How accurately do clinical diagnosis correlate with biopsy findings in leprosy?

Authors

  • Singh Akhil Kumar
  • Singh Ranjana
  • Singh Savitri
  • Grover Sanjiv

Keywords:

Leprosy, clinicopathological correlation, clinical presentations, Ridley and Jopling classification

Abstract

Objective To document the clinical profile of leprosy patients and to determine concordance between clinical and histopathological diagnosis using Ridley and Jopling classification. Methods 58 clinically and histological confirmed cases of leprosy ranging in age from 7-70 years who attended dermatology outpatient department (OPD) in Saraswathi Institute of Medical Sciences were included in the study. Slit-skin smear examination was performed in all cases. Histopathological investigations were carried out in all cases to confirm the diagnosis and to classify the cases. Results A total of 58 clinically diagnosed cases of leprosy comprised the study material. Out of them, 42 (72.4%) were males and 16 (27.6%)females with male to female ratio of 2.6:1. The highest number of cases was in age group 20-29 years with 22 (37.9%) cases. 10 (17.2%) cases were multibacillary and 48 (82.8%) cases were paucibacillary. The most common site of biopsy was from lower extremities in 24 (41.4%) cases. Clinically, maximum number of patients was borderline tuberculoid (BT) type with 22 (37.9%) cases, followed by tuberculoid leprosy (TT) in 14 (24.1%) cases. Lepromatous leprosy (LL) was confirmed in 3 (5.2%) cases. Most common clinical presentation was altered sensation in 57 (98.3%) cases, skin plaques in 46 (79.3%) cases and nerve involvement was noted in 36 (62.1%) cases. Maximum clinicopathological correlation was noted in both poles i.e. LL with 3 (100%) cases and TT with 12 (85.7%) cases and maximum disparity was noted in borderline lepromatous leprosy (BL) in 3 (60%) cases. Overall concordance between clinical and histopathological diagnosis observed in our study was 46 (79.3%) cases. Conclusion Leprosy continues to remain a public health problem. Clinical-histopathological discordance leading to inadequate treatment could be contributory. Our study revealed a 20.7% rate of discordance. Early assessment and adequate management is essential for reducing the discordance rate. 

References

Mohite RV, Mohite VR, Durgawale PM. Differential trend of leprosy in rural and urban area of Western Maharashatra. Indian J Lepr. 2013;85:11-8.

Abulafia J, Vignale RA, Leprosy: Pathogenesis updated. Int J Dermatol. 1999;38:321-4.

Jopling WH, McDougall AC, Editors. Handbook of Leprosy. Fifth edition. Mumbai (India): CBS Publishers; 2008.

World Health Organization. Chemotherapy of leprosy for control programs. WHO Tech Rep Ser675. Geneva: WHO;1982.

Bhusan P, Sardana K, Korrane RV, Chaudary M, Manjul P. 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.

Badhan R, Kundal RK, Raj RT, Bahl RK, Bal MS. A clinicopathological correlation study of leprosy in a tertiary care teaching institute in Northwest Punjab, India. Am J Med Sci Med. 2014;2:99-108.

Giridhar M, Arora G, Lajpal K, Chahal KS. Clinico-pathological concordance in Leprosy - A clinical, histopathological and bacteriological study of 100 cases. Indian J Lepr. 2012;84:217-25.

Manandhar U, Adhikari RC, Sayami G. Clinico-histopathological correlation of skin biopsies in leprosy. J Pathol Nepal. 2013;3:452-8.

Tiwari PK, Kar HK, Sharma PK, Gautam RK, Arora TC, Naik H et al. Epidemiological trends of leprosy in an urban leprosy centre. Indian J Lepr. 2011;83:201-8.

Kalla G, Salodkar A, Kachhawa D. Clinical and histopathological correlation in leprosy. Int J Lepr. 2000;68:184-5.

Jerath VP, Desai SR. Diversities in clinical and histopathological classification of leprosy. Lepr India. 1982;54:130-4.

Singh PA, Agarwal R, Misra V, Gupta SC, Bajaj AK. Clinico-histopathological concordance in leprosy. Trop Doct. 2000;30:228-31.

Downloads

Published

2017-06-13

How to Cite

1.
Kumar SA, Ranjana S, Savitri S, Sanjiv G. How accurately do clinical diagnosis correlate with biopsy findings in leprosy?. J Pak Assoc Dermatol [Internet]. 2017Jun.13 [cited 2024Mar.29];27(1):23-9. Available from: http://jpad.com.pk/index.php/jpad/article/view/1022

Issue

Section

Original Articles