DETERMINATION OF ACCURACY OF SLIT SKIN SMEAR IN DIAGNOSING CUTANEOUS LEISHMANIASIS AS COMPARED TO SKIN BIOPSY FOR HISTOPATHOLOGY

Abstract

Introduction: Cutaneous Leishmaniasis is the most common form of Leishmaniasis. Its diagnosis is based on clinical appearance and history of visit to endemic areas but confirmation is through demonstration of the leishmania tropica bodies in sores. This can be achieved by various smears like slit skin smears, saline aspirate smears, scalpel scrapping by using a dental broch, by fine-needle aspiration, impression smears of skin biopsy specimens and skin biopsy.

Objective: The objective of this study was to determine accuracy of slit skin smears in diagnosing cutaneous leishmaniasis as compared to skin biopsy for histopathology.

Study Design: Cross-sectional study.

Setting: Research was conducted at Department of Dermatology, PAF Hospital Islamabad.

Duration: Duration of study was 6 months after the approval of synopsis from 31/12/2016 to 30/06/2017.

Material and Methods: This study involved 100 patients of both genders aged between 18-65 years presenting with suspected cutaneous leishmaniasis. Patient’s demographic details were noted. Slit skin smear and skin biopsy were performed and the results of these two techniques were cross tabulated to label a case as true positive or true negative. This information was then used to calculate the diagnostic accuracy of Slit Skin Smear. A written informed consent was obtained from every patient.

Results: The age of the patients ranged from 18 years to 65 years with a mean of 37.64±11.32 years. There were 66 (66.0%) male and 34 (34.0%) female patients with a male to female ratio of 1.9:1. Face was involved in 48 (48.0%) patients followed by upper extremity (31.0%) and lower extremity (21.0%) lesions. In majority (n=67, 67.0%) of the patients the size of the lesion was between 1-3 cm while in 33.0% patients the size of the lesion was between 3-6 cm. 61.0% patients had lesions for less than 4 months’ duration while 39.0% patients had leishmaniasis for 4-8 months’ period.

Conclusion: The accuracy of slit skin smear was found to be 52.0% in the diagnosis of cutaneous leishmaniasis as compared to skin biopsy for histopathology irrespective of patient’s age, gender, site, size and duration of lesion.