Demografía, presentación clínica y diagnóstico de laboratorio para la lepra por microscopio, histopatología, y PCR de la ciudad de Dhaka en Bangladesh

Background: Recent data regarding demography, clinical presentation and molecular diagnosis of leprosy patients are lacking in Bangladesh.
Methods: A cross sectional study on 55 leprosy cases of 16–70 years old, both sexes was done. Ziehl-Neelsen (Z-N) stain, histopathology and PCR of skin specimens were done.
Results: 40% patients were between 21–30 years, mean age 34・5 years, male to female ratio was 2・9:1. Fourteen (25%) patients were destitute, 11 (20%) were housewives. 62% patients had more than 5 skin lesions. 58% had two and 36% had single nerve involvement. Altogether 9 (16%) were smear positive for AFB, 3 (33%) were graded as 2+, 2 (22%) as 3+ and 4 (44%) as 4+. Histologically, 52 (95%) showed features of leprosy, 14 (25%) were diagnosed as tuberculoid and 5 (9%) were lepromatous leprosy. In total, 40 (73%) of 55 patients were positive by PCR. Thirty (88%) of 34 multibacillary leprosy and 10 (48%) of 21 paucibacillary leprosy patients were PCR positive. One of 3 histopathologically negative leprosy patients was PCR positive.
Conclusion: Multiple skin lesions and multiple nerve involvement are the predominant features. For diagnosis of multibacillary leprosy, Z-N stain and for paucibacillary leprosy, PCR are suitable methods. In smear negative cases, results of histopathology may be suggestive, and PCR can give confirmatory results.

Antecedentes: Existe una falta de informacion sobre la demografia, presentacion clinica y diagnostico molecular de pacientes de lepra en Bangladesh.
Métodos: Se realizo un estudio transversal de 55 casos de lepra de entre 16–70 anos, de ambos sexos. La tincion Ziehl-Neelsen (Z-N), histopatologia y PCR de las muestras cutaneas fueron las tecnicas realizadas.
Resultados: El 40% de los pacientes tenia entre 21–30 anos, la edad media fue de 34・5 anos, el ratio varon/hembra fue de 2・9:1. Catorce pacientes (25%) eran indigentes, 11 (20%) amas de casa. El 62% de pacientes presentaba mas de 5 lesiones cutaneas. El 58% tenia dos y el 36% tenia solo una afectacion neural. En conjunto, 9 (16%) eran frotis positivos para la tincion acido-alcohol resistente a (BAAR), 3 (33%) se clasificaron como 2+, 2 (22%) como 3+ y 4 (44%) como 4+. Histologicamente, 52 (95%) presentaban caracteristicas de lepra lepromatosa, 14 (25%) fueron diagnosticados como tuberculoides y 5 (9%) como lepra lepromatosa. En total, 40 (73%) de los 55 pacientes eran PCR positivos. Treinta (88%) de los 34 pacientes multibacilares y 10 (48%) de los 21 paucibacilares era PCR positivos. Uno de 3 pacientes de lepra histopatologicamente negativos fue PCR positivo.
Conclusión: Las principales caracteristicas son multiples lesiones cutaneas y compromiso neural multiple. Para el diagnostico de lepra multibacilar, la tincion Z-N y para la lepra paucibacilar, la PCR son metodos adecuados. En los casos frotis negativos, los resultados de la histopatologia pueden ser sugestivos y la PCR puede confirmarlos.