A Study of Clinical, Bacteriological & Histopathological Correlation in Leprosy Cases attending a Government Medical College in Western Odisha: Some Observations.

The study was undertaken in VSS Institute of Medical Sciences to observe the clinical, bacteriological and histological diagnosis of leprosy patients attending the hospital who consented to undergo slit skin smear (SSS) examination, punch biopsy and participate in the study. Fifty leprosy patients aged 5 to 70 years, which included 41 male and 9 female patients participated in the study. These included 4 TT, 24 BT, 2 BB, 5 BL and 15 ILL clinically diagnosed patients as per the IAL classification (1982 ). SSS were undertaken from 4 sites, stained with ZN stain and BI calculated as per Ridley Scale. Four patients were skin smear negative all TT). Of the 24 BT patients enrolled in the study, 11 were skin smear negative while 13 were smear positive (BI ranging from 1+ to 4+); Both the BB cases, all 5 BL cases, and all the 15 LL cases were smear positive (BI range 2+ to 6+). Histologically there was complete parity and correlation in.the TT group, while the correlation was observed to be 83%, 50%, 60%, and 93% in the clinically diagnosed BT, BB, BL and LL patients respectively. The sample size in the study was small, however, the overall bacteriological skin smear negativity/positivity correlation was observed to be 53.6% for paucibacillary (TT+BT) disease and 100% for MB (BB, BL and LL) disease Histological correlation was 100%, 83%, 50%, 60% and 93% respectively for clinically diagnosed TT, BT, BB, BL and LL disease. A sizeable number of BT patients were found to be bacteriologically positive and were therefore being treated with lesser number of drugs as well duration under programme conditions, Although there is inter-observer variation and overlapping of clinical and histological diagnosis in the borderline patients (BT, BB & BL), bacteriological and histological confirmation helps in deciding on adequate treatmeht and should be undertaken.