Clinicobacteriological and Histopathological Correlation in Leprosy in a Tertiary Care Centre: A Study of 220 cases
The burden of leprosy has reduced drastically with the use of multi-drug treatment. However, the goal of appropriate diagnosis for therapeutic purposes remains an important issue. A study of 220 newly diagnosed cases of leprosy was conducted using the Ridley-Jopling classification of leprosy. For histopathology routine Haematoxylin & Eosin staining as well as a Fite-Faraco staining for acid-fast bacillus was done. The data regarding age, sex, clinical findings like type, number, morphology, site of lesion and neural involvement, histopathological features like an invasion of the epidermis, involvement of subepidermal zone, character and extent of granuloma, lymphocytic infiltrate, epithelioid cells, Langhans giant cells, foamy macrophages, involvement of arrector pilorum and presence of Mycobacterium leprae on Fite-Faraco stain and slit skin smears were collected and analysed. Out of these 220 clinically diagnosed cases of leprosy, borderline tuberculoid leprosy (37.27%) was the most common type followed by lepromatous leprosy (29.09%), borderline lepromatous leprosy (24.54.%), mid borderline (5%) and tuberculoid leprosy (4.09%). The overall correlation of clinical diagnosis with histopathology was seen in 79.55%, and the maximum concordance 88.89% was found in Borderline lepromatous leprosy patients. By Fite-Faraco staining 120 out of 220 showed AFB positivity. Overall clinical diagnosis correlated with histopathology was seen in 79.55% (175/220). Higher proportion of multibacillary (MB) cases was diagnosed by bacteriological and histopathological examination including Fite-Faraco staining. Hence, to arrive at a conclusive diagnosis and optimum treatment, it might be preferrable to consider multiple parameters like clinical features, bacillary index, and histopathological findings and use of special stains rather than relying on a single criterion. Any improved criteria should be based on therapeutic gains to be proved in proper follow-up studies.