Comparing the Clinical and Histological Diagnosis of Leprosy and Leprosy Reactions in the INFIR Cohort of Indian Patients with Multibacillary Leprosy

Abstract

BackgroundThe ILEP Nerve Function Impairment in Reaction (INFIR) is a cohort study designed to identify predictors of reactions and nerve function impairment in leprosy. The aim was to study correlations between clinical and histological diagnosis of reactions.Methodology/Principal FindingsThree hundred and three newly diagnosed patients with World Health Organization multibacillary (MB) leprosy from two centres in India were enrolled in the study. Skin biopsies taken at enrolment were assessed using a standardised proforma to collect data on the histological diagnosis of leprosy, leprosy reactions and the certainty level of the diagnosis. The pathologist diagnosed definite or probable Type 1 Reactions (T1R) in 113 of 265 biopsies from patients at risk of developing reactions whereas clinicians diagnosed skin only reactions in 39 patients and 19 with skin and nerve involvement. Patients with Borderline Tuberculoid (BT) leprosy had a clinical diagnosis rate of reactions of 43% and a histological diagnosis rate of 61%; for patients with Borderline Lepromatous (BL) leprosy the clinical and histological diagnosis rates were 53.7% and 46.2% respectively. The sensitivity and specificity of clinical diagnosis for T1R was 53.1% and 61.9% for BT patients and 61.1% and 71.0% for BL patients. Erythema Nodosum Leprosum (ENL) was diagnosed clinically in two patients but histologically in 13 patients. The Ridley-Jopling classification of patients (n = 303) was 42.8% BT, 27.4% BL, 9.4% Lepromatous Leprosy (LL), 13.0% Indeterminate and 7.4% with non-specific inflammation. This data shows that MB classification is very heterogeneous and encompasses patients with no detectable bacteria and high immunological activity through to patients with high bacterial loads.Conclusions/SignificanceLeprosy reactions may be under-diagnosed by clinicians and increasing biopsy rates would help in the diagnosis of reactions. Future studies should look at sub-clinical T1R and ENL and whether they have impact on clinical outcomes.

Description of Leprosy Classification at Baseline Among Patients Enrolled at the Uniform Multidrug Therapy Clinical Trial for Leprosy Patients in Brazil

“…The INFIR study pointed out the important role that pathologists in leprosy centers play supporting and helping clinicians with difficult cases. 10 This study indicated that slit-skin smear results, serological tests, and the WHO classification criterion were consistent with the R&J classification. We acknowledge that all classification approaches investigated herein had limitations.…”

“…Indeterminate leprosy patients were excluded. patients with high BI have a higher risk of developing reactions, [10][11][12] but besides the high BI other unknown factors play a role in the susceptibility to leprosy reactions. Previous results of U-MDT/CT-BR trial showed that there is no statistical difference between U-MDT or regular-MDT (R-MDT) treatment regimen regarding frequency of reactions among MB patients, even when BI was stratified as BI or 3.0.…”

“…E-mail: samira@buhrer.net to the prompt identification of MB leprosy patients, 6,8,9 which are the ones with higher risk to develop reactions. [10][11][12] This study used the U-MDT/CT-BR database to describe and report the performance of available tools to classify PB and MB leprosy patients at baseline. Anti-PGL-I serology, bacterial load, and the number of skin lesions were evaluated considering a modified R&J classification criteria as the gold standard.…”

Cell-type deconvolution with immune pathways identifies gene networks of host defense and immunopathology in leprosy

“…The heterogeneity of the RR samples may relate to differences in the severity and/or duration of the reactional state or intrinsic host ability to respond, as was also observed for RR blood samples (17). It is noteworthy that the histologic differentiation of T-lep and RR forms is often difficult (18,19). In contrast, the ENL samples formed a separate group that was equally dissimilar to both the L-lep and T-lep/RR clusters.…”

Histopathological Study of Infectious Granulomatous Skin Lesions

“…Special stains play a supportive role in infectious granulomas. [7,8] The aim of this study is to determine the etiology and study the morphology of all granulomatous skin lesions evaluated histopathologically and to determine relative frequencies of different infectious granulomatous conditions.…”