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Clinico-histopathological Correlation of Leprosy in Western Region of Nepal - A Pilot Study

Abstract

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, affecting mainly cutaneous and peripheral nervous system. Clinically leprosy presents with a wide array of clinical manifestations and may mimic variety of disparate diseases, therefore, occasionally it may be difficult to diagnose and accurately classify the disease clinically. With more active detection and wide use of multi-drug treatment (MDT), spectrum of disease may be changing which can be better understood by histopathology which can better characterize the immunological spectrum. Hence, the present pilot study was conducted to correlate different types of clinical forms of leprosy with histopathology in Western Nepal. This study was conducted on 21 biopsy samples from Department of Dermatology, Nepalgunj Medical College and Teaching Hospital, Nepalgunj over a period of one year from December 1, 2014 to December 31, 2015. Biopsies were taken from skin lesions of all the clinically diagnosed leprosy cases during this period. Ridley and Jopling classification was applied for histopathological taxonomy. Of 21 patients, 12 were males (57.1%) and 9 females (42.9%) with a male: female ratio of 1.33:1. Majority of the patients (7/21) were between 31 to 40 years of age. Based on histopathology, 14 (66.7%) patients had Tuberculoid leprosy (TT); 5 patients had Borderline Lepromatous (BL) leprosy; 1 (4.8%) had Borderline Tuberculoid (BT) leprosy and Lepromatous Leprosy (LL) each. Maximum clinico-histopathological correlation was seen in BL 3/3 (100%), followed by 11/13 in TT (84.6%), 1/2 in LL (50%) and 0% in BT (all three diagnosed as TT by histopathology). Overall clinico-histopathological agreement was seen in 15 (71.4%) cases and disagreement in 6 (28.7%) cases. This limited data shows the need of further population based studies, need for development of better markers, may be better expertise and may be second opinion for improving the clinicopathological correlation in leprosy.

More information

Type
Journal Article
Author
Pokhrel K
Parajuli S
Shah M
Subedi S