Summary In 2 non-governmental organization projects in Bangladesh 244 new leprosy patients were classified in the field according to clinical criteria. Skin smears were taken at 4 standardized sites and at the most active peripheral lesion, where a biopsy was also taken.Comparison of the clinical field classification with the results of the skin smears and biopsies gives a sensitivity of 92· 1 % for the clinical criteria, but a specificity of only 41'3%. The skin-smear results, on the other hand, have a sensitivity of 88-4% and a specificity of 98·1 %.Thus, skin smears may contribute considerably to the operational classifica tion of leprosy patients under field conditions. Quality control of the peripheral laboratory is essential. Appropriate site selection for the smear taking will also contribute to increased performance. Analysis of the skin-smear results suggests that the policy of taking smears at standardized sites should be abandoned in favour of the earlobes and active peripheral lesions.According to WHO recommendations, 1 the operational classification of leprosy cases in paucibacillary (PB) and multi bacillary (MB) patients should be based on the bacter iological index, whereby the presence of acid-fast bacilli (AFB) at any single site is the criterion used fo r classification as MB. However, the validity of skin smear results has often been questioned, 2 -4 and many leprosy control programmes base their operational

DESCRIPTIONWe describe a case of chronic tongue ulceration with systemic symptoms in a patient with poorly controlled diabetes. A biopsy of a lesion from the posterior third of the tongue showed features typical of histoplasmosis (figure 1). A CT of the thorax and abdomen revealed a diffuse reticulonodular pattern bilaterally ( figure 2A). The intraabdominal organs were normal. A diagnosis of disseminated histoplasmosis was made. The patient was started on intravenous amphotericin B for 3 weeks followed by oral itraconazole 100 mg twice a day for 1 month. A repeat CT thorax 6 weeks after antifungal treatment revealed resolution of the lesions (figure 2B).Disseminated histoplasmosis refers to a process of severe fungus colonisation in the lungs and other organs and body sites 1 The first ever case of disseminated histoplasmosis in a patient with diabetes living in a non-endemic area was reported in 1977.2 Since the AIDS epidemic, disseminated histoplasmosis is more commonly seen. Chronic infection often presents with pancytopenia, hepatosplenomegaly,