Diffuse cutaneous leishmaniasis in Ethiopia I. The clinical and histological features of the disease
Identifieur interne : 003726 ( Istex/Corpus ); précédent : 003725; suivant : 003727Diffuse cutaneous leishmaniasis in Ethiopia I. The clinical and histological features of the disease
Auteurs : A. D. M. BrycesonSource :
- Transactions of the Royal Society of Tropical Medicine and Hygiene [ 0035-9203 ] ; 1969.
Abstract
The clinical and histological features of 33 cases of diffuse cutaneous leishmaniasis (DCL) seen in Ethiopia are described. The disease starts as a nodule, usually on a limb. After a period of months or years, during which the initial lesion may rarely ulcerate, or even disappear, it starts to spread locally and distant metastases appear on the face, arms and legs; in appearance and distribution they bear some resemblance to leprosy. The disease spreads slowly, does not ulcerate, invade the viscera or heal. The patient remains remarkably well and there are no consistently abnormal findings in the blood or urine. Smears from the lesions show numerous amastigotes (L-D bodies). The histology is characterized by a thin epidermis and an intense dermal infiltration with macrophages, many of them vacuolated and stuffed with parasites; lymphocytes are absent or scanty. Under the influence of treatment the histology changes towards the tuberculoid. The leishmanin skin test is negative. Reasons are given why DCL in Ethiopia is not post kala-azar dermal leishmaniasis, and the features that distinguish it from simple oriental sore are presented. An attempt has been made to correlate the clinical and histological findings and to show that, whereas the distribution of the lesions is a feature of the parasite, the appearance of the lesions and their histology is a feature of the host's immune response. A histological classification, which indicates the state of the patient's cellular immune response, is given. In untreated DCL this response is absent. The state of reaction is not useful or protective. The frequency with which lymphatic damage was seen in these cases is considered as a possible cause, as opposed to effect, of the disease. The differential diagnosis is discussed.
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DOI: 10.1016/0035-9203(69)90116-3
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The disease starts as a nodule, usually on a limb. After a period of months or years, during which the initial lesion may rarely ulcerate, or even disappear, it starts to spread locally and distant metastases appear on the face, arms and legs; in appearance and distribution they bear some resemblance to leprosy. The disease spreads slowly, does not ulcerate, invade the viscera or heal. The patient remains remarkably well and there are no consistently abnormal findings in the blood or urine. Smears from the lesions show numerous amastigotes (L-D bodies). The histology is characterized by a thin epidermis and an intense dermal infiltration with macrophages, many of them vacuolated and stuffed with parasites; lymphocytes are absent or scanty. Under the influence of treatment the histology changes towards the tuberculoid. The leishmanin skin test is negative. Reasons are given why DCL in Ethiopia is not post kala-azar dermal leishmaniasis, and the features that distinguish it from simple oriental sore are presented. An attempt has been made to correlate the clinical and histological findings and to show that, whereas the distribution of the lesions is a feature of the parasite, the appearance of the lesions and their histology is a feature of the host's immune response. A histological classification, which indicates the state of the patient's cellular immune response, is given. In untreated DCL this response is absent. The state of reaction is not useful or protective. The frequency with which lymphatic damage was seen in these cases is considered as a possible cause, as opposed to effect, of the disease. 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The histology is characterized by a thin epidermis and an intense dermal infiltration with macrophages, many of them vacuolated and stuffed with parasites; lymphocytes are absent or scanty. Under the influence of treatment the histology changes towards the tuberculoid. The leishmanin skin test is negative. Reasons are given why DCL in Ethiopia is not post kala-azar dermal leishmaniasis, and the features that distinguish it from simple oriental sore are presented. An attempt has been made to correlate the clinical and histological findings and to show that, whereas the distribution of the lesions is a feature of the parasite, the appearance of the lesions and their histology is a feature of the host's immune response. A histological classification, which indicates the state of the patient's cellular immune response, is given. In untreated DCL this response is absent. The state of reaction is not useful or protective. 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The clinical and histological features of the disease</title><author xml:id="author-0000"><persName><forename type="first">A.D.M.</forename><surname>Bryceson</surname></persName><note type="biography">Now at Institute of Dermatology, Homerton Grove, London, E.9.</note><affiliation>Now at Institute of Dermatology, Homerton Grove, London, E.9.</affiliation><affiliation>Department of Medicine, Haile Sellassie I University, Addis Ababa Ethiopia</affiliation></author><idno type="istex">75A6C754EF8F27C951AA4DCD4663F71B8F8F28A7</idno><idno type="DOI">10.1016/0035-9203(69)90116-3</idno><idno type="PII">0035-9203(69)90116-3</idno></analytic><monogr><title level="j">Transactions of the Royal Society of Tropical Medicine and Hygiene</title><title level="j" type="abbrev">TRSTMH</title><idno type="pISSN">0035-9203</idno><idno type="PII">S0035-9203(00)X0430-0</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1969"></date><biblScope unit="volume">63</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="708">708</biblScope><biblScope unit="page" to="737">737</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1969</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>The clinical and histological features of 33 cases of diffuse cutaneous leishmaniasis (DCL) seen in Ethiopia are described. The disease starts as a nodule, usually on a limb. After a period of months or years, during which the initial lesion may rarely ulcerate, or even disappear, it starts to spread locally and distant metastases appear on the face, arms and legs; in appearance and distribution they bear some resemblance to leprosy. The disease spreads slowly, does not ulcerate, invade the viscera or heal. The patient remains remarkably well and there are no consistently abnormal findings in the blood or urine. Smears from the lesions show numerous amastigotes (L-D bodies). The histology is characterized by a thin epidermis and an intense dermal infiltration with macrophages, many of them vacuolated and stuffed with parasites; lymphocytes are absent or scanty. Under the influence of treatment the histology changes towards the tuberculoid. The leishmanin skin test is negative. Reasons are given why DCL in Ethiopia is not post kala-azar dermal leishmaniasis, and the features that distinguish it from simple oriental sore are presented. An attempt has been made to correlate the clinical and histological findings and to show that, whereas the distribution of the lesions is a feature of the parasite, the appearance of the lesions and their histology is a feature of the host's immune response. A histological classification, which indicates the state of the patient's cellular immune response, is given. In untreated DCL this response is absent. The state of reaction is not useful or protective. The frequency with which lymphatic damage was seen in these cases is considered as a possible cause, as opposed to effect, of the disease. The differential diagnosis is discussed.</p></abstract></profileDesc><revisionDesc><change when="1969">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/75A6C754EF8F27C951AA4DCD4663F71B8F8F28A7/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="sco"><item-info><jid>TRSTMH</jid><aid>69901163</aid><ce:pii>0035-9203(69)90116-3</ce:pii><ce:doi>10.1016/0035-9203(69)90116-3</ce:doi><ce:copyright type="unknown" year="1969"></ce:copyright></item-info><head><ce:dochead><ce:textfn>Communication</ce:textfn></ce:dochead><ce:title>Diffuse cutaneous leishmaniasis in Ethiopia I. The clinical and histological features of the disease</ce:title><ce:author-group><ce:author><ce:given-name>A.D.M.</ce:given-name><ce:surname>Bryceson</ce:surname><ce:cross-ref refid="FN1"><ce:sup>∗</ce:sup></ce:cross-ref></ce:author><ce:affiliation><ce:textfn>Department of Medicine, Haile Sellassie I University, Addis Ababa Ethiopia</ce:textfn></ce:affiliation><ce:footnote id="FN1"><ce:label>∗</ce:label><ce:note-para>Now at Institute of Dermatology, Homerton Grove, London, E.9.</ce:note-para></ce:footnote></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>The clinical and histological features of 33 cases of diffuse cutaneous leishmaniasis (DCL) seen in Ethiopia are described. The disease starts as a nodule, usually on a limb. After a period of months or years, during which the initial lesion may rarely ulcerate, or even disappear, it starts to spread locally and distant metastases appear on the face, arms and legs; in appearance and distribution they bear some resemblance to leprosy. The disease spreads slowly, does not ulcerate, invade the viscera or heal. The patient remains remarkably well and there are no consistently abnormal findings in the blood or urine. Smears from the lesions show numerous amastigotes (L-D bodies). The histology is characterized by a thin epidermis and an intense dermal infiltration with macrophages, many of them vacuolated and stuffed with parasites; lymphocytes are absent or scanty. Under the influence of treatment the histology changes towards the tuberculoid. The leishmanin skin test is negative.</ce:simple-para><ce:simple-para>Reasons are given why DCL in Ethiopia is not post kala-azar dermal leishmaniasis, and the features that distinguish it from simple oriental sore are presented. An attempt has been made to correlate the clinical and histological findings and to show that, whereas the distribution of the lesions is a feature of the parasite, the appearance of the lesions and their histology is a feature of the host's immune response. A histological classification, which indicates the state of the patient's cellular immune response, is given. In untreated DCL this response is absent. The state of reaction is not useful or protective. The frequency with which lymphatic damage was seen in these cases is considered as a possible cause, as opposed to effect, of the disease.</ce:simple-para><ce:simple-para>The differential diagnosis is discussed.</ce:simple-para></ce:abstract-sec></ce:abstract></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Diffuse cutaneous leishmaniasis in Ethiopia I. The clinical and histological features of the disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Diffuse cutaneous leishmaniasis in Ethiopia I. The clinical and histological features of the disease</title></titleInfo><name type="personal"><namePart type="given">A.D.M.</namePart><namePart type="family">Bryceson</namePart><affiliation>Department of Medicine, Haile Sellassie I University, Addis Ababa Ethiopia</affiliation><description>Now at Institute of Dermatology, Homerton Grove, London, E.9.</description><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="brief-communication" displayLabel="Short communication"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1969</dateIssued><copyrightDate encoding="w3cdtf">1969</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">The clinical and histological features of 33 cases of diffuse cutaneous leishmaniasis (DCL) seen in Ethiopia are described. The disease starts as a nodule, usually on a limb. After a period of months or years, during which the initial lesion may rarely ulcerate, or even disappear, it starts to spread locally and distant metastases appear on the face, arms and legs; in appearance and distribution they bear some resemblance to leprosy. The disease spreads slowly, does not ulcerate, invade the viscera or heal. The patient remains remarkably well and there are no consistently abnormal findings in the blood or urine. Smears from the lesions show numerous amastigotes (L-D bodies). The histology is characterized by a thin epidermis and an intense dermal infiltration with macrophages, many of them vacuolated and stuffed with parasites; lymphocytes are absent or scanty. Under the influence of treatment the histology changes towards the tuberculoid. The leishmanin skin test is negative. Reasons are given why DCL in Ethiopia is not post kala-azar dermal leishmaniasis, and the features that distinguish it from simple oriental sore are presented. An attempt has been made to correlate the clinical and histological findings and to show that, whereas the distribution of the lesions is a feature of the parasite, the appearance of the lesions and their histology is a feature of the host's immune response. A histological classification, which indicates the state of the patient's cellular immune response, is given. In untreated DCL this response is absent. The state of reaction is not useful or protective. The frequency with which lymphatic damage was seen in these cases is considered as a possible cause, as opposed to effect, of the disease. The differential diagnosis is discussed.</abstract><note type="content">Section title: Communication</note><relatedItem type="host"><titleInfo><title>Transactions of the Royal Society of Tropical Medicine and Hygiene</title></titleInfo><titleInfo type="abbreviated"><title>TRSTMH</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">1969</dateIssued></originInfo><identifier type="ISSN">0035-9203</identifier><identifier type="PII">S0035-9203(00)X0430-0</identifier><part><date>1969</date><detail type="volume"><number>63</number><caption>vol.</caption></detail><detail type="issue"><number>6</number><caption>no.</caption></detail><extent unit="issue pages"><start>689</start><end>885</end></extent><extent unit="pages"><start>708</start><end>737</end></extent></part></relatedItem><identifier type="istex">75A6C754EF8F27C951AA4DCD4663F71B8F8F28A7</identifier><identifier type="DOI">10.1016/0035-9203(69)90116-3</identifier><identifier type="PII">0035-9203(69)90116-3</identifier><recordInfo><recordContentSource>ELSEVIER</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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