Abstract
Differentiation of leprosy from other cutaneous granulomatous disease is routinely based on characteristic histopathological features and demonstration of acid-fast bacilli by microscopy. Increased presence of other mycobacterial infections in the skin has made this task more difficult, but the distinction remains fundamental in selecting appropriate treatment. We review a 9-year experience using PCR for identifying Mycobacterium leprae in specimens from patients in the United States and discuss its potential as an adjunct diagnostic tool to the standard diagnostic practices. Specimens for this study were skin biopsy preparations referred to the National Hansen's Disease Programs. PCR was positive in 60% of all patients clinically diagnosed with leprosy and increased to 93% of patients when only lepromatous leprosy was evaluated. No false positives were obtained even when some clinical specimens contained other mycobacterial species. Therefore, in a population where leprosy is non-endemic, the sensitivity and specificity of PCR support its use, primarily as an adjunct to other clinical and histopathological diagnostic tools, to identify M. leprae when acid-fast organisms are discernible but atypical clinical or histopathological features obscure diagnosis. The potential use of PCR-based assays for antileprosy drug susceptibility testing are also discussed.
Published Version
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