title: The use of polymerase chain reaction to confirm diagnosis in skin biopsies consistent with American tegumentary leishmaniasis at histopathology: a study of 90 cases.
abstract: BACKGROUND
  Cutaneous leishmaniasis is a chronic, infectious disease caused by protozoa of the genus leishmania. The incidence of this disease is high in Brazil, with 19,746 new cases having been detected in 2008. The presence of amastigotes in the cytoplasm of histiocytes constitutes diagnosis of the disease; however, their presence is rarely found in late lesions, making histological diagnosis difficult. Polymerase chain reaction has been shown to represent a highly sensitive and specific technique for the diagnosis of cutaneous leishmaniasis.
  
  
  OBJECTIVE
  To use polymerase chain reaction to evaluate paraffin-embedded skin biopsies with histopathological features consistent with cutaneous leishmaniasis.
  
  
  METHODS
  Polymerase chain reaction amplification of a 120-base-pair fragment of Leishmania kinetoplast DNA (kDNA) minicircles was performed on 90 skin biopsies. The male/female ratio was 75/15. Mean age was 32.36 years, with a median of 31 years, range 4-72 years. Samples were histologically compatible with cutaneous leishmaniasis but a definitive diagnosis could not be made since amastigotes were not found. All cases were histologically classified according to the patterns described by de Magalhães.
  
  
  RESULTS
  According to the de Magalhães classification, the most common histological pattern was type IV (exudative granulomatous reaction), which was found in 65.6% of cases (56/90), followed by type I (exudative cellular reaction) in 21.1% of cases (19/90) and type III (exudative and necrotic granulomatous reaction) in 12.2% of cases (11/90). Leishmania DNA was found in 96.7% of the biopsies (87/90).
  
  
  CONCLUSIONS
  Polymerase chain reaction performed by amplifying kDNA is able to confirm a diagnosis of cutaneous leishmaniasis with a high degree of sensitivity in cases in which histopathology is consistent with a diagnosis of cutaneous leishmaniasis but not definitive.
authors.affiliation: Heitor Vieira Dourado Foundation of Tropical Medicine, Manaus, Amazonas, Brazil. rosilene.dev@uol.com.br
authors.forename: Rosilene Viana de
authors.initials: RV
authors.lastname: Andrade
authors.forename: Cesare
authors.initials: C
authors.lastname: Massone
authors.forename: Meline Nogueira Barbosa de
authors.initials: MN
authors.lastname: Lucena
authors.forename: Anette Chusciak
authors.initials: AC
authors.lastname: Talhari
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
authors.forename: Jorge Augusto de Oliveira
authors.initials: JA
authors.lastname: Guerra
authors.forename: Luiz Carlos de Lima
authors.initials: LC
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D018105:DNA, Kinetoplast / Q000032:analysis*; D016054:DNA, Protozoan / Q000032:analysis*; D005260:Female; D006801:Humans; D007891:Leishmania / Q000235:genetics*; D016773:Leishmaniasis, Cutaneous / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology*; D055815:Young Adult
chemical_list: D018105:DNA, Kinetoplast; D016054:DNA, Protozoan