Kumaran Sendhil M, Bhat Ishwara P, Madhukara J, Rout Pritilata, Elizabeth J
Department of Dermatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Dermatology, St. John's Medical College and Hospital, Bangalore, Karnataka, India.
Indian J Dermatol. 2015 Jan-Feb;60(1):51-4. doi: 10.4103/0019-5154.147791.
As the world moves toward elimination of leprosy, persistence of infective cases in endemic pockets remains a significant problem. The use of clinical criteria to decide the paucibacillary (PB) versus multibacillary (MB) regimens has greatly simplified therapy at the field setting. However, a small but significant risk of under-treatment of so-called "PB" cases which actually have significant bacillary load exists. This study was undertaken to assess this risk and compare two methods of assessment of bacillary load, namely bacillary index on slit skin smear (BIS) versus bacillary index of granuloma (BIG).
To compare BIS with BIG on skin biopsy in consecutive untreated cases of leprosy.
This prospective study was conducted over a period of 12 months, wherein new untreated patients with leprosy were consecutively recruited. After a thorough clinical examination, each patient underwent slit skin smear (SSS) where the BIS was calculated. The same patient also underwent a skin biopsy from a clinical lesion where, the BIG was calculated. SSS and skin biopsy for BIS and BIG respectively were repeated for all patients at the end of therapy for comparison. All patients received therapy according to World Health Organization-Multidrug Therapy Guidelines.
The BIG was positive in all cases where the BIS was positive. Significantly, BIG was positive in three cases of borderline tuberculoid leprosy with <5 lesions who received PB regimen, whereas the BIS was negative in all three cases.
This study suggests that BIG may be a better indicator of the true bacillary load in leprosy as compared to BIS. Its role in management is significant, at least in tertiary care centers to prevent "under-treatment" of so called PB cases, which may actually warrant MB regimens.
随着全球朝着消除麻风病的目标迈进，麻风病流行地区存在传染性病例的持续存在仍是一个重大问题。使用临床标准来决定少菌型（PB）与多菌型（MB）治疗方案极大地简化了现场治疗。然而，所谓“PB”病例实际菌量很大但治疗不足的风险虽小却显著存在。本研究旨在评估这一风险，并比较两种评估菌量的方法，即皮肤涂片细菌指数（BIS）与肉芽肿细菌指数（BIG）。
比较连续未治疗的麻风病病例皮肤活检中BIS与BIG的情况。
本前瞻性研究为期12个月，连续招募新的未治疗的麻风病患者。经过全面的临床检查后，每位患者进行皮肤涂片检查（SSS）以计算BIS。同一位患者还从临床病变处进行皮肤活检以计算BIG。所有患者在治疗结束时分别再次进行SSS和皮肤活检以比较BIS和BIG。所有患者均按照世界卫生组织的多药联合治疗指南接受治疗。
所有BIS呈阳性的病例中BIG均为阳性。值得注意的是，3例皮损少于5处的界线类偏结核样型麻风患者接受PB治疗方案，其BIG为阳性，而这3例患者的BIS均为阴性。
本研究表明，与BIS相比，BIG可能是麻风病真实菌量的更好指标。其在治疗管理中的作用显著，至少在三级医疗中心可防止对所谓PB病例的“治疗不足”，这些病例实际上可能需要MB治疗方案。
