Histological findings associated with treatment response in cutaneous leishmaniasis: a clinicopathological correlation study.
Histological findings associated with treatment response in cutaneous leishmaniasis: a clinicopathological correlation study.
复制标题
与皮肤利什曼病治疗反应相关的组织学发现：临床病理学相关研究。
DOI：
10.1111/ijd.16826
复制
发表时间：
2023
影响因子：
3.6
通讯作者：
Karunaweera,NadiraD
中科院分区：
文献类型：
--
作者：
Riyal,Hasna;Samaranayake,Nilakshi;Amarathunga,Priyani;Munidasa,Deepani;Karunaweera,NadiraD
斯里兰卡对皮肤利什曼病(CL)的治疗反应表现出多样性，从快速愈合到延迟或失败的反应，再到常规药物治疗。这些治疗反应差异的决定因素还没有很好地确定。本研究旨在明确杜氏利什曼原虫引起的局限性CL的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表现。方法对来自寄生虫学确诊患者的3 mm穿孔活检组织切片(n= 10 3)进行评估。每周随访一次，直到皮损完全愈合，并在6个月和1年末进行复查。结果愈合需要每周7-21次局部注射硫代葡萄糖酸钠(平均 = 12.2 ± 0.622)。29名患者(28.1%)被确认为延迟应答者。1年后无1例复发。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)对治疗反应没有显著影响。大量寄生虫负载和棘皮病是治疗延迟反应的重要预测因素(P<； 0.001)。更高的寄生虫载量与整个真皮的炎症(P= 0.008)、巨噬细胞的更强烈的渗透(P= = 0.001)和表皮萎缩(P= 0.033)有关。形态良好的肉芽肿与寄生虫载量成反比。结论对于对延迟治疗有反应的患者，组织学表现被证明是比临床特征更好的预后指标，并有助于在CL的初始诊断中进行组织活检时的靶向患者处理。
BackgroundTreatment 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 byLeishmania donovani, focusing on both clinical and histopathological findings in the patients.MethodsTissue 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.ResultsHealing 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.ConclusionsHistology 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.