Clinico-Pathological Co-relation in Leprosy

摘要

Introduction:Leprosy is an important communicable disease caused by M. leprae 1,9, and one of the major health problems of developing countries like India2. Most of the time, clinical judgment is adequate for diagnosis. But in some, especially early and borderline cases of leprosy histopathology, the study of epidemiological and demographic factors can be important.Method:The aim of the present study is to study epidemiological and demographic factors among patients of leprosy, to describe the clinical pattern of the disease, and to correlate clinical diagnosis with histopathological findings with AFB (acid-fast bacilli – M. leprae) status. A total of 100 cases were studied. A detailed history was taken, and a complete examination of the patient was carried out, including general, local and systemic examinations. The biopsies were taken and stained using the routine haematoxylin-eosin method and modified Fite-Faraco stain for detection of acid-fast bacilli. The histopathological diagnosis was based on the scheme put forth by Ridley and Jopling.Results:The study shows that 34 patients (34%) belonged to a sexually active age group i.e., 21-30 years (Table-1). The highest number of cases (29%) were clinically diagnosed as borderline tuberculoid (BT), followed by tuberculoid (TT) (24%), borderline leprosy (BL) (21%), lepromatous leprosy (LL) (20%) and the fewest cases were mid-borderline leprosy (BB) (6%). 26% of patients were histologically diagnosed as TT and BT, followed by BL (25%), LL (20%) and BB (03%). Modified Fite-Faraco stain for AFB in skin biopsy were negative in TT (26%), BT (26%) and BB (03%) cases. 21 out of 25 cases of BL and 19 out of 20 cases of LL were positive for AFB.Discussion:This age difference may be due to differences in exposure, opportunities for infection and immunological differences in children and adults. Histopathological examination in leprosy increases the accuracy of diagnosis whereas clinical features indicate only the gross morphology of lesion caused by underlying pathological changes, since tissue response varies in disease spectrum due to the availability of CMI.Key Message: Correlation of clinical and histopathological features along with bacteriological index appears to be more useful for accurate typing of leprosy than considering any of the single parameters alone. Introduction Leprosy is an important communicable disease caused by M. leprae 1,2, one of the major health problems of developing countries like India.1,2,3,4 The organism has a special predilection for the skin and peripheral nerves1 and resides mainly within cells of mononuclear phagocytic series. Lepromatous leprosy patients are the most important reservoirs of infection5.Most of the time clinical judgment is adequate for diagnosis. But in some, especially early and borderline cases of leprosy, histopathological examination is required. The mislabeling of a case can lead to inadequate therapy, which may be disastrous to the case and also to the society. So, clinicopathologic correlation of leprosy cases assumes a pivotal role not only for early diagnosis but also for proper labeling of cases. Method The aim of the present study is to study epidemiological and demographic factors among patients of leprosy, to describe the clinical pattern of the disease, and to correlate clinical diagnosis with histopathological findings with AFB (acid fast bacilli – M. leprae) status. A total of 100 cases were studied. The history was taken in detail, and complete examination of patients was carried out, including general, local and systemic examination, particularly with reference to skin, nerves and sensory disturbances. Relevant past and family history was asked. Deformities were graded as per the WHO (1998) grading system6.The biopsies were taken from the most active and untempered lesions. It included the margin of the lesion and was sent to the Pathology Department in 10% formalin bulbs. The biopsy specimens were processed as per sta