A Single Centre Cross-Sectional Study of Clinicopathological Correlation in Leprosy: Discordance and Spectral Shift

Classifying a case of Leprosy is very important from the point of view of management, prognosis and complications. Among the various methods, the Ridley-Jopling (R-J) classification is most widely used. However, there are discrepancies between the clinical diagnosis and histopathological diagnosis across the spectrum, necessitating correlation for accurate diagnosis and management. This study aimed to correlate the clinical and histopathological diagnosis of Hansen's disease and study its effect on the classification. Seventy-nine non-reactional cases of leprosy were subjected to clinical and histopathological examination and classified separately according to R&J classification and WHO classification. On confirmation, the diagnoses were correlated, concordance and discordance noted and analysed. A perfect correlation was found in total of 48.1% patients, maximum in TT (66.7%) followed by BL (65%). Major mismatch was seen in 31.7% of cases. A statistically significant correlation of the Fite Faraco positivity for Acid-fast bacilli was found with the histopathological diagnosis than with the clinical. The higher 51.9% discordance in the clinical and histopathological classification points towards the possibility of a spectral shift having occurred in the Indian population (from paucibacillary to multibacillary), which may be responsible for the resurgence of cases and pushing us back in time with regards to the elimination of Leprosy and failure of the existing control programs. Hence clinicopathological correlation should be mandatory in every case.