A STUDY OF CLINICO-HISTOPATHOLOGICAL CORRELATION OF CUTANEOUS MANIFESTATIONS IN LEPROSY

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A STUDY OF CLINICO-HISTOPATHOLOGICAL CORRELATION OF CUTANEOUS MANIFESTATIONS IN LEPROSY

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 46

Abstract

BACKGROUND Leprosy is one of the oldest and chronic infectious diseases known to human beings caused by Mycobacterium leprae. The disease still carries a grave social stigma and ostracism, which compels the patients to hide the disease. Leprosy continues to be an important public health problem in most parts of Asia, especially India.1 Leprosy is a progressive, chronic granulomatous disease of the peripheral nerves and skin and other tissues such as mucous membranes, muscles and reticuloendothelial system. The disease presents in various clinico-pathological forms depending on the immune status of the host. The disease spectrum has been characterised in a number of classification systems, most widely being the Ridley-Jopling. Aim- Fifty cases were taken to correlate clinical diagnosis with histopathological findings. MATERIALS AND METHODS All clinically suspected Leprosy patients attending Department of DVL were included in this study. History was taken in detail and complete examination of patients carried out, particularly with reference to skin, nerves and sensory disturbances. Slit skin smear was taken from the patients with specific findings. The biopsies were taken from the most active and untampered lesions including the margin of the lesion and sent to the Pathology Department in 10% neutral buffered formalin. The histopathological diagnosis was made based on the scheme put forth by Ridley and Jopling. RESULTS The present study comprised of 50 patients, 33 were male (66%) and 17 female (34%) with a male: female ratio of 1.9: 1. Table 1 shows the distribution of patients according to age group and gender. Majority of the patients (11 patients: 7 males and 4 females) were between 31-40 years of age, whereas least affected were below 10 years (2 female patients). The mean age of the patients studied was 41.3441.34 ± 17.104. The range of youngest patient is 7 years old female and the oldest patient is 75 years old male. With regard to patient’s occupation, the largest group included are 20 farmers (40%) followed by 12 daily labourers (24%), students and housewife are equal percentage (12%), whereas only 2.0% of the patients are employees. The distribution of these cases based on Ridley and Jopling clinical and histopathological classification is shown in Table 4. It is clearly evident from Table 4 that clinically majority of the patients (40%) belonged to Lepromatous Leprosy (LL) group followed by borderline tuberculoid (BT) group (24%), tuberculoid leprosy (TT) group (14%) and mid-borderline (BB) group and indeterminate leprosy (IL) group with 6% to 4% each. Histopathologically, majority of the cases 32% belonged to Lepromatous Leprosy (LL) followed by BT (18%), BL (16%), TT and IL (12% each). Among cases with negative slit skin smear were 40 patients. 10 patient’s slit skin smears were positive in 20% of patients. Out of 20 patients, 2+ for 2 patients, 3+ for 7 patients and BI was maximum 4+ for 1 patient. The correlation between clinical and histopathological classification is shown in Table No. The overall concordance between the clinical and histopathological agreement was seen in 15 (34.5%) cases and maximum. Clinico-histopathological correlation was seen in BB (100%) followed by TT (57.1%), BT (50%), IL and BL (33.3%) and 0% in LL. The concordance rate was lower in the borderline groups with 33.3% in BL, 33% in IL and least concordance of 16.7% in LL. However, the concordance for TT was higher than the borderline groups with 57.1%. Histopathological analysis of the cases in the present study as shown in Table 3 was carried out with due attention to the epidermal atrophy, presence of clear subepidermal zone, dermal inflammatory infiltrate, presence and composition of granulomas, presence of giant cells and relative proportion of lymphocytes and foamy histiocytes in accordance with Ridley and Jopling histopathological criteria. Out of the 50 patients included in the study, 15 (30%) presented with a clinical suspicion of paucibacillary leprosy and 35 (70%) of multibacillary leprosy. From the chi-square output table, we see that no significance level has been achieved. McNemar Bowker test table showing no systematic association between the above two variables at 95% level of confidence. Hence, it concludes that there is no significant relationship between age wise patients and histopathological diagnosis. CONCLUSION Leprosy, though reported to be eliminated, still continue to be one of the common infectious diseases in India. Skin biopsy is the useful tool in clinical diagnosis of leprosy as well as therapeutic guide.

Authors and Affiliations

Rahul P, Jonnalagadda Balachandrudu, Shivakumar V

Keywords

Mycobacterium Leprae Leprosy Histopathology Ridley-Jopling Classification.

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EP ID EP548005
DOI 10.14260/jemds/2018/1102
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