Veena S, Kumar Prakash, Shashikala P, Gurubasavaraj H, Chandrasekhar H R
Department of Pathology, Kasturba Medical College, Manipal, Karnataka, India.
J Lab Physicians. 2011 Jan;3(1):21-4. doi: 10.4103/0974-2727.78557.
Patients with 1-5 skin lesions are clinically categorized as paucibacillary for treatment purposes. For betterment and adequate treatment of patients, this grouping needs further study.
To study a group of leprosy patients with 1-5 skin lesions, compare clinical details with histopathological findings and bacteriological status of the skin to evaluate the relevance of this grouping.
Two-year study involving 31 patients of leprosy with 1-5 skin lesions was included in this study. A number of skin lesions were recorded. Skin biopsies were taken in all patients. The biopsies were evaluated for the type of pathology and acid fast bacilli (AFB) status.
Of 31 patients, 19 (61.2%) had single skin lesion, 7 (22.5%) had two lesions, 4 (12.9%) had three lesions, and only one (3.22%) had four lesions, there were no patients with five lesions. Of the 31 patients, 30 (96.7%) were clinically diagnosed as borderline tuberculoid and one patient (3.22%) has tuberculoid leprosy. Skin smears were negative for AFB in all patients. The histological diagnoses were: TT 1 (3.22%), BT 24 (77.41%), and IL 6 (19.2%). AFB were found in 2 (6.45%) out of 31 skin biopsies. Clinicopathological correlation was 76.6% in the BT group.
Tissue biopsy findings in 1-5 skin lesions which were not considered relevant for treatment purposes until now should be given a status in the categorization and assessment of severity of the disease. The significance of finding of AFB and histopathology of multibacillary (MB) type of leprosy in tissue biopsies, in patients grouped as PB should be resolved so that patients could be given the drug therapy and duration of therapy they warrant.
出于治疗目的，临床上将有1至5处皮肤损害的患者归类为少菌型。为了改善患者治疗并提供充分治疗，这一分类需要进一步研究。
研究一组有1至5处皮肤损害的麻风病患者，比较其临床细节、组织病理学发现及皮肤细菌学状况，以评估该分类的相关性。
本研究纳入了一项为期两年的研究，涉及31例有1至5处皮肤损害的麻风病患者。记录皮肤损害数量。对所有患者进行皮肤活检。对活检组织进行病理类型和抗酸杆菌（AFB）状况评估。
31例患者中，19例（61.2%）有单个皮肤损害，7例（22.5%）有两处损害，4例（12.9%）有三处损害，仅有1例（3.22%）有四处损害，无患者有五处损害。31例患者中，30例（96.7%）临床诊断为界线类偏结核型，1例患者（3.22%）为结核样型麻风。所有患者皮肤涂片AFB均为阴性。组织学诊断为：结核样型1例（3.22%），界线类偏结核型24例（77.41%），中间界线类6例（19.2%）。31例皮肤活检中有2例（6.45%）发现AFB。界线类偏结核型组的临床病理相关性为76.6%。
对于目前认为在治疗方面无相关性的1至5处皮肤损害的组织活检结果，应在疾病分类和严重程度评估中赋予其地位。对于归类为少菌型的患者，组织活检中发现AFB及多菌型（MB）麻风的组织病理学意义应予以明确，以便给予患者应有的药物治疗及疗程。
