Fite-Faraco Staining Research Articles

A Retrospective Study of the Histopathological Spectrum of Erythema Nodosum Leprosum.

There are no recent studies with a focus on the histopathology of erythema nodosum leprosum (ENL). To describe the histopathological spectrum of ENL. Digital records from the pathology department were searched, and 125 slides were included. The histopathologic findings were recorded using a pre-designed proforma. Several patterns were noted with the most common being a superficial and deep, perivascular and peri-appendageal, well-circumscribed dermal infiltrate that was seen in 70 (56.0%) biopsies. Other dermal patterns included a similar but loose infiltrate in 19 (15.2%) biopsies, diffuse dermal involvement in 9 (7.2%), top-heavy in 9 (7.2%), and bottom-heavy infiltrates in 12 (9.6%). Subcutaneous tissue was included in 107 biopsies. Extension of dermal infiltrates to the subcutis was noted in 71 (66.4%) biopsies and predominant involvement of the subcutis was noted in 6 (4.8%) biopsies, with lobular involvement in 60 (56.1%), septal involvement in 3 (2.8%), and septo-lobular involvement in 14 (13.1%). In 30 (28.0%) biopsies, the subcutaneous fat was uninvolved. The infiltrates contained neutrophils and foamy histiocytes in variable proportions, along with lymphocytes and plasma cells. Eosinophils were noted occasionally. Medium and/or small vessel vasculitis was noted in 11 (8.8%) biopsies. Fite-Faraco staining was available for 112 biopsies and revealed mainly fragmented and granular acid-fast bacilli (AFB) in 29 (25%) biopsies. Our study had a retrospective design; we could not compare the lesional age and clinical characteristics of patients with the histological features. ENL is characterized by dermal infiltrates composed of foamy histiocytes and neutrophils in varying proportions arrayed in different dermal patterns. Extension of dermal infiltrates into the subcutis was frequent but absent in some. Predominant or exclusive involvement of the subcutis was rare. Vasculitis was noted in a small minority, while AFB were demonstrated in about a quarter of cases.

Hansen’s disease: Is histopathological correlation mandatory for all clinically diagnosed patients? A descriptive study in a tertiary care hospital

Background: Leprosy has been historically associated with social stigma and discrimination. Leprosy, also known as Hansen’s disease, is indeed a chronic infectious disease caused by the bacterium Mycobacterium leprae. Diagnosis of leprosy is usually done by clinically and classified as multibacillary (MB) and paucibacillary (PB). The disease was also classified into different types based on histopathological findings, such as tuberculoid, borderline tuberculoid (BT), mid-borderline, borderline lepromatous, and lepromatous. Aims and Objectives: The aim of the study was the clinicohistopathological correlation of all clinically diagnosed cases of Hansen’s disease. Materials and Methods: The study was done at Bankura Sammilani Medical College and Hospital for a period of 18 months. Ethical approval was taken from the Institutional Ethics committee. All new patients 66 in number clinically diagnosed as leprosy attending the Dermatology Outpatient Department were included in the study. The skin biopsy and staining were done with hematoxylin and eosin staining and Fite-Faraco stain for every patient. The skin biopsy was reported according to the Ridley-Jopling classification. Results: Males were more commonly affected than females. Most of the leprosy cases in the study were classified as MB (86.4%) and the upper extremities were the most commonly affected sites. Bacterial index was observed negative in clinically PB cases. The most common histological subtype of leprosy identified in the study was BT, Regarding bacterial index, all clinically diagnosed MB cases were smear positive and PB cases were smear negative. Out of nine clinically diagnosed PB cases, inflammatory cells were found in 3 (33.4%). Conclusion: In a large country like India where resources are limited, no need for skin biopsy for every patient. Biopsy should do if there is any confusion with other skin lesions.

MYCOLICIBACTERIUM FORTUITUM INFECTION IN EX SITU EMERALD TREE BOA (Corallus batesii).

Emerald tree boas (Corallus batesii) are boids that in situ occurs in forested habitats in the Amazon Basin. The mycobacterial species can infect reptiles but the species Mycolicibacterium fortuitum was identified only in feces samples of ex situ Python regius and was isolated from granulomatous lesions of an ex situ Iguana iguana when was still part of the genus Mycobacterium. This article aims to report a mycobacteria infection case in a female Corallus batesii kept under human care. The animal presented apathy and 2months of anorexia, being found dead. The necropsy revealed presence of tracheal and pulmonary nodules besides multifocal, bacterial, granulomatous pneumonia. After Fite-Faraco histochemical staining, immunohistochemistry, semi-nested polymerase chain reaction (PCR) and genetic sequencing the Mycolicibacterium fortuitum complex was diagnosed with 99.54% of nucleotide similarity. This mycobacterial species was already pointed out as an important nosocomial pathogen and more studies are necessary to explore their zoonotic potential.

An Observational Study to Correlate the Histopathological and Dermoscopic Features in Leprosy Patients in a Tertiary Care Hospital.

Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermoscopy is a noninvasive technique widely used in the diagnosis of various skin diseases. To see the correlation between the clinical and dermoscopic features with the histopathological findings in leprosy. A prospective observational study was conducted on clinically suspected leprosy patients attending the dermatology outpatient department (OPD) for 18 months. Representative lesions were observed by dermoscopy, and a biopsy was performed, followed by histopathology for final diagnosis. Patients were categorized by Ridley-Jopling classification. A total of 70 clinically suspected leprosy patients were included in the study. Amongst 70 cases, 56 cases were diagnosed as leprosy by dermoscopy, and 53 cases were confirmed as leprosy by histopathology (hematoxylin and eosin [H and E] staining and Fite-Faraco staining). The other six cases were diagnosed as other nonspecific dermatitis by histopathological findings. Eleven cases that were dermoscopically negative were also confirmed by histopathology to be truly negative. There are three inconclusive cases of dermoscopic findings, which were diagnosed as mid-borderline leprosy by histopathology. Dermoscopic and histopathological correlation was found above 87% in all types of leprosy except mid-borderline leprosy, which showed only a 25% correlation. Dermoscopy is a useful noninvasive tool to assess lesions of leprosy, requires less time for diagnosis, skin features are magnified several times and may become evident before clinical presentation. It definitely helps to reduce the number of biopsies in case of diagnosis of leprosy. However, in doubtful cases, histopathology is required for definitive diagnosis as it is the gold standard to date.

Mediastinal lymphadenopathies and skin lesions in a 49-year-old Sinhalese man.

Leprosy is a neglected disease sporadically reported in high-income countries. Skin lesion and peripheral nerve involvement represent most common manifestations. Mediastinal lymphadenopathy in the absence of superficial lymph nodes involvement is very rare. Atypical or rare clinical presentations of disease may delay diagnosis and therapy and cause potential life-threatening manifestations and disabilities. We describe the case of a 49-year-old Sinhalese man who was admitted to our hospital with a one-month history of peripheral neurological symptoms and skin lesions on lower limbs. CT scan showed the presence of mediastinal lymphadenopathies without lung parenchymal and superficial lymph nodes involvement. Endobronchial ultrasound-guided transbronchial needle aspiration showed the presence of granulomas while skin biopsy revealed dermo-hypodermic granulomas with perineural lymphohistiocytic inflammatory reaction. Fite-Faraco staining demonstrated the presence of acid-fast bacilli in both lymph nodal and skin biopsy and polymerase chain reaction was positive for Mycobacterium leprae. Multibacillary leprosy was then diagnosed.

Lucio phenomenon or necrotic erythema nodosum leprosum in an untreated case of leprosy?? A diagnostic dilemma…

Lucio phenomenon (LP) or erythema necroticans is a rare reaction pattern seen in untreated or partially treated lepromatous (LL) or borderline lepromatous (BL) leprosy cases. Necrotic Erythema Nodosum Leprosum (nENL), although seen in the same spectrum of leprosy, is seen in cases already undergoing treatment for leprosy and rarely in untreated cases. A 33-year-old male, a serving soldier presented to the medical clinic, in a remote area in the Northeast part of India with complaints of tender violaceous rash over previously normal looking skin, for 10 days along with myalgia and arthralgia, followed by low grade fever for 5 days. Cutaneous examination showed the presence of hyperpigmented to erythematous, irregularly shaped, discrete as well as coalescing purpuric macules and a few papules, with the presence of angular superficial ulcerations and haemorrhagic crusting, located over the trunk, abdomen, bilateral upper and lower extremities, including the palms and soles. He was started on systemic antibiotics by the physicians. Unfortunately, despite the treatment, the patient succumbed to the illness. A post-mortem biopsy sent from various parts of the body showed diffuse infiltration in the dermis with macrophages and lympho-histiocytic cells, numerous foam cells, panniculitis and necrotizing vasculitis. Fite-Faraco stain showed numerous cigar shaped bacilli arranged in the form of globi within macrophages. The cutaneous features were suggestive of LP, but the systemic features and histopathology favoured nENL, even though the patient had not been on any multibacillary therapy for leprosy, and showed no nodular eruptions preceding the haemorrhagic crusting.

Histopathological panoroma and clinocopathological correlation of Hansen’s disease in tertiary care hospital

Background: The present study was undertaken to study the histopathological features of leprosy in skin punch biopsies and to categories them in to various type based on microscopy and bacterial index. The aim of study was to know the role of histopathology in diagnosis of Hansen’s disease and to study the clinicohistopathological correlations of suspected cases of Hansen’s disease. Materials and methods: A retrospective hospital-based study of clinically diagnosed leprosy cases was conducted over a period of one year (April 2021 to March 2022). Lesional skin biopsies obtained were fixed, processed and stained with Haematoxylin and Eosin (H&E) followed by Fite-Faraco staining. The lesions were classified on microscopy as per Ridley-Jopling classification. Results: 63 Skin biopsies were obtained from patients with age range of 14-72 years. Highest incidence was in age group of 31 – 50 years. There was male predominance with male to female ratio of 2:1. Clinically borderline Hansen’s (BB) (25.40%) was the most frequent subtype observed followed by borderline lepromatous (BLH) (19.04%) and lepromatous Hansen’s (LL) (19.04%). On histopathology we found tuberculoid Hansen’s (TT) (28.57%) was the most frequently observed subtype followed by borderline tuberculoid Hansen’s (BT) (19.04%). Fite stain revealed lepromatous bacilli in all cases of LL, BL, histoid and indeterminate Hansen’s; whereas bacilli could be demonstrated in six cases of BB, eight cases of BT and two cases of TT. Conclusion: Early diagnosis of leprosy is clinically difficult as patient present in different clinicopathological form, depending on host immune status. Therefore combined clinical, histopathological and bacteriological features are required for accurate diagnosis and classification.

Comparative Evaluation of RLEP-PCR and Conventional Laboratory Methods for Confirmation of Clinically Diagnosed Early-stage Leprosy in Eastern India

Introduction: Leprosy is an infectious disease caused by Mycobacterium leprae (M. leprae). Diagnosis of leprosy is confirmed based on cardinal signs and symptoms along with supportive laboratory investigations. Early diagnosis and treatment of new cases are essential to prevent disease burden and spread in community. Aim: To evaluate the efficacy of currently available laboratory tests like M.leprae-specific repetitive element Polymerase Chain Reaction (RLEP-PCR) and conventional methods like, Slit Skin Smears (SSS), Histopathology (HP) and Fite-Faraco (FF) staining for detection of M. leprae in clinically diagnosed cases of early- stage leprosy. Materials and Methods: A cross-sectional study of 82 newly diagnosed cases of leprosy was carried out in S.C.B Medical College, a tertiary care hospital of Odisha, India from September 2018 to August 2020. For every case, skin tissue was punched out to get biopsy for HP and FF staining and incised for SSS. At least two SSS slides were prepared per case. One SSS slide was stained by modified Ziehl-Neelsen (ZN) staining to demonstrate Acid Fast Bacilli (AFB). The other SSS slide was air dried and the dried material was scraped off to perform PCR. Data were analysed by Statistics software IBM Statistical Package for the Social Sciences (SPSS), version 24.0. Association between categorical variables was studied by using Chi-square test. Comparison of mean±SD and median (IQR) were done by using independent sample‘t’ test. Agreement on different types of laboratory methods was done by using Kappa test. Results: Among 82 cases, 68.3% were RLEP-PCR positive, 56% had relevant chronic granulomatous features histopathologically, 39% were FF stain positive, and only 29% were ZN stain positive. Improvement in case detection of 39%, 29.3%, and 12.2% by PCR over SSS, FF Stain and HP respectively proved superiority of PCR over other procedures. Conclusion: PCR was most sensitive to detect leprosy both in pauci and multibacillary groups, thus considered as investigation of choice for diagnosis of early-stage leprosy.

First report of nocardiosis due to Nocardia asteroides in a domestic canary (Serinus canaria domestica) in Mexico

Nocardiosis is a multi-systemic disease that has been reported in several species of birds. It is characterized by the development of granulomatous inflammation in several organs, mainly affecting the respiratory system. An adult male domestic canary (Serinus canaria domestica) weighing 14.5 g was received for examination. Multiple nodules were identified in the epicardium, air sacs, and lungs. Histologically these nodules corresponded to granulomas, in which numerous thin, filamentous branching bacteria were identified. Gram stains of the epicardium, air sacs, and lungs revealed many filamentous branching Gram-positive bacteria. These bacteria were also strongly acid-fast positive by Fite-Faraco stain. PCR end-point analysis and sequencing using total DNA extracted from formalin-fixed paraffin-embedded samples of lungs, heart, and air sacs confirmed the presence of Nocardia asteroides. To the best of the authors’ knowledge, this is the first case report of nocardiosis associated with Nocardia asteroides in a Domestic Canary (Serinus canaria domestica) in Mexico.

Histopathological Evaluation of Skin Biopsies of Leprosy at a Tertiary Care Centre of Western Rajasthan, India: A Cross-sectional Study

Introduction: Leprosy is a slowly progressive chronic granulomatous disease caused by Mycobacterium Leprae (M. leprae) and predominantly affects skin and peripheral nerves. Leprosy is a leading cause of physical disability in India and poses a major public health challenge for the country. Histopathological evaluation and demonstration of Lepra bacilli by special stain is gold standard for definitive diagnosis and subtyping of leprosy. Aim: To study the common histological subtypes of leprosy on the basis of microscopic features and bacteriological index. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Dr. S.N. Medical College, Jodhpur, Rajasthan, India. The duration of the study was two years and 11 months, from January 2019 to December 2021. A total of 55 skin biopsies which were histologically diagnosed as different types of leprosy were included. Patients data of age, gender, skin examination and other investigations were collected from the requisition forms and analysed. After proper fixation and processing of biopsy samples, Haematoxylin and Eosin (H&E) stained sections were examined for epidermal atrophy, presence of grenz zone, granulomas, infiltrates of lymphocytes, histiocytes, foam cells, infiltration of nerves and adnexa. The sections stained with Fite-Faraco stain were studied for the assessment of bacteriological index. On the basis of microscopic features, cases were categorised into tuberculoid leprosy, borderline tuberculoid leprosy, indeterminate leprosy, borderline leprosy, lepromatous leprosy and histoid leprosy as per Ridley-Jopling classification and percentage is calculated for each category. Data was entered and analysed by using Microsoft Excel version 2008 and Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study participants was 39.6 years. Male to female ratio was 2.92:1. There were 33 (60%) cases with erythematous lesions followed by 15 (27.27%) hypopigmented lesions and 7 (12.73%) nodules. Out of 55 there were 21 (38.18%) cases of tuberculoid leprosy followed by 11 (20%) cases of borderline tuberculoid leprosy, 8 (14.55%) cases of indeterminate leprosy, 6 (10.91%) cases of borderline leprosy, 5 (9.09%) cases of lepromatous leprosy and 4 (7.27%) cases of histoid leprosy. Bacteriological index was negative in 35 (63.64%) cases followed by 2+ in 6 (10.91%) cases, 5 (9.09%) had index of 4+, 4 (7.27%) cases had index of 3+, 3 (5.45%) had index of 1+, and 1 (1.82%) case had index of 5+ and 6+ each. Conclusion: Skin biopsy is easy, simple, inexpensive and outpatient procedure which provides adequate material for confirmation of the clinical diagnosis and further management. Histopathological examination including microscopic features of H&E stained sections, along with assessment of bacteriological index on Fite-Faraco stained sections remain the gold standard for diagnosis and subtyping of leprosy cases.

Morbus Hansen Multibacillary Type Mid Borderline: A Case Report

Background: Morbus Hansen (MH) is a granulomatous infectious disease caused by an obligate intracellular pathogenic bacterium, Mycobacterium leprae (M. leprae). Cardinal signs of Hansen's morbus (MH) include patches of numb skin, thickening of the peripheral nerves, and acid-fast bacteria (AFB) on a skin smear or biopsy. This case report aims to establish the diagnosis of mid borderline (BB) MH with clinical and histopathological examination.
 Case presentation: A 44-year-old woman presented with red patches on her face and body 1 month ago. Madarosis and multiple erythematous plaques confluent, poorly demarcated, raised edges, atrophic center with some smooth shiny and some rough surfaces found in the facial region and superior extremities et al. bilateral inferior with bilateral auricular infiltrates. A sensory examination of the lesion showed decreased sensitivity to pain and temperature. Skin-slit smear examination showed AFB with bacterial index (IB) +2 and morphological index (IM) 30%. On histopathological examination with hematoxylin and eosin staining, Grenz zone appeared, epithelioid granuloma affecting the epidermis, no lymphocytes, and no giant Langhans cells were found, and nerves were surrounded by lymphocytes and granulomas. On fite-faraco staining, BTA was obtained with IB +3 and IM 30%. The diagnosis of MH type BB was established, and the patient was given multidrug therapy (MDT) multibacillary (MB).
 Conclusion: Morbus Hansen type BB has a typical histopathological picture of granulomas composed of mature epithelioid cells, Grenz zone, AFB, enlarged and swollen nerves surrounded by lymphocytes or infiltrated with granulomas without damage. After 3 months of therapy, there was a decrease in IB and IM on AFB examination.

Efficacy of fluorescent microscopy versus modified Fite‐Faraco stain in skin biopsy specimens of leprosy cases – a comparative study

Histopathological examination of skin remains the cornerstone in the diagnosis of leprosy. At a few centers, fluorescent microscopy has been found to be useful in detecting more acid-fast bacilli (AFB) compared to modified Fite-Faraco staining but is sparsely documented. Hence, we studied the sensitivity of fluorescent microscopy and modified Fite-Faraco stain in the detection of Mycobacterium leprae in tissue sections. Patients attending our outpatient department during January 2019 to June 2020 with the clinical features of leprosy were examined, and the diagnosis was confirmed by histopathology after informed consent. Tissue sections were stained by fluorescent stain and modified Fite-Faraco stain. Bacillary index was calculated for each case. Forty patients were recruited after following the inclusion and exclusion criteria. AFB were demonstrated in 20 patients by modified Fite-Faraco stain and in 27 patients with fluorescent stain. The sensitivity of fluorescent staining method (67.5%) was higher than modified Fite-Faraco stain (50%). Bacillary index was increased in 26 out of 40 cases by the fluorescent staining compared to the modified Fite-Faraco staining. Chi-square value was 69.3 and P value was 0.000, indicating a statistically significant correlation. Fluorescent microscope is expensive, and trained people are needed to identify the bacilli. Fluorescent staining is more sensitive than modified Fite-Faraco staining in the detection of AFB in tissue sections. The bacilli detected per field were high with the fluorescent staining compared to the modified Fite-Faraco method.

Traversing the Spectrum of Non-Langerhans Cell Histiocytosis: A Case of Rosai-Dorfman Disease with Features of Necrobiotic Xanthogranuloma

Introduction. Non-Langerhans cell histiocytoses (non-LCH) are a group of rare diseases with varied clinical manifestations and overlapping features seen among the subtypes. Here, we present a case of Rosai-Dorfman disease with features of necrobiotic xanthogranuloma.
 Case. A 45-year-old female presented with a 10-year history of an enlarging neck mass with normal overlying skin accompanied by dysphagia and multiple asymptomatic pink to yellowish-brown papules, nodules, and plaques on the face, trunk and extremities. Biopsies of a skin nodule and plaque revealed granulomatous dermal infiltrates (lymphocytes, foamy histiocytes, and Touton giant cells), emperipolesis and areas of necrosis. CD1A and Fite-Faraco staining showed negative results while CD68 and S100 positively stained the tissues of interest. Histopathology of the neck mass paralleled these findings in addition to being negative for lymphoid markers. Patient had monoclonal gammopathy and thyromegaly with enlarged cervical lymph nodes on further tests and imaging. Intralesional and systemic steroids were given which led to flattening of skin lesions and improvement in dysphagia, respectively.
 Conclusion. Diagnosis and classification of a particular type of non-LCH may be difficult due to similarities across its subtypes. Hence, it is our belief that these diseases may occur on a spectrum. Treatment involves a multidisciplinary approach for the best possible care.

Slit skin smear or Fite-Faraco staining of tissue sample, which is a better indicator of bacillary load?

<p><strong>Background: </strong>Leprosy is clinically diagnosed on the basis of presence of following cardinal signs: 1. Hypopigmented or erythematous anesthetic patch on skin, 2. Thickened and/or tender peripheral/cutaneous nerve, 3. Acid fast bacilli in slit skin smear. This study aims at comparing bacillary indices in slit skin smears with that from biopsy samples.</p><p><strong>Methods: </strong>After obtaining informed written consent, slit skin smears were performed and observed for acid fast bacilli. Punch biopsies of lesions were taken and processed and stained with Fite-Faraco technique. The presence or absence of acid-fast bacilli in both modalities was noted.</p><p><strong>Results: </strong>Slit skin smears were positive in 24 patients and negative in the rest. And 26 patient’s biopsy reports had Fite-Faraco positivity, out of the total 46 patients. The p=0.67 which was not significant at significance value 0.05.</p><p><strong>Conclusions: </strong>Skin smear is an equally reliable indicator of bacillary load as Fite-Faraco bacillary index in tissue.</p><p><strong> </strong></p>

Cutaneous Mycobacteriosis Caused by Mycobacterium kansasii in a Yellow-naped Amazon Parrot (Amazona auropalliata)

An approximately 25-year-old, female, yellow-naped Amazon parrot (Amazona auropalliata) was evaluated for a chronic, raised, ulcerative mass on the lateral aspect of the left thigh. Histopathology of an excisional biopsy revealed severe, chronic, multifocal-to-coalescing, ulcerated dermal and subcutaneous granulomas. No infectious organisms were observed on Ziehl-Neelsen or Gomori methenamine silver stains. The parrot was treated with oral sulfamethoxazoletrimethoprim and meloxicam. When reexamined 2 weeks later, the biopsy site had healed. Surgical biopsies were resubmitted 14 months after the original presentation due to recurrence of similar ulcerative lesions on the right leg. Histopathology revealed a similar inflammatory pattern, and hematoxylin-eosin, Ziehl-Neelsen, and silver stains on the biopsy samples were all negative. A Fite-Faraco stain revealed rare acid-fast bacilli throughout the lesion. Tissue polymerase chain reaction test was negative for Mycobacterium avium and Mycobacterium genavense. Mycobacterial culture and subsequent genotyping revealed Mycobacterium kansasii. Mycobacterium kansasii is a significant cause of mycobacteriosis in humans and, therefore, should be considered a potential zoonotic organism. This report describes an unusual primary cutaneous presentation of avian mycobacteriosis.

Clinico-pathological Study of Leprosy- A Descriptive Study

Introduction: Leprosy is an age old disease affecting mankind with various clinico-pathological forms. Mycobacterium Leprae causes a chronic infectious disease known as Leprosy or Hansen’s disease. It remained a major public health issue due to associated case load, morbidity and stigma attached to it. Clinical and histopathological examination along with demonstration of lepra bacilli in skin smears by Fite-faraco stain and Bacillary Index (BI) is widely used for proper classification and diagnosis of leprosy. Aim: To study the clinico-pathological features of leprosy in skin biopsies and to categorise it into various types of lesions according to Ridley Jopling classification. Materials and Methods: The descriptive study included clinically diagnosed 183 leprosy cases who underwent skin biopsy for histopathological examination from January 2017 to December 2018 at Shri Bhausaheb Hire Government Medical College Dhule, Maharashtra. All sections were stained with Haematoxylin and Eosin (H&E) and Fite-faraco stain. Ridley-Jopling classification was done to classify leprosy. Clinical diagnosis was in concordance with that of histopathological diagnosis. Results: A total of 183 skin biopsies were studied from patients in an age group of 11-76 years. Male to female ratio was 1.5:1 and commonest age group affected was 21-40 years. Clinically, 78 cases (42.6%) were diagnosed as Borderline Tuberculoid (BT) leprosy followed by indeterminate leprosy 34 (18.57%). On histopathological examination maximum cases had BT leprosy 64 (82.05%) followed by Tuberculoid (TT) leprosy 13 (81.25%). Fite- faraco stain was done in 71 cases and was found positive in all cases of Borderline Lepromatous (BL) and Lepromatous Leprosy (LL). Also,concordance between Bacillary Index (BI) and histopathology examination was done. The clinico-histopathological concordance was seen in 127 cases (69.39%). Conclusion: Early and accurate diagnosis by clinical and histopathological examination along with special stain is essential for proper diagnosis and treatment of the patient as well as prevention of its complications.

Analysis of histomorphological study in Hansen’s disease: A hospital based study done in rural population

Leprosy, also known as Hansen’s disease is a chronic infectious disease caused by Mycobacterium Leprae. It still continues to be a major public health problem in India. AIM: The study was aimed at analysing the histomorphological features of leprosy in skin biopsies and based on histological findings they were categorised according to Ridley-Joplings classification. Clinical correlation was also done wherever possible. Materials and methods: After adequate fixation of skin biopsies with 10% formalin, routine processing was done and tissue embedded in paraffin section of 5µ thickness and then stained with Hematoxylin and Eosin (H&E) and Fite-Faraco stain, subsequently studied under microscope. Results: Total of 35 skin biopsies were studied, with the mean age of presentation ranging from 14-72 years, showing male predominance. Boderline tuberculoid (37.14%) was the most common type. Atrophic epidermis was seen only in 9 cases but Grenz zone was present in all 12 cases of Lepromatous leprosy. Epithelioid granuloma is the commonest finding in Boderline Tuberculoid type. Clinico histomorphological correlation was made in 23 cases and discoherence was found in remaining 12cases. Conclusion: Correlation of clinical and histopathological features along with bacteriological index plays a pivotal role for accurate typing and for prognostication. Clinicopathological concordance is highest in polar forms, and being least in Indeterminate Leprosy (IL).

Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil.

We investigated palatine tonsil and adenoid specimens excised from otorhinolaryngological patients in a leprosy-endemic region of Brazil. Fite-Faraco staining identified Mycobacterium spp. in 9 of 397 specimen blocks. Immunohistochemistry and molecular analysis confirmed the presence of Mycobacterium leprae, indicating that these organs can house M. leprae in persons inhabiting a leprosy-endemic region.

Characteristics of Oral Lesions in Patients With Hansen Disease

Background and objectiveHansen disease, or leprosy, is caused by Mycobacterium leprae or Mycobacterium lepromatosis. Because these bacteria enter the body via the upper airways, they generate clinical manifestations in the nasal mucous membranes and the mouth. We aimed to describe the characteristics of oral lesions in patients with Hansen disease. Material and methodsCross-sectional observational study of 100 patients diagnosed with Hansen disease. We examined the oral cavity and recorded clinical findings on a disease reporting form for each patient. We also included the histopathologic findings for lesions that required a biopsy. Samples suggestive of Hansen disease were processed with hematoxylin-eosin, Ziehl–Neelsen, and Fite–Faraco staining. Variables were analyzed, as appropriate, with the χ2 test, the Mann-Whitney U test, or the Spearman correlation coefficient. ResultsSixty-seven men and 33 women were included. The mean (SD) age was 48.1 (16.4) years. Thirty-four patients had oral lesions. Lesions related to Hansen disease were found in 9 patients. The locations were the hard palate and upper lip. Oral lesions were significantly more frequent in patients with lepromatous leprosy, borderline lepromatous leprosy (P = .029), and erythema nodosum leprosum (P = .031). ConclusionsThe frequency of oral lesions is low in Hansen disease. Such lesions present as lepromas and leprous plaques on the hard palate and upper lip.

A HISTOPATHOLOGICAL STUDY OF LEPROSY ALONG WITH CLINICAL CORRELATION.

Background: Leprosy or Hansen’s disease is a chronic infectious disease that mainly affects skin and peripheral nerves. Histopathology and demonstration of lepra bacilli is an essential tool to supplement clinical examination and diagnosis for correct classification and therefore treatment of patients. Aim: To study histopathology of leprosy cases and identify histological types in patients in a tertiary care centre, Asram hospital in Eluru. Materials and Methods: 18 skin biopsies diagnosed as leprosy over a period of two years from January 2018 to December 2019 were studied. Haematoxylin-eosin and Fite-Faraco staining for demonstrating lepra bacilli were done. Results: Male to female ratio of patients was 4.5:1. Maximum number of cases was seen in the 3rd and fourth decades of life. The commonest histological type was borderline tuberculoid (5 cases, 28%) and indeterminate type, lepromatous type (3 cases, 16%); followed by tuberculoid leprosy and erythema nodosum leprosum (2 cases, 11%), the least common cases were of lepromatous leprosy to borderline tuberculoid leprosy (1cases, 6%). The most common site was upper limb (26%). All 3/18(24%) patients with affected nerves showed ulnar and auricular nerve involvement. Hypopigmented, anaesthetic plaque was the commonest clinical feature followed by erythematous lesions. All cases of borderline tuberculoid, borderline lepromatous, lepromatous, midboderline and indeterminate showed acid-fast bacilli on Fite stain. Tuberculoid cases showed well-formed granulomas, borderline tuberculoid type showed additional feature of giant cells and lepromatous types showed grenz zone and no granulomas. Conclusion: Histopathological examination is the gold standard for accurate diagnosis and typing of leprosy. It should be done in all leprosy cases presenting to the clinician.