el Hassan A M, Kadaru A M, Khalil E A, Fadl A, el Hassan M M
Institute of Endemic Diseases, University of Khartoum, Sudan.
Ann Trop Med Parasitol. 1996 Oct;90(5):485-90. doi: 10.1080/00034983.1996.11813073.
The pathology of cutaneous leishmaniasis (CL) caused by Leishmania major zymodeme LON 1 in the Sudan was compared with that caused by L. major zymodeme LON 4 in Saudi Arabia and with that already described for L. tropica infections in Iran and for localized CL in the New World. The lesions were classified according to Ridley's five histological types. Most of the lesions in the Sudan and Saudi Arabia were of types B and C, characterized, respectively, by diffuse macrophage necrosis and focalized necrosis. B was the most common type in Nicaragua and Guyana whereas responses of types A (in which there are heavily parasitized macrophages without necrosis) and D (reactive tuberculoid) were the most frequent in Iran. The type-E response, which is similar to D but with virtual absence of plasma cells, was uncommon in all areas. The type-D reaction is a chronic relapsing disease when associated with L. tropica but not when associated with L. major. The major differences in the pathology of CL in different geographical areas most probably relate to differences in the Leishmania species involved. Minor differences, however, not only occur between patients from the same area but may also occur, with time, in the same patient. Detailed comparison between areas is therefore difficult; lesions on one patient may heal asynchronously and show different histological types at any point in time and rebiopsy from the same lesion during healing reveals changes from one histological type to another.
将苏丹由大利什曼原虫酶株LON 1引起的皮肤利什曼病（CL）的病理学与沙特阿拉伯由大利什曼原虫酶株LON 4引起的皮肤利什曼病的病理学进行了比较，并与伊朗已描述的热带利什曼原虫感染的病理学以及新大陆局限性CL的病理学进行了比较。根据里德利的五种组织学类型对病变进行了分类。苏丹和沙特阿拉伯的大多数病变分别为B型和C型，其特征分别为弥漫性巨噬细胞坏死和局灶性坏死。B型在尼加拉瓜和圭亚那最为常见，而A型（有大量被寄生但无坏死的巨噬细胞）和D型（反应性结核样）反应在伊朗最为常见。E型反应与D型相似，但几乎没有浆细胞，在所有地区都不常见。D型反应与热带利什曼原虫相关时是一种慢性复发性疾病，但与大利什曼原虫相关时则不是。不同地理区域CL病理学的主要差异很可能与所涉及的利什曼原虫种类的差异有关。然而，微小差异不仅会出现在同一地区的患者之间，而且随着时间的推移，同一患者也可能出现。因此，不同地区之间的详细比较很困难；一名患者的病变可能会不同步愈合，在任何时间点显示出不同的组织学类型，并且在愈合过程中对同一病变进行再次活检会发现从一种组织学类型到另一种组织学类型的变化。
