International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 2, Issue 12 | Research Article | Open Access

A Cross Sectional Study of Clinical and Histopathological Correlation of Patient with Different Spectrum of Leprosy from Central West India

Shreya K*

AIIMS PG Saketnagar Habibganj, MP, India

*Correspondence to: Shreya K 

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Background:Hansen’s disease, is a chronic, infectious disease that primarily affects the skin and the peripheral nerve. Leprosy expresses itself in different clinico-pathological forms depending on the immune status of the host; diagnosis of leprosy is based on different clinical parameters which involves detailed examination of skin lesions and peripheral nerves. Demonstration of acid –fast bacilli in slit skin smears by Ziehl- Neelsen’s staining also aids in diagnosis of leprosy. A reliable diagnosis hinges around a good histopathological diagnosis and demonstration of bacilli in histopathological sections. Clinical classification gives recognition only to gross appearances of the lesions, while 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. Histopathology provides confirmatory information for suspect cases which can be missed in clinical practice or epidemiological studies and helps in exact typing. Histology also gives indication of progression and regression of disease under treatment.

Objective: The aim of the study is to observe the patient of various spectrum of leprosy and correlate clinical findings with histopathological findings.

Materials and Method: It is a Cross sectional observational study conducted in Dept. of Dermatology, from central west India, from April 2015 to September 2016. Person with sign and symptoms of leprosy, cases with hypopigmented lesions with definitive sensory impairment, cases with erythematous papule, plaque and nodule with sensory impairment. Person with no known history of prior leprosy treatment, and willingness to do biopsy and signing the informed consent form were included. Subjects with no skin lesions, only sensory loss or thickened nerve, not giving consent for biopsy, history of prior treatment with MDT regime complete or incomplete and patient with lepra reactions were excluded. Prevalence of Leprosy in 2014 at Maharashtra was 0.9 per 10000. So, number of new cases is very low, that’s why I had included all cases of leprosy presented to my department for this study, which was fulfilling the inclusion criteria within study duration. Hence the study sample is 70.

Results: The age of the cases included in study ranged from 5 years to 70 years (mean age 34.42 ± 16.02 years). The majority of the cases 32 (36%) were in the age group of 20-40 years (3rd and 4th decade). There were 50(70.4%) males and 21(29.6%) females with a male to female ratio of 2.4: 1.The present study showed the duration of disease ranging 1 to 72 months (mean 9.84 months). Majority of patients (63.8%) presented within 6 months of onset of disease. In this study, most common observed lesion were macule consisting 50 in number, followed by plaque (n=39). 8 cases presented with papule whereas 4patients had nodule.In our study clinical diagnosis of TT and BTH leprosy were found to be common in 20-40 years of age group accounted for 54.5% of total TT cases and 37.83%of total BTH cases respectively. All cases of clinically diagnosed BB cases wereseen in 20-40 year of age group. Whereas cases of lepromatous pole of leprosy distributed equally in each age groups of, 20 to 40 yrs, 40 to 60 yrs, > 60 yrs. In this study, upper limb was found to be most common site 46 (64.8%), followed by trunk in 29 (40.8%) patients. 27(38%) cases had lesions over face and 23(32.4%) had lower limb. Most common nerve involved was ulnar nerve which was palpable in total 51 patients, among them 28 were unilateral whereas 23 cases with bilateralinvolvement. Out of 71 cases studied, most commonly observed type of leprosy was BTH presented in 52.1% of cases, followed by TT in 31%. Patient with Lepromatous pole were 9 in number accounted 12.7% of total. Rest 4.2% of cases were of BB. On histopathology, majority of patient observed were BTH contributing 60.6% of total, followed by lepromatous pole 16.9%. 11.3% of patients were found to be indeterminate type of leprosy, whereas 8.5% of patients in BB. Rest 2.8% patients were of TT. TT showed only 4.55% of cases positively correlate with clinical diagnosis. BB showed 33.3% of cases positively correlate with clinical diagnosis. BTH showed 75.7% of cases positively correlate with clinical diagnosis. Lepromatous pole showed highest correlation 88.9%.

Limitations of the study were histopathological response during treatment course couldn’t be assessed as it was a cross sectional study and sample size was less.

Conclusion: Most common clinical and histopathological diagnosis was observed as borderline tuberculoid Hansen. Most common age group was 20-40 years (3rd and 4th decade). Most patients came to seek health care within 6 months of period. Overall agreement in between clinical and histopathological diagnosis was found to be 53.52%. For treatment purpose parity to be found was 89.83% in paucibacillary and 100% for multibacillary.


Hansen disease; Histopathology; Leprosy; Spectrum of leprosy; Mycobacterial disease


Ankita Aggrawal, Poonam Singh, Shreya K, Abhishek Gupta. A Cross Sectional Study of Clinical and Histopathological Correlation of Patient with Different Spectrum of Leprosy from Central West India. Int Clinc Med Case Rep Jour. 2023;2(12):1-18.