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Transepidermal elimination in cutaneous leishmaniasis: A multiregional study

Show simple item record Karram S. Loya A. Hamam H. Habib R.H. Khalifeh I.
dc.contributor.editor Apr-2012 2017-10-05T15:59:33Z 2017-10-05T15:59:33Z 2012
dc.identifier 10.1111/j.1600-0560.2012.01890.x
dc.identifier.issn 03036987
dc.description.abstract Background: Transepidermal elimination has been documented in a myriad of infectious diseases; however, its occurrence in cutaneous leishmaniasis has not been evaluated. Methods: Skin biopsies (n = 212) with cutaneous leishmaniasis in Lebanon (n = 46), Syria (n = 53), Saudi Arabia (n = 45) and Pakistan (n = 68) were evaluated. Clinical data collected included age, gender, eruption type (papule, nodule, verrucous or scar), duration and anatomic location. Histopathologically, multiple parameters were recorded including Ridley's parasitic index and pattern, transepidermal elimination, interface changes, ulceration and necrosis. Transepidermal elimination was defined as the presence of amastigotes in the epidermis in all layers, limited to the basal layer or present in a perforating plug. All cases were confirmed by polymerase chain reaction (PCR) analysis followed by restriction fragment length polymorphism analysis for molecular subspeciation. Results: Leishmania tropica was identified in 88.2percent and Leishmania major in 11.8percent of all cases. Transepidermal elimination was observed in 28.3percent of cases (29 perforating plug, 19 all layers and 12 basal layer) with a significant prevalence of L. major in this group (35 vs. 2percent, p 0.001). Cases with transepidermal elimination were associated with interface changes and higher parasitic index (p 0.001) but not with an increased ulceration rate (p 0.05). Multivariate analysis showed that transepidermal elimination was independently predicted by L. major [OR (95percent confidence interval) = 80 (9-712); p 0.001], parasitic index [OR = 3.4 (2.1-5.3); p 0.001], interface changes [OR = 6.24 (2.2-17.8); p 0.001] and necrosis [OR = 0.2 (0.1-0.8);p = 0.026]. Conclusions: We report the largest multiregional cutaneous leishmaniasis series with a 28.3percent documented transepidermal elimination incidence of which 48percent were perforating plug; a significant prevalence of L. major was also identified in the transepidermal elimination group. The association of transepidermal elimination with interface changes and a higher parasitic index, without an increased ulceration rate, may reflect a unique biologic alteration in the epidermis, serving to facilitate the extrusion of the parasites through the skin. Copyright © 2012 John Wiley and Sons A-S.
dc.format.extent Pages: (406-412)
dc.language English
dc.publisher MALDEN
dc.relation.ispartof Publication Name: Journal of Cutaneous Pathology; Publication Year: 2012; Volume: 39; no. 4; Pages: (406-412);
dc.source Scopus
dc.title Transepidermal elimination in cutaneous leishmaniasis: A multiregional study
dc.type Article
dc.contributor.affiliation Karram, S., Department of Pathology, Laboratory Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
dc.contributor.affiliation Loya, A., Department of Pathology, Shaukat Khanum Memorial Cancer Hospital, Research Center, Lahore, Pakistan
dc.contributor.affiliation Hamam, H., Department of Dermatology, Hammoud Hospital University Medical Center, Saida, Lebanon
dc.contributor.affiliation Habib, R.H., Department of Internal Medicine, Outcomes Research Unit, American University of Beirut Medical Center, Beirut, Lebanon
dc.contributor.affiliation Khalifeh, I., Department of Pathology, Laboratory Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon
dc.contributor.authorAddress Khalifeh, I.; Department of Pathology, Laboratory Medicine, American University of Beirut Medical Center, Beirut, 1107 2020, Lebanon; email:
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Pathology and Laboratory Medicine;
dc.contributor.authorDepartment Pathology and Laboratory Medicine
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Karram, S
dc.contributor.authorInitials Loya, A
dc.contributor.authorInitials Hamam, H
dc.contributor.authorInitials Habib, RH
dc.contributor.authorInitials Khalifeh, I
dc.contributor.authorReprintAddress Khalifeh, I (reprint author), Amer Univ Beirut Med Ctr, Dept Pathol and Lab Med, Beirut 11072020, Lebanon.
dc.contributor.authorUniversity American University of Beirut Medical Center
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dc.description.citedCount 3
dc.description.citedTotWOSCount 6
dc.description.citedWOSCount 6
dc.format.extentCount 7
dc.identifier.coden JCUPB
dc.identifier.pubmedID 22443392
dc.identifier.scopusID 84859054744
dc.publisher.address COMMERCE PLACE, 350 MAIN ST, MALDEN 02148, MA USA
dc.relation.ispartOfISOAbbr J. Cutan. Pathol.
dc.relation.ispartOfIssue 4
dc.relation.ispartofPubTitle Journal of Cutaneous Pathology
dc.relation.ispartofPubTitleAbbr J. Cutaneous Pathol.
dc.relation.ispartOfVolume 39
dc.source.ID WOS:000301921500004
dc.type.publication Journal
dc.subject.otherAuthKeyword cutaneous leishmaniasis
dc.subject.otherAuthKeyword molecular subspeciation
dc.subject.otherAuthKeyword transepidermal elimination
dc.subject.otherIndex adolescent
dc.subject.otherIndex adult
dc.subject.otherIndex aged
dc.subject.otherIndex article
dc.subject.otherIndex Asia
dc.subject.otherIndex child
dc.subject.otherIndex clinical trial
dc.subject.otherIndex epidermis
dc.subject.otherIndex female
dc.subject.otherIndex genetics
dc.subject.otherIndex human
dc.subject.otherIndex Leishmania major
dc.subject.otherIndex Leishmania tropica
dc.subject.otherIndex male
dc.subject.otherIndex methodology
dc.subject.otherIndex middle aged
dc.subject.otherIndex multicenter study
dc.subject.otherIndex parasitology
dc.subject.otherIndex pathology
dc.subject.otherIndex polymerase chain reaction
dc.subject.otherIndex preschool child
dc.subject.otherIndex restriction fragment length polymorphism
dc.subject.otherIndex retrospective study
dc.subject.otherIndex skin leishmaniasis
dc.subject.otherIndex Adolescent
dc.subject.otherIndex Adult
dc.subject.otherIndex Aged
dc.subject.otherIndex Aged, 80 and over
dc.subject.otherIndex Asia
dc.subject.otherIndex Child
dc.subject.otherIndex Child, Preschool
dc.subject.otherIndex Epidermis
dc.subject.otherIndex Female
dc.subject.otherIndex Humans
dc.subject.otherIndex Leishmania major
dc.subject.otherIndex Leishmania tropica
dc.subject.otherIndex Leishmaniasis, Cutaneous
dc.subject.otherIndex Male
dc.subject.otherIndex Middle Aged
dc.subject.otherIndex Polymerase Chain Reaction
dc.subject.otherIndex Polymorphism, Restriction Fragment Length
dc.subject.otherIndex Retrospective Studies
dc.subject.otherKeywordPlus TRANS-EPITHELIAL ELIMINATION
dc.subject.otherKeywordPlus CHRONIC-RENAL-FAILURE
dc.subject.otherKeywordPlus EPIDERMAL ELIMINATION
dc.subject.otherKeywordPlus DIABETES-MELLITUS
dc.subject.otherKeywordPlus DENDRITIC CELLS
dc.subject.otherKeywordPlus DERMATOSIS
dc.subject.otherKeywordPlus GRANULOMA
dc.subject.otherWOS Dermatology
dc.subject.otherWOS Pathology

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