Demography, clinical presentation and laboratory diagnosis of leprosy by microscopy, histopathology and PCR from Dhaka city in 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 2þ, 2 (22%) as 3þ and 4 (44%) as 4þ. 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.