Simeen Ber Rahman, Bari A U.
Histopathological patterns of Cutaneous Leishmaniasis with clinical correlation seen in Pakistan.
Pak Armed Forces Med J Jan ;53(2):142-7.

A wide spectrum of clinical presentation of cutaneous leishmaniasis is encountered in various endemic areas of Pakistan. No detailed study on histopathlogical patterns was done previously. This study was conducted in an attempt to delineate the different histopathological patterns of the disease and its clinical correlation in Pakistan. Sixty three patients of either age or sex with clinical diagnosis of cutaneous leishmaniasis, were included in the study from western, south western and northern regions of the country (Quetta, Multan, Chakwal, Kohat, Northern areas and Islamabad). 13 patients were excluded due to various reasons. Skin slit smears and skin biopsies were done in all cases, which were studied by a competent dermatopathologist. Histological patterns then were correlated with clinical presentations. Four distinct histological patterns emerged and these were neither related to any age or sex group, nor there was any predilection for some geographical area. Pattern "A" (mixed inflammatory group) was seen in maximum patient (56%) and this was coincided with most common clinical wet (rural) type of presentation. Pattern "B" (mixed inflammatory infiltrate with necrosis and fibrosis) was the next common pattern (20%) coinciding with the late lesions of the wet type. Pattern "C"(chronic inflammatory group) was seen in 12% cases and these were clinically associated with dry (urban) type of lesions. Pattern "D" (tuberculoid granulomatous reaction) was again not very common (12%) and was clinically related chronic forms of cutaneous leishmaniasis. Various histological patterns seen are related to distinct clinical forms of cutaneous leishmaniasis. No geographical restriction for any pattern suggests that the host immune response is primarily responsible for varied presentation of the disease.

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