Histopathology and Bacteriology in Hansen’s Disease

Abstract

BACKGROUND Leprosy is a disease, which has been associated with tremendous social stigma with cases recorded in the Old Testament. It is an infectious disease caused by Mycobacterium leprae. Leprosy expresses itself in different clinicopathological forms depending on the immune status of the patient. Diagnosis of leprosy only on clinical basis is difficult. So, confirmation of diagnosis in leprosy is an important indication for histopathological examination. The parameters used for the histopathological classification are well defined, precise and also take into account the immunological manifestations which enable it to successfully bridge the pitfalls in leprosy diagnosis. Moreover, correct labelling of paucibacillary and multibacillary cases is a prerequisite to treat them adequately, which reduces the chances of occurrence of resistant cases. The study aims at analysing the histological patterns of Hansen's disease in skin biopsy specimens received in Histopathology Department in Medical College Kottayam and to correlate the histopathology and bacteriology in Hansen's disease. MATERIALS AND METHODS A descriptive study was conducted in 34 new clinically diagnosed cases of Hansen's disease received in the Department of Pathology in Govt. Medical College, Kottayam, during the study period of 18 months (May 2015-November 2016). RESULTS Among 34 clinically diagnosed cases of leprosy, most common histological type was borderline tuberculoid followed by borderline lepromatous type. The maximum number of patients were in the age group of 31-40 and 41-50 yrs. Tuberculoid type and indeterminate type showed maximum clinicohistopathological correlation (100%) followed by lepromatous leprosy (80%). Midborderline cases showed minimum correlation. Cases in tuberculoid spectrum showed significant granuloma fraction, bacterial index and histopathological index. In our setting, modified Fite-Faraco stain is more superior than fluorescent staining for demonstration of bacilli in tissue sections. CONCLUSION Among 34 clinically diagnosed cases of leprosy, histological diagnosis of leprosy was established in 100% of cases. In our setting, modified Fite-Faraco stain is more superior than fluorescent staining for demonstration of bacilli in tissue sections. Tuberculoid type and indeterminate type showed maximum clinicohistopathological correlation (100%) followed by lepromatous leprosy (80%). Mid-borderline cases showed minimum correlation.

Histopathological panoroma and clinocopathological correlation of Hansen’s disease in tertiary care hospital

“…Present study shows the histopathologically most common subtypes of leprosy were TT and BT which are similar to the study of Srismitha et al [15], Dhakwa et al [3] and Sushilkumar et al [17]. In study done by Nila Theresa Davis et al [18] BT was the most common subtype found followed by BL.…”

“…Like our study, few studies done by Shushilkumar et al [17] and Davis et al [18] 6+ grade is found in all cases of histoid Hansen's and maximum cases of LL whereas acid fast bacilli were not demonstrated in maximum cases of TT.…”