How is a biopsy performed in the workup of cutaneous leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

For cutaneous leishmaniasis, take a 3-mm punch or wedge biopsy sample from a cutaneous sore from the raised edge of an active lesion where parasites are present. Avoid samples from the necrotic center. Additional tissue can be obtained through saline aspiration, tissue scrapings, or slit incisions.

Once tissue is obtained, send touch preparations, tissue impression slides, and formalin-fixed paraffin sections for hematoxylin and eosin staining. Send touch preparations and aspirations for Giemsa staining, as well. Direct visualization of amastigotes with their red rodlike cytoplasmic kinetoplast is diagnostic and helps distinguish them from other parasites (see the image below). Brown-Hopps staining has a higher sensitivity than other staining techniques.

Finding an organism in a tissue sample depends on the parasitic burden, the efficacy of the host's immune response, any coexisting bacterial contamination of the ulcer, and the age of the lesion (findings in older lesions are frequently nondiagnostic).


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