应，9例出现弥漫性坏死，11例出现局灶性坏死；其余53例活检样本显示寄生虫数量稀少或无寄生虫，有少量至大量上皮样细胞，可能代表病变完全愈合前的坏死后期变化。23例类狼疮性皮肤利什曼病的活检样本显示，上皮样肉芽肿组织相当良好，周围有淋巴细胞、不明显的浆细胞，无无鞭毛体，也无坏死。类狼疮病例对利什曼原虫素表现出强烈的迟发型超敏反应，血清抗体滴度较低。看来城市皮肤利什曼病的病变在无反应期持续很长时间。活化巨噬细胞对寄生虫的部分破坏以及抗体水平的逐渐升高，为PI3处坏死的最佳发展准备了合适的抗原-抗体比例，从而有效清除寄生虫。浆细胞似乎在坏死的诱导和上皮样肉芽肿的抑制中起重要作用。已发现浆细胞与上皮样细胞之间存在显著的负相关关系。类狼疮性皮肤利什曼病中观察到的迟发型超敏反应可能是体液反应不佳的结果，表现为浆细胞不明显和血清抗体滴度较低。
