Correlation of clinical, parasitological and histopathological diagnosis of cutaneous leishmaniasis in an endemic region in Sri Lanka

INTRODUCTION: Diagnosis of cutaneous leishmaniasis (CL) largely depends on the clinical appearance of the lesions in endemic areas. OBJECTIVES: The aim of this study was to correlate the clinical diagnosis with positive laboratory tests used for the identification of leishmania parasite (stained smears and histopathology) and therapeutic response. METHODS: 114 clinically suspected patients (190 lesions) were studied. They were diagnosed as typical clinical cases (87.4%) and clinically suggestive cases (12.6%) on the basis of criteria for clinical diagnosis. Slit-skin-smear and histopathology were performed in all patients. RESULTS: Out of 103 who were clinically diagnosed, 62 (60.2%) were confirmed parasitologically. Out of 41 who were negative for both smear and histology, 34 (33%) had supportive histology and the diagnosis was supported by good treatment response in 37 (35.9%). Hence, the clinical diagnosis was 93.2% accurate and this increased to 96% after observing the good response to therapy. CONCLUSIONS: Considering the magnitude of the problem, limited resources, and clinical accuracy of 96%, clinical diagnosis by a dermatologist appears to be reliable enough in diagnosing CL lesions in endemic areas in Sri Lanka.