Title: Clinico-Histopathological Correlative Study of Leprosy at a Rural Hospital
Authors: Dr Deepa Tekwani, DCP, DNB (Pathology) , Dr Vaibhav Patil, MD (Pathology), Dr Ram Joshi, MD (Medicine), Dr Sneha Joshi, MD (Pathology)
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.203
Abstract
Objectives
1. To analyze the clinico-histopathological correlation in different types of leprosy.
2. To study histopathological spectrum of skin lesions in leprosy.
3. To observe disparity between clinical and histopathological features in different types of leprosy.
Methods: The history and complete clinical examination of 197 patients coming to Dr. Bhausaheb Sardesai Hospital,Talegaon-Dabhade was noted, with reference to skin lesions, nerves and sensory disturbances. Relevant past and family history was taken. Biopsies were taken from most active skin lesions including margins of lesion by Department Of Dermatology & samples were sent to the Department Of Pathology in 10% formalin. The tissue section was stained routinely by Hematoxylin and Eosin. Special stain like Modified Fite Faraco was done to demonstrate lepra bacilli. Histopathological findings were graded into Tuberculoid (TT), Borderline-Tuberculoid (BT), Midborderline (BB), Borderline-Lepromatous (BL), and Lepromatous (LL), according to Ridley and Jopling scale. Clinico-Histopathological correlation was done.
Results: Out of 197 suspected cases of Leprosy which are biopsied, 135(68.52%) cases showed histological features consistent with one type of leprosy. A comparison of histopathological findings with that of clinical pattern revealed that maximum correlation was seen with TT(83.33%) followed by BT(79.76%), BL(54.16%), LL(50%) & BB(25%). There were 3 cases of Histoid Leprosy which showed 100% correlation.
Conclusions: As there can be some degree of overlap between different types of leprosy, both clinically and histopathologically, correlation of clinical and histopathological features along with bacteriological index appears to be more useful for accurate typing of leprosy than considering any one of the single parameters alone.
Key Words: Leprosy, BT, BL,TT,LL.
References
1. Park JE, Park K.Epidemiology of communicable diseases. In: Preventive and Social Medicine Jabalpur. Banarasidas Bhanol; 1991.p215-225.
2. Gail L.Woods. Wayne M. Meyers. Mycobacterial Diseases. Chapter 34.In: Ivan Damjanov. James Linder;Anderson’s Pathology 10th Edition 2009 Vol 1,p854-855.
3. NLEP (2016). Progress report for the year 2015-16 ending on 1st March 2016. Central leprosy division, Directorate general of health services, Government of India, New Delhi.
4. WHO, Global strategy for further reducing the leprosy burden and sustaining leprosy control activities. 2005; 53.
5. Singh A, Gaur R et al: Spectrum of Leprosy Patients withClinico-Histopathological Correlation: A Hospital Based Study. Asian Journal of Medical Science. 2013; 4(4): 11-6.
6. Noordeen SK. The epidemiology of Leprosy, In; HatingsRC,editors, Leprosy, New York; Churchil Livi Guha PK, Pandey SS, Singh G et al. Age of onset of Leprosy. Lepr. India 1981; 53(1): 83-87.
7. Guha PK, Pandey SS, Singh G et al. Age of onset of Leprosy. Lepr. India 1981; 53(1): 83-87.
8. Sehgal VN, Rege VL, Kharangate VN. Epidemiological and clinical pattern of leprosy in Goa. Lepr India 1976; 48: 382-90.
9. Mathur MC, Ghimire RBK, Shrestha P, Kedia SK. Clinicohistopathological Correlation in Leprosy, Kathmandu Univ Med J 2011; 36(4).p.248-51.
10. Kaur I, Indira D, Dogra S et al. Relatively spared zones in leprosy: A clinicopathological study of 500 patients. Int J Lepr 2003; 71(3): 227-229.
11. Sehgal VN, Ghorpade A, Saha K. Urban leprosy an appraisal from Northern India. Lepr Rev. 1984; 55.p.159-166.Verma KC, Ganguli DD and Jain VK.
12. Kaur I, Indira D, Dorga S, Sharma VK, Das A, Kumar B. Relatively spared Zones in leprosy; A clinicopathological study of 500 patients. Int J Lepr2003;71(3).p277-229.
13. Kar PK, Arora PN et al. A Clinico-pathological study of macular lesions in leprosy. Indian J Lepr 1994;66(4): 435-41.
14. Nadkarni NS, Rege VL. Significance of histopathological classification in leprosy. Indian J. Lepr. 1999; 71(3): 325-332.
15. SuriSushilkumar K, IyerRekha R, Patel Darshana U, BandilSupriya, BaxiSeema. Histopathology and Clinico-histopath-ological correlation in Hansen’s disease. JRMDS. Jan- Mar 2014; 1(2): 37-44.
16. Moorthy BN, Kumar P, Chatura KR, et al. Histopathological correlation of skin biopsies in leprosy. Ind J Dermatol Ven Leprol 2001; 67: 299-301.
17. Kaur I, Indira D, Dorga S, Sharma VK, Das A, Kumar B. Relatively spared Zones in leprosy; A clinicopathological study of 500 patients. Int J Lepr2003;71(3).p277-229.
18. Shivamurthy V, Gurubasavaraj H, Shas-hikala PS, Kumar P. Histomorphological study of leprosy. Afr J Med Health Sci 2013; 12:68-73.
19. Shivaswamy KN, Shyamprasad AL et al. Clinicohistopathological correlation in leprosy. Dermatology Online Journal 2012; 18(9).p.2.
20. Jopling WH, MacDougall AC. The Disease. Handbook Of Leprosy 5th Ed, New Delhi: CBS Publishers and Distrib-utors: 1996: p.10-53.
21. Shivamurthy V, Gurubasavaraj H, Shash-ikala PS, Kumar P. Histomorphological study of leprosy. Afr J Med Health Sci 2013; 12:68-73.
22. Bhushan P, Sardana K and Koranne RV, et al. Diagnosing multibacillary leprosy: A comparative evaluation of diagnostic accuracy of slit-skin smear, bacterial index of granuloma and WHO operational classification. Indian J Dermatol Venereol Leprol 2008; 74: 322-6.
23. Shenoi SD, Siddappa K. Correlation of clinical and histopathologic features in untreated macular lesions of leprosy- a study of 100 cases. Ind J Lepr 1988; 60: 202-06.
24. S Bijjaragi , V Kulkarni , KK Suresh , KR Chatura , P Kumar. Correlation of clinical and histopathological classification of Leprosy in post elimination era. Indian J Lepr 2012, 84 : 271-275.
25. Kakkad K, Padhi T,Pradhan K and Agrawal KC(2016). A Study of Clinical, Bacteriological & Histopathological Correlation in Leprosy cases attending a Government Medical College in Western Odisha: some observations. Indian J Lepr.88:97-103.
26. Sharma A, Sharma R, GoswsamiK C et al. Clinico-Histopathological Correlation in Leprosy. JK Science.2008; 10(3): 120-123.