ABSTRACT
Leprosy is a chronic disease of ancient world and is still afflicting patients in many parts of world mainly Asia and Africa. Leprosy is one of the most dreaded diseases of humankind. We wanted to study the various microscopic patterns and subtypes of Leprosy. We also wanted to study the Bacterial Index in the region of Sawangi, Meghe.METHODS80 skin biopsies after adequate fixation in 10% of formalin, were routinely processed and were stained with H and E, Fite-Faraco stain and Modified Rapid Acid-Fast Bacilli (MRAFB staining) method, were studied microscopically and bacterial index was calculated.RESULTSA total of 80 skin biopsies were obtained from patients of department of dermatology over a period of two years from 2017 to 2019. Among them Lepromatous leprosy were 43 cases, Tuberculoid leprosy were 23 cases, Borderline lepromatous leprosy were 09 cases, Borderline tuberculoid leprosy were 03 cases, histoid leprosy were 01 case and ENL were 01 case. With an age range of 6 - 85 years, majority were in 31-40 years of age group, with male to female ratio of 2.47:1. LL was the most common type of leprosy (53.75%).CONCLUSIONSAccurate diagnosis of leprosy purely on clinical grounds is extremely difficult. Hence, there can be false positive and false negative diagnosis. Since histopathology is confirmatory, with application of Fite-Faraco and MRAFB staining it can also evaluate the bacterial load. Hence in all suspected cases of leprosy, histopathology along with Fite-Faraco and MRAFB staining should compulsorily be done.
ABSTRACT
Introduction: The main feature of the vast majority of leprosy biopsy specimens is a granulomatous infiltrate that has differentfeatures according to the form of leprosy, the time and site of the biopsy, the presence of a leprosy reaction, and therapy.Aim: This study aims to analyze the clinicohistopathological correlation in different types of leprosy.Materials and Methods: Skin biopsies were taken from clinically suspected patients. The tissue section was stained routinelyby hematoxylin and eosin. Aspecial stain like modified Fite-Faraco (FF) was done to demonstrate lepra bacilli. Histopathologicalfindings were graded into tuberculoid, borderline tuberculoid, midborderline, borderline lepromatous (BL), and lepromatous (LL),according to Ridley and Jopling scale. The clinicohistopathological correlation was done.Results: In 162 cases, 154 cases were confirmed as leprosy in histopathology. LL leprosy was more common 26.6% followedby BL leprosy 25.3%. In histopathologically confirmed leprosy cases, 103 cases (67.6%) were positive in FF stain.Conclusion: Some degree of overlap between different types of leprosy, both clinically and histopathologically, correlation ofclinical and histopathological features along with bacteriological index appears to be more useful for accurate typing of leprosythan considering any one of the single parameters alone.
ABSTRACT
Background: Leprosy (Hansen’s disease) is one of the major health problems of the world especially in developing countries. In India, it was first described in “Sushruta Samhita ” & treated by Chaulmoogra oil and caused by Mycobacterium Leprae. Early diagnosis of leprosy, an absolute necessity for control as well as effective therapy. For this, clinical diagnosis, skin smear examination is adequate coupled with histo-pathological examination of skin and nerve lesions with modified Fite Faraco stain for demonstration of acid fast bacilli. Moreover, bacillary index is required for adequate combined chemotherapy regimen. Detection of anti PGL-1 antibodies in serum gives an added advantage for detection and monitoring treatment. Materials & Methods : A total of 85 cases of leprosy who attended outpatient department of Skin & VD, Shri Sayaji General Hospital Baroda chosen for study during '07-08' period with 75 cases from leprosy hospital, Baroda which included 50 detected patients and 25 child contacts with 25 healthy voluntary blood donors from blood bank, SSGH selected.Clinical, past and family history taken with slit skin smears stained with Z-N stain,graded and histopathological evaluation done. Serological study done from serumof leprosy patients and healthy blood donors; tested by serodia kitsand interpretation made. Results : Most cases were in 2nd to 4th decade and males dominated. Clinically most cases were of indeterminate and tuberculoid type and histologically indeterminate and borderline tuberculoid. Clinico-histopathological correlation was found most in indeterminate followed by histoid type. Voluntary blood donors were seronegative. 21 out of 48 multibacillary cases and 6 out of 28 paucibacillary showed seropositivity for anti PGL-1 antibodies (p<0.001). Conclusion : . All suspected leprosy cases clinically should be subjected to slit skin smear examination with histopathological evaluation; bacillary study which helps in diagnosis and adequate treatment of patients. Detection of antibodies to PGL-1 in patients indicate pres-ence of leprosy bacilli and useful in preclinical diagnosis and determining progress of therapy.
ABSTRACT
Background: Leprosy is not always an easy disease to diagnose, and patients can remain undiagnosed for longtime, not only at the peripheral clinics but also even at places with higher medical facilities, so, there is an urgent need for rapid and definitive modalities for leprosy diagnosis. This prospective study evaluates the ability of Fite-Faraco staining (FF staining) and multiplex polymerase chain reaction (PCR) over hematoxylin and eosin staining (H and E staining) and Ziehl-Neelsen staining (ZN staining). Aims: The aim of this perspective study is to evaluate the effectiveness of FF staining in combination with multiplex PCR for the early and rapid diagnosis of leprosy than any other coexisting diagnosis tool. Methods: Patients with new skin patches or nodules with or without evidence of nerve damage were selected for the study. Punch biopsy was collected according to standard procedures. Each biopsy sample was divided into two equal parts, one half was fixed in 4% (v/v) buffered neutral formalin and then accordingly embedded in paraffin. Sections were stained by three different methods: H and E staining for histopathological examination, ZN staining, and FF staining for detection of acid-fast bacilli (AFB). And the other part was subjected for DNA extraction and PCR was carried out by the obtained DNA sample. Results: H and E staining, ZN staining, FF staining, and PCR yield 58.2%, 50.9%, 60%, and 67.7% successful diagnosis of leprosy. The true diagnostic performances for these techniques were as follows: H and E staining - sensitivity 70.6%, positive predictive value (PPV) 81.9%, negative predictive value (NPV) 53.6%. For ZN staining - sensitivity 59.9%, PPV 69%, NPV 45.7%. For FF st aining - sensitivity 74.6%, PPV 85.9%, NPV 56.7%, and for PCR - sensitivity 87.8%, PPV 95.6%, NPV 71.2%. Conclusion: The combination of FF staining and PCR was shown to provide a rapid and definitive diagnosis in the majority of leprosy suspected cases with a higher positive likelihood ratio (+LR) of 7.76 and 2.716, respectively, than H and E staining of 2.244 and ZN staining of 1.378.