Clinico-histopathological Concordance in Leprosy Patients - A Study of 200 Cases

ABSTRACT

As information about profile of leprosy from different geographical areas is important, this study was carried out to document the clinical profile of leprosy cases reporting to a medical college, a tertiary care settings in Rajkot, Gujarat. Further this study also aimed at analysing the concordance of clinical findings with bacteriological and histopathological characteristics. 200 leprosy patients who came to Dept. of D.V.L., P.D.U. G.M.C, Rajkot from October 2014 to September 2016 were included. Thorough history with routine investigations, slit skin smear, biopsy for H & E and Fite Faraco stain was undertaken. The most common age group was 21-30 years (31%) with male to female ratio 1.821. 15 (7.5%) of these cases were migrants. 71.5% were multibacillary patients. 8% were relapse cases. Only 3 (1.5%) belonged to paediatric age group. Clinically maximum patients (91, 45.5%) were of lepromatous leprosy followed by borderline tuberculoid leprosy (46, 23%). An overall 65% of these cases were positive for acid fast bacilli (AFB) in slit skin smears. 17% had Type II reactions whereas only 2% had Type I reactions. 36% of these patients had grade I and 12.5% had grade II deformity. The most common histopathological entity was borderline tuberculoid (25%) followed by lepromatous leprosy (24.5%). Maximum clinical concordance was seen in borderline lepromatous (72.72%. The histopathological diagnosis was consistent with clinical diagnosis in 116 cases (58%) which indicates the need for strengthening of skills and or more research into criteria or dynamics of disease spectrum in this area. A combined approach including clinical, bacteriological and histopathological examination would be desirable to reach at final diagnosis and classification in tertiary care/referral centres. Population based studies followed by intensification of anti-leprosy activities appear to be necessary in this area.