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Proposal of a histopathological predictive rule for the differential diagnosis between American tegumentary leishmaniasis and sporotrichosis skin lesions
Author(s) -
Quintella L.P.,
Passos S.R.L.,
de Miranda L.H.M.,
Cuzzi T.,
Barros M.B. de L.,
FrancesconidoVale A.C.,
Galhardo M.C.G.,
Madeira M. de F.,
Figueiredo de Carvalho M.H.,
Schubach A.de O.
Publication year - 2012
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.2012.11012.x
Subject(s) - sporotrichosis , medicine , leishmaniasis , differential diagnosis , dermatology , pathology
Summary Background American tegumentary leishmaniasis (ATL) and sporotrichosis exhibit similar histopathology and low frequencies of microorganism detection. Objectives This study seeks to identify microscopic alterations that can distinguish between these diseases. Methods Haematoxylin and eosin stained slides of 171 ATL and 97 sporotrichosis samples from active cutaneous lesions were examined for histopathological alterations. The lesions were diagnosed by isolating the agent (which was not visible) in culture. An intuitive diagnosis was assigned to each slide. The strength of the association between the histopathological findings and the diagnosis was estimated by an odds ratio, and each finding was graded according to a regression model. A score was assigned to each sample based on the histopathological findings. A study of the interobserver reliability was performed by calculating kappa coefficients of the histopathological findings and intuitive diagnoses. Results The markers ‘macrophage concentration’, ‘tuberculoid granuloma’ and ‘extracellular matrix degeneration’ were associated with ATL. ‘Suppurative granuloma’, ‘stellate granuloma’, ‘different types of giant cells’, ‘granulomas in granulation tissue’ and ‘abscess outside the granuloma’ were associated with a diagnosis of sporotrichosis. ‘Macrophage concentration’ and ‘suppurative granuloma’ had the highest (substantial and almost perfect, respectively) reliability. The regression model score indicated 92·0% accuracy. The intuitive diagnosis had 82·5% diagnostic accuracy and substantial reliability. Conclusions Taking into account the clinical and epidemiological context, some histopathological alterations might be useful for the differential diagnosis between ATL and sporotrichosis cutaneous lesions in cases in which the aetiological agent is not visible.