A cytomrphologic study of the different manifestation seen for the amastigote form in cutaneous leishmania

Abstract EN

Objective: although the specificity of the microscopic method by identifying the LD bodies within the infected macrophage from the skin lesion was very high, its sensitivity (30%) remains limited.

The purpose of our study is to work on elevating the sensitivity of the microscopic method by not only identifying the LD bodies within the macrophage, but by checking the amastigote presence in its different cytomorphologies in both the intra cellular macrophage and the extra cellular fluid of the infected area. Methods: Thirty seven cases of clinically diagnosed cutaneous Leishmaniasis were studied after staining the microscopic slides taken from the presumed infected area with Wright stain.

The study was divided into two parts: Part one: Defining the different microscopic cytomorphologies of the amastigote forms and later, classifying the amastigote forms according to their common microscopic features into specific classification.

Part two: Studying and calculating the appearance of the amastigote forms in each and every case in either the intra or extra cellular fluid and comparing them. Results: The oval in shape and spindle in shape amastigote types are found in the same rate (43% of the cases referred), whereas the round shape amastigotes ar present only in 5 % of the cases referred, and the overall amastigote presence of any type was at about 49% of all the 37 cases referred to us.

Fourty nine percent of the cases referred show the presence of a smooth and spreading type of chromatin inside the amastigotes, and other 49% show the amastigotes with a condensed and or polarized chromatin in one pole of the amastigote.

A third type of the amastigote is seen with only condensed chromatin and total absence of the cytoplasm (candle flame-shape).

Overall, the appearance of the amastigote of any of the mentioned above features constitutes 49% of the cases referred to us.

The amastigote is seen at 41% of the cases referred inside the macrophage, and 46% of the cases referred are having the amastigote present in the outer cellular compartment.

In 38% of the cases referred to us, the amastigote is shown sharing both the intra and extra cellular compartments, while an overall appearance of the amastigote in the cases referred was 49%. Conclusions: Our data showed that an additional 20% sensitivity and more specificity is gained by the microscopic method making the method more competitive with other procedures and to be considered as the gold standard method for such leishmaniasis diagnosis.