Rekam Anusha Et Al.

Int J Clin and Biomed Res.
2016;2(1): 10-12
Journal homepage: www.ijcbr.com
Original Article
AUTHOR DETAILS
1Final
year post graduate,

Resident,
Dermatology venerology and
leprosy, Father Muller Medical
College, Mangalore, India.
2Senior
ARTICLE INFO
Received: 11th Nov 2015,
Accepted: 13th Dec 2015.
*Corresponding author email:
[email protected],
[email protected].
.
ABSTRACT
Introduction: Leprosy, caused by Mycobacterium leprae, is widely prevalent in India and presents
with different subtypes. However, there exists a great variation in the interpretation of clinical
and histopathological examination of these lesions. The present study was carried to correlate
clinical diagnosis of leprosy cases with histopathological diagnosis. Methodology: A retrospective
Hospital-based study was conducted in patients of Leprosy, who attended Dermatology Out
Patient Department for a period of 18 months. Clinical diagnosis was noted and the biopsies were
processed as per standard protocol in the Department of Pathology. The clinical and
histopathological concordance was calculated using percentage parity. Results & Conclusion: In
a total of 52 cases, 29(55.7%) were males and 23(44.2%) were females. The histopathological
diagnoses from our study showed agreement with clinical diagnoses in 27 (57.69%) cases. Clinicohistopathological agreement was noted maximum in LL (80%), followed by BT (57.14%), BL (50
%), BB (50%), TT (46.2 %), and least in IL (42.8 %).
KEYWORDS
Leprosy, Ridley-Jopling, Acid Fast bacilli, skin lesions
INTRODUCTION
Leprosy is one of the oldest chronic infectious diseases,
prevalent in most parts of Asia, especially India. [1,8] The
disease manifests in various morphological and histological
types depending immunity status of the host. Before
confirming a case of Leprosy of particular type, the clinical
features should be correlated and confirmed with histological
examination along with bacteriological index and start the
multidrug treatment.[3] The Ridley-Jopling classification based
on immunopathological data has been widely accepted to
classify the disease spectrum in Leprosy. [2] Though, clinical
diagnosis is based on the characteristic skin lesions,
anaesthesia and presence of Acid Fast bacilli (AFB) in the slit
skin smear, great disparity has been noticed in the
interpretation both clinically and histopathologically. [3]
socioeconomic status. Patients already treated with

antileprosy medications in any time earlier and 3 patients
diagnosed as reactions clinically and pathologically were
excluded.
The present study is carried to assess the concordance in

different clinical types of leprosy and the histopathology of
the skin biopsies.
The spectrum of the disease is diagnosed clinically and graded

into Tuberculoid Type (TT), Borderline Tuberculoid (BT), Midborderline (BB), Borderline Lepromatous (BL), Lepromatous
Leprosy (LL) and Indeterminate type (IDL) as per RidleyJopling classification which is accepted worldwide[9] . Skin
biopsies were obtained from the lesions after taking informed
consent. An approval from the Ethical Committee of the
institution was obtained and the biopsies processed as per
standard protocol in the Department of Pathology. The
sections thus obtained were stained with hematoxylin and
eosin. AFB were demonstrated using Fite Faraco stain. The
clinical and histopathological concordance was calculated
using percentage parity.
MATERIAL AND METHODS
STATISTICAL ANALYSIS
A retrospective Hospital-based study was conducted in 52

patients of Leprosy, who attended Dermatology Out Patient
Department, Father Muller Medical College Hospital,
Mangalore between December 2013 and May 2015 (i.e., 18
months). All the newly diagnosed cases were selected
regardless of their age, sex, occupation and socioeconomic
status. Inclusion criteria: All the newly diagnosed cases were
selected regardless of their age, sex, occupation and
Statistical analysis is done

percentage, chi square test.
using
range,
frequency,
RESULTS
A total of 52 cases were included in our study out of which 29
(55.7%) were males and 23 (44.2%) were females as shown in
Table 2. The age group of the patients ranged from 10 years
to 74 years (Table 1). The majority of the cases belonged to
10
Rekam Anusha et al.
Int J Clin and Biomed Res. 2016;2(1): 10-12

the age group of 31-50 years i.e., 26 (53.1%) cases and the
least affected group was children below 15 years i.e., 4
(7.69%). Clinically, BT was the most common type of leprosy
with 28.6% (14) followed by TT in 26.5%(13), IDL in 14.3 %(7),
BB in 12.2%(6), LL in 10.2%(5) and BL in 8.2%(4).
Histopathologically, majority of the cases i.e., 36.7%(18 )
belonged to BT followed by TT in 24.5%(12), BB in 10.2%(5),
IDL in 10.2%(5) and LL in 10.2%(5) patients each and BL being
8.2 %(4) (Table 3).
Table 1. Showing age distribution in the subjects
Age group(years)
No. Of cases
percentage
Below 30
14
28.6%
31-50
26
53.1%
Above 50
18.4%
Total
49
100%
Frequency
%age
Females
22
42.30%
Males
30
57.69%
Total
52
100
Table 3. Showing clinical and histopathological distribution

of leprosy
Histopathological
cases
No. of
clinical
cases
%age of
clinical
cases
TT
13
26.5
12
24.5
BT
14
28.6
18
36.7
BB
12.2
10.2
BL
8.2
8.2
LL
10.2
10.2
IDL
14.3
10.2
Total
49
100.0
49
100
No.
Type
of
leprosy
No. of
clinical
cases
TT
13
BT
14
BB
6
BL
4
LL
5
IDL
7
Total
49
P<0.05, significant
Histopathological breakup among

clinically diagnosed cases
TT BT BB BL LL IDL
%
age parity
7
3
3
2
15
4
8
1
2
15
1
1
1
3
1
1
2
1
5
- 2
1 1 - 4 - 3
6 5
53.84
57.14
50.0
50.0
80.0
42.85
55.10
DISCUSSION
Table 2. Showing frequency and percentage of gender

distribution
Type of
leprosy
Table 5. Clinico histopathological concordance in leprosy
% age
Table 4. AFB positivity in various types of leprosy

Type of leprosy
No. of positive
cases
% age
TT
BT
28.57
BB
16.66
BL
25.00
LL
100
IDL
Total
12
24.49
Leprosy is a chronic granulomatous disease widely prevalent

in India. It affects the skin, peripheral nervous system and
other visceral organs There were 0.83 lakh leprosy cases with
prevalence rate of 0.68 per 10,000 (NLEP 2012-13)[1,7].
Accurate classification of leprosy is needed as it is present in
different clinicopathological forms. The most widely accepted
classification system is that of Ridley- Jopling.[2] However,
many diversities are seen between the histopathological and
clinical features.
Mathur MC et al conducted a study which showed 53.8%
males and 46.1% females out of 156 leprosy patients and the
majority of them were in between 21-30 years with 1 child
below 10 yrs being least affected.[2] Bijjaragi S et al also
conducted a similar study which showed
male
preponderance of 64.3%. [5]
The distribution of these cases showing clinical and
histopathological distribution as per Ridley-Jopling
classification is shown in table 3.
In our study, clinically, BT was the most common type of
leprosy with 28.6% (14) followed by TT in 26.5%, IDL in 14.3
%, BB in 12.2% ,LL in 10.2% and BL in 8.2%. Clinico
histopathological features of leprosy in reaction were seen in
3 patients (table 5). Histopathologically, majority of the cases
i.e., 36.7 % (18) belonged to BT followed by TT in 24.5% (12).
BB, IDL and LL cases were observed in 10.2% (5) patients each
and least being 8.2 % (4) was seen in BL. Overall agreement in
the diagnosis was seen in 27 (55.10%) cases. The maximum
concordance of 80% was seen in LL cases followed by BT
(57.1%), BL (50%), BB (50%), TT (46.2%) and major
discordance was observed in IDL (42.9%) cases. Similar results
were obtained by Mathur MC et al[2] , Nitesh Mohan et al [3]
and Moorthy BN et al[6] . These results suggest the importance
of histopathological examination in the diagnosis of
lepromatous leprosy. However, there was incongruity
between the clinical and histopathological diagnosis among
other types (BL + BB) of leprosy which may be due to
occurrence of some degree of overlap among various types
and inter observer variation both clinically and
histopathologically. The discordance seen in IDL type may be
due to its nonspecific and unstable histology as it is found in
11
Rekam Anusha et al.
Int J Clin and Biomed Res. 2016;2(1): 10-12

patients whose immune status is yet to be determined thus
progressing to other determinate forms of leprosy.
Limitations: Our study is a record based retrospective study.
A prospective study and larger sample size could give better
results. Inter observer variations regarding the clinical and
histopathological analysis exists.
CONCLUSION
Study of different types of leprosy lesions contribute a great
deal in understanding the disease .A gold standard method for
the diagnosis of type of leprosy cannot be established since
the tissue response differs depending on the immunity of the
host [10]. However, biopsy of the skin lesion is a useful tool in
confirming the clinical diagnosis and hence should be carried
out for all suspected cases of leprosy to determine the
spectrum of the disease and initiate multidrug therapy as per
the treatment category.
ACKNOWLEDGEMENT
I acknowledge the support and help of Dr. Ramesh Bhat,
Dr. Nandakishore B, Dr. Sukumar D, Department of
Dermatology, Dept of Pathology, MRD staff, Mrs. Sucharitha
(for statistical support) and my colleagues, Father Muller
Medical College, Mangalore, India.
CONFLICT OF INTEREST
None.
REFERENCES
1)
Kumar B. World Leprosy Day 2015: Renewing commitment for a

leprosy free world! Indian J Med Res [Internet]. Medknow
Publications and Media Pvt. Ltd.; 2015 Jan 1 [cited 2015 Nov
20];141(1):1.
2) Mathur MC, Ghimire RB, Shrestha P, Kedia SK.
Clinicohistopathological correlation in leprosy. Kathmandu Univ
Med J (KUMJ). 2011 Oct-Dec;9(36):248-51.
3) Nitesh Mohan, Nitin Mishra. Clinico Histopathological Correlation
Within The Spectrum Of Hansen's Disease: A Multicentric Study In
North India. Int J Med Res Health Sci 2013; 2(4):887-92.
4) Giridhar M, Arora G, Lajpal K, Chahal KS. Clinicohistopathological
concordance in Leprosy- A Clinical, Histopathological and
Bacteriological study of 100 cases. Indian J Lepr 2012;84:217-25.
5) Bijjaragi S, Kulkarni V, Suresh KK, Chatura KR and Kumar P.
Correlation of clinical and histopathological classification of Leprosy
in post elimination era. Indian J Lepr 2012;84:271-5.
6) Moorthy BN, Kumar P, Chatura KR, Chandrasekhar HR, Basavaraja
PK. Histopathological correlation of skin biopsies in leprosy. Indian
J Dermatol Venereol Leprol [Internet]. Medknow Publications; 2001
Jan 1 [cited 2015 Nov 27];67(6):299301.
7) Badhan, R. , Kundal, R. K. , Raj, R. T. , Bahl, R. K. , & Bal, M. S. (2014).
A Clinico-Pathological Correlation Study of Leprosy in a Tertiary
Care Teaching Institute in Northwest Punjab, India. American
Journal of Medical Sciences and Medicine, 2(5), 99-108.
8) Mohite RV, Mohite VR, Durgawale PM Differential Trend of Leprosy
in Rural and Urban Area of Western Maharashtra. Indian J Lepr.
2013;85:11-18.
9) Jopling WH, Mc Dougall. The disease. In: Jopling WH, Mc Dougall.
(Authors) Handbook of leprosy. Fifth edition. CBS Publishers and
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10) Kar PK, Arora PN. Clinicopathological study of macular lesions in
leprosy. Indian J Lepr 1994;66:435-41.
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Int J Clin and Biomed Res.

year post graduate,

socioeconomic status. Patients already treated with

The present study is carried to assess the concordance in

The spectrum of the disease is diagnosed clinically and graded

MATERIAL AND METHODS

A retrospective Hospital-based study was conducted in 52

Statistical analysis is done

Int J Clin and Biomed Res. 2016;2(1): 10-12

Table 3. Showing clinical and histopathological distribution

Histopathological breakup among

Table 2. Showing frequency and percentage of gender

Table 5. Clinico histopathological concordance in leprosy

Table 4. AFB positivity in various types of leprosy

Leprosy is a chronic granulomatous disease widely prevalent

Int J Clin and Biomed Res. 2016;2(1): 10-12

Kumar B. World Leprosy Day 2015: Renewing commitment for a

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