14 research outputs found
Diagnosing multibacillary leprosy: A comparative evaluation of diagnostic accuracy of slit-skin smear, bacterial index of granuloma and WHO operational classification
Background: In view of the relatively poor performance of skin smears
WHO adopted a purely clinical operational classification, however the
poor specificity of operational classification leads to overdiagnosis
and unwarranted overtreatment while the poor sensitivity leads to
underdiagnosis of multibacillary (MB) cases with inadequate treatment.
Bacilli are more frequently and abundantly demonstrated in tissue
sections. Aims and Methods: We compared WHO classification, slit-skin
smears (SSS) and demonstration of bacilli in biopsies (bacterial index
of granuloma or BIG) with regards to their efficacy in correctly
identifying multibacillary cases. The tests were done on 141 patients
and were evaluated for their ability to diagnose true MB leprosy using
detailed statistical analysis. Results: A total of 76 patients were
truly MB with either positive smears, BIG positivity or with a typical
histology of BB, BL or LL. Amongst these 76 true-MB patients, WHO
operational classification correctly identified multibacillary status
in 56 (73.68%), and SSS in 43 (56.58%), while BIG correctly identified
65 (85.53%) true-MB cases. Conclusion: BIG was most sensitive and
effective of the three methods especially in paucilesional patients. We
suggest adding estimation of bacterial index of granuloma in the
diagnostic workup of paucilesional patients
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