Paucibacillary Leprosy: Reappraisal using Ziehl-Neelsen staining of slit skin smears and 16S rRNA Real Time Polymerase Chain Reaction of nasal swabs

Background: Leprosy is diagnosed by cardinal signs. Classification of paucibacillary (PB) and multibacillary (MB) leprosy is based on the number of skin lesions and nerve involvement. Objective: The study was conducted to determine the role played by acid fast bacilli (AFB) positivity of slit skin s...

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Bibliographic Details
Published in:	Leprosy review Vol. 89; no. 3; pp. 272 - 279
Main Authors:	Turankar, Ravindra P., Lavania, Mallika, Singh, Itu, Singh, Vikram, Ahuja, Madhvi, Pathak, Vinay Kumar, Jakhmola, Prashant, Das, Loretta, Darlong, Joydeepa, Hembrom, Ujjwal, Ramesh, V., Khanna, Neena, John, Annamma S., Sengupta, Utpal
Format:	Journal Article
Language:	English
Published:	British Leprosy Relief Association 01-09-2018
Subjects:	Diagnosis Leprosy Polymerase chain reaction Skin lesions India
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Summary:	Background: Leprosy is diagnosed by cardinal signs. Classification of paucibacillary (PB) and multibacillary (MB) leprosy is based on the number of skin lesions and nerve involvement. Objective: The study was conducted to determine the role played by acid fast bacilli (AFB) positivity of slit skin smear (SSS) in clinical classification. Methodology: SSSs and nasal swab smears (NSSs) were stained by Ziehl-Neelsen staining. RNAs was extracted from 120 NSSs. NSSs and SSSs were examined by microscopy and M. leprae viability in NSS was determined by real time polymerase chain reaction (RT-PCR). NSSs from 50 healthy individuals were used as controls. Results: Group-A PB cases, classified simply by presenting with < 5 patches, showed the presence of AFB in NSSs (7-5%) and SSSs (15%). Group-B PB cases, classified on the basis of a negative skin smear were AFB negative. Control group NSSs were AFB negative. RT-PCR of NSSs of PB cases of Group A and Group B were 65% and 87% positive for viable M. leprae respectively. All NSSs were positive for 16S rRNA gene with variable copy numbers. It was noted that 3 SSSs negative AFB cases from Group-A were positive for AFB in NSS. It was also observed that 6 SSSs positive AFB (Group-A) cases were negative for AFB in NSS. It was interesting to note that none of the patients in Group-A was AFB positive in both NSS and SSS. However, all of these patients were positive for 16S rRNA qPCR in NSSs. Conclusion: Our findings strongly suggest immediate inclusion of AFB staining of SSS for classification of leprosy. Keywords: PB leprosy cases, AFB, M. leprae, Real Time PCR, BI negative, 16S rRNA gene target, Z-N staining
ISSN:	2162-8807 0305-7518 2162-8807
DOI:	10.47276/lr.89.3.272