Study of Histomorphological Spectrum of Lesions in Leprosy- One Year Study in S N Medical College, Bagalkote

Introduction: Leprosy one of the oldest and chronic infectious disease caused by Mycobacterium leprae. Leprosy is widely prevalent in India. Most of the cases present as hypopigmented patches or erythematous lesions over skin. However on histopathology these lesions show a wide spectrum of changes and variations. Material And Methods: A retrospective study of diagnosed cases of leprosy on skin biopsy in Department of Pathology, S Nijalingappa Medical College from January 2015 to January 2016. Total of 63 cases were re-evaluated and classified according to Ridley-Jopling classification. Results: Lesions were most oftenly seen in middle aged patients and most common symptom was hypopigmented patch (68.2%). Based on Ridley-Jopling classification, most cases were lepromatous leprosy (23.8%) followed by borderline lepromatous type (22.2%), indeterminate type (22.2%), tuberculoid leprosy (6.3%), borderline tuberculoid leprosy (17.4%) and borderline borderline leprosy (7.9%). Wade-Fite staining was done in 42 cases out of which 17 cases showed positive for acid-fast bacilli. Also noted that the bacilli load was >2+ in lepromatous spectrum. Conclusion: Histopathology remains the important tool to diagnose the subtype of leprosy lesions. Lepromatous leprosy is most often associated with high bacterial load. Key-wordsHistomorphological Spectrum, Lepromatous spectrum, Mycobacterium leprae, Leprosy INTRODUCTION Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is also known as Hansen’s disease. M. leprae commonly affects the skin and peripheral nerves. It can also involve muscles, eyes, bones, testis and internal organs. Diagnosis of leprosy can be done by clinical, microbiological and histopathological examination which includes, detail examination of skin lesions and peripheral nerves, demonstration of lepra bacilli by Fite’s acid fast stain in slit skin smears and histopathological diagnosis and demonstration of bacilli in histopathological sections. Though most cases of leprosy can be diagnosed clinically without histopathological examination, it is still considered as important test for confirmatory diagnosis, for assessment of regression of the disease in patient under treatment and also for research purposes. Access this article online Quick Response Code Website: www.ijlssr.com DOI: 10.21276/ijlssr.2017.3.5.19 Interaction between pathologist and dermatologist may be beneficial for proper diagnosis and management of the patient. The principle of reducing the load of infection is the cornerstone of leprosy control by early diagnosis and early adequate drug treatment. So confirmation of diagnosis in doubtful cases is an important indication for histopathological examination. The disease spectrum has been characterised in a number of classification systems, most widely being the Ridley-Jopling classification. In this classification, leprosy has been divided into five groups as Tuberculoid (TT), Borderline tuberculoid (BT), Mid-bordrline (BB), Borderline Lepromatous (BL), and Lepromatous (LL). The Classification has been accepted worldwide and is highly recommended. Though the clinical diagnosis is based on characteristic skin lesions with sensory loss, a great variation is seen in interpretation of these lesions, both clinically and histopathologically. MATERIALS AND METHODS It was a retrospective study from January 2015 to January 2016 in Department of Pathology, S Nijalingappa Medical College, Karnataka, India. We commonly received cone biopsy specimens of clinically suspected RESEARCH ARTICLE Int. J. Life. Sci. Scienti. Res., 3(5): 1377-1381 SEPTEMBER 2017 Copyright © 2015-2017| IJLSSR by Society for Scientific Research is under a CC BY-NC 4.0 International License Page 1378 cases of leprosy. The specimens were routinely processed and sectioned; slides were stained with haematoxylin and eosin. Extra sections were taken and also stained with Wade-Fite stain in order to demonstrate acid-fast bacilli. The bacillary index was calculated based on the criteria given in Table 1. Histopathological evaluation included invasion of epidermis, involvement of sub-epidermal zone, character & extent of granulomas, density of lymphocytic infiltrate, epitheloid cells and other cellular elements, nerve involvement and presence of M. leprae. RESULTS Total of 63 cases were re-evaluated and classified according to Ridley-Jopling classification. Out of 63 cases 40 were males and 23 females. The age of the patients ranged from 10 to 80 years. Majority of patients belonged to the age group of 30-45 years. Based on Ridley-Jopling classification the cases were divided into six groups. Table 1: Grading of Bacillary load according to Bacillary Index criteria Grade Bacilli Examine OIF 1+ 1-10 bacilli in 100 OIF 100 OIF 2+ 0 1-10 bacilli in 10 OIF 100 OIF 3+ 1-10 bacilli in 1 OIF 25 OIF 4+ 10-100 bacilli in 1 OIF 25 OIF 5+ 100-1000 bacilli in 1 OIF 25 OIF 6+ ≥1000 bacilli in 1 OIF 25 OIF Table 2: Distribution of cases based on Ridley Jopling Classification Type of Leprosy No. of cases Percentage (%)