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Objective: To compare the diagnostic efficacy of multiplex polymerase chain reaction (PCR), Mycobacterium leprae-specific repetitive element (RLEP) PCR and loop-mediated isothermal amplification (LAMP) PCR in the diagnosis of pediatric leprosy as an alternative to slit-skin smear (SSS) examination. Methods: A cross-sectional study was performed on 26 children aged 0–18 years with characteristic skin lesions of leprosy. SSS examination for acid fast bacilli (AFB) was performed for all children. Additionally, urine, stool and blood samples were tested by three PCR techniques - multiplex, RLEP and LAMP. The results of these tests were compared with each other and with results of SSS examination for acid fast bacilli (AFB) using appropriate statistical tests. Results: Out of 26 patients studied, SSS examination was positive for AFB in 7 cases (26.9%). In blood samples, the positivity of multiplex PCR, RLEP PCR and LAMP PCR was 84.6%, 80.8%, and 80.8%, respectively. Multiplex PCR in blood samples was positive in 100% (n = 7) of SSS positive cases and 84.2% (16 out of 19) of the SSS negative cases (P < 0.001). The positivity of all PCR methods in urine and stool samples was significantly lesser than in blood. Conclusion: Multiplex PCR in blood sample is a superior diagnostic tool for pediatric leprosy compared to RLEP PCR and LAMP PCR as well as SSS examination. [ABSTRACT FROM AUTHOR]

IntroductionLeprosy is a chronic infectious disease caused by the agent Mycobacterium leprae, characterized by its high disabling power. Data points to Brazil being the second country with the highest number of cases in the world, behind only India, representing a major challenge for public health. This work aims to determine the prevalence of paucibacillary (PB) cases in relation to leprosy cases in Brazil, using data published in the literature.MethodsThis is a systematic review and meta-analysis carried out with studies from the last 20 years, being developed based on the Preferred Reporting Items for Systematic Review and Meta-analyzes (PRISMA).The search was carried out in the databases: PUBMED, SciELO, LILACS (via VHL)and Science Direct in October 2023, using the following descriptors (((“Brazil” [Mesh]) AND (“Leprosy, paucibacillary” [Mesh])) AND “Epidemiology” [Mesh]), in English, Portuguese and Spanish. Original studies of the analytical case–control, cohort, cross-sectional, epidemiological types were selected, as well as articles with satisfactory information for numerical extraction with separate data on the paucibacillary and multibacillary clinical forms. The methodological quality assessment followed the JBI critical appraisal checklist. Statistical analysis was performed using the Comprehensive Meta-Analyses-CMA software, version 3.0 (Biostat, Engewood, NJ, United States).ResultsThe meta-analysis of the 48 studies obtained a paucibacillary prevalence rate in Brazil of 50.5% or 0.505 (95% CI = 0.502–0.509).The differences in the analyzes were statistically significant (Q-value 4302.681;df 47; I 98.905), with a high heterogeneity value evidenced by I2 (98.905). This analysis demonstrated that the frequency in the Midwest region was the highest and the South region was the lowest (21.4%). Begg’s (Kendall Tau p = 0.35) and Egger’s tests (p = 0.20) were performed, in which no high publication bias was noted. Subgroup analysis indicated that paucibacillary cases varied from region to region, with the Midwest region having the highest prevalence and the South region having the lowest.ConclusionThe results stand out significantly for the research gaps that investigate PB cases, requiring more research aimed at investigating the paucibacillary clinical form that can contribute to the early diagnosis of leprosy.Systematic review registrationPROSPERO code: CRD42024514106.

Background Leprosy, sometimes referred to as Hansen's disease, is a chronic granulomatous infection caused by bacteria that predominantly impacts the peripheral nerves but may additionally harm the eyes, muscles, bones, skin, the mucous membrane of the mouth, upper respiratory tract, reticuloendothelial system, eyeballs, and the testicles. The factors that predispose to illness development must be recognized. Poverty, undernutrition, food scarcity, insufficient food supply, and a lack of food diversity are the most obvious risk factors. Objective To determine the relationship between body mass index (BMI) and leprosy type. Methods This is an analytical cross-sectional study design involving 30 subjects with leprosy. Clinical examination and history-taking were carried out and the BMI was taken into account. Results It was discovered that this study's leprosy subjects were more likely to be male, with 20 male subjects (66.6%) and 10 female subjects (33.3%). 11 patients (36.6%) of the study group's participants were beyond the age of 47. The correlation between the BMI value and the type of leprosy has a positive direction of 0.123 with very low relationship criteria and there's no relationship between body mass index and leprosy type (p=0.069). Conclusion No association between body mass index and leprosy type. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic value of targeted next generation sequencing (tNGS) in childhood tuberculosis (TB) and compare the accuracy with Xpert MTB/RIF method. Methods: Children aged ≤18 years with symptoms suggestive of TB during July 2021 to December 2022 at Beijing Children's Hospital were included, and the performances of tNGS and Xpert were evaluated. Results: A total of 103 children with suspected TB were recruited, including 72 discharge diagnosis of TB and 31 non-TB cases. The mean age was 7.37 ± 4.77 years, and 62.1 % were male. The most common type of specimens was gastric aspirate (GA) (59, 57.3 %). Among all the 72 TB patients, tNGS showed higher sensitivity than Xpert, but the difference was not significant (34.7 %, 25/72 vs 20.8 %, 15/72; P = 0.063). The specificities of tNGS and Xpert were 87.1 % (27/31) and 96.8 % (30/31), respectively (P = 0.162). Among different types of specimen, the highest sensitivity of tNGS on sputum and pus was observed (80.0 %, 4/5), followed by pleural effusion (50.0 %, 2/4). One rifampin resistance and one protionamide resistance were detected in bacteriologically confirmed TB by tNGS. Conclusion: tNGS had a higher sensitivity but lower specificity compared to Xpert in diagnosis of children TB. tNGS yielded higher sensitivity than Xpert on gastric aspirate and sputum and pus.

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially <6 years). Since, transmission can happen at any time from index case to the contact (before diagnosis or during treatment), all contacts of TB patients should be screened. Aim: To focus on the screening of paediatric contacts of TB positive patients by Mantoux test and to find out active and latent TB. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The duration of the study was 16 months, from February 2020 to June 2021. Participants, who were proven cases, either sputum positive or clinically diagnosed and were less than 18 years of age were included. Contacts in whom Isoniazid Preventive Therapy (IPT) had been started were excluded. The candidates who tested Mantoux positive and had symptoms of TB were further screened by following test chest X-ray, Ultrasonography (USG) abdomen, Microscopy for Acid Fast Bacilli (AFB), Cartridge Based Nucliec Acid Amplification Test (CBNAAT), Cerebrospinal Fluid (CSF) analysis and contrast Magnetic Resonance Imaging (MRI). The data collected was analysed statistically with Statistical Package for Social Sciences (SPSS) version 26.0 and the level of significance was determined p-value <0.05 as insignificant, p-value >0.05 as significant and p-value <0.001 as highly significant. Results: A total of 82 contacts were included. Out of these, 60 children had no organ system involvement, whilst 11 had lymphadenopathy, five had respiratory involvement and six had abdominal involvement. Out of 82 contacts, 23 children tested Mantoux positive and 59 tested negative. Out of 23 Mantoux positive contacts 16 (19.51%) had latent TB and only 1 (2.44%) had active TB. Conclusion: A significant number of children in contact with TB positive patients were found to have latent TB, and it is possible that, there can be activation from latent to active TB later on in these children. [ABSTRACT FROM AUTHOR]

Objectives: Smear-negative pulmonary TB (PTB) is difficult to diagnose. Current diagnosis and treatment monitoring methods have inherent limitations. Droplet digital PCR (ddPCR) is a new technique with high sensitivity. This study presents a novel ddPCR for rapid and sensitive identification of Mycobacterium tuberculosis (MTB). Methods: MTB DNA was detected in respiratory specimens from suspected PTB cases using ddPCR assay, which was directed at two different locations within IS6110. We, for the first time, evaluated the clinical diagnostic ability of this ddPCR for paucibacillary smear-negative PTB. Results: A total of 605 PTB suspects were recruited, including 263 patients with confirmed PTB (84.03% from smear-negative PTB) and 342 without PTB. The sensitivity and specificity of IS6110 ddPCR were 61.22% (95% confidence interval (CI) 55.00-67.10%) and 95.03% (95% CI 92.20-97.10%) for total PTB and 57.92% (95% CI 51.10-64.50%) and 94.57% (95% CI 91.20-96.90%) for smear-negative PTB. ddPCR assay outperformed Xpert MTB/RIF (53.08% vs 28.46%, P = 0.020) in smear-negative PTB detection. Furthermore, effective anti-TB treatment was linked to significantly lower IS6110 copies detected by ddPCR. Conclusion: Herein, we developed and validated a highly sensitive and robust ddPCR assay for MTB quantification in respiratory specimens, which improves diagnosis and therapeutic effect evaluation of smear-negative PTB.

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially 0.05 as significant and p-value

Background: Childhood leprosy is an indicator of ongoing transmission of the disease. The prevalence rate of pediatric leprosy is considered an important epidemiological index for determining the level of transmission of the disease. Our aim was to estimate the proportion of leprosy cases among children aged 0–14 years in our tertiary care hospital. Methods: A retrospective study was carried out for a period of 4 years from January 2017 to December 2020. Secondary data were collected from leprosy records pertaining to childhood leprosy (aged between 0 and 14 years). Only new cases presented during the period were included. Details of the patients such as age, sex, family history, number and site of lesions, nerve involvement, reactions, and deformities were noted. Slit-skin smear and biopsy findings were tabulated and descriptive analysis was done. Results: Fifty-five cases (9.54%) of childhood leprosy were diagnosed. Majority of the cases were in the age group of 10–14 years. The most common leprosy type was borderline tuberculoid found in 42 patients (76.36%). Forty-nine patients (89.09%) had paucibacillary (PB) and 6 (10.91%) had a multibacillary type. The most common presenting symptom was patch (61.8%). Eleven patients had a family history. Clinicopathological correlation was observed in 50 (90%) patients. Lepra reactions were seen in six (10.9%) patients and two deformities in three patients. Conclusion: The proportion of pediatric leprosy cases was 11.61% in 2017 and decreased to 6.45% in 2020. PB type is the most common type. To achieve zero childhood leprosy cases, thorough follow-up and contact tracing of adult leprosy patients, early diagnosis of childhood leprosy to prevent disabilities is the need of the hour.

Background: The World Health Organization is considering substituting Xpert MTB/RIF (Xpert) with Xpert MTB/RIF Ultra (Ultra) for tuberculosis (TB) diagnosis, but supportive evidence is scarce, particularly among people more likely (presumptive) to have paucibacillary pulmonary TB (PTB). Methods: During January-July 2018, presumptive PTB patients visiting TB Screening and Treatment Centres of Dhaka for routine chest X-ray (CXR) and conventional Xpert were enrolled. Sputum specimens were additionally tested with microscopy, culture, and Ultra. Specimens with “Trace call” by Ultra (Ultra-trace) were retested. Yield and diagnostic accuracy using various approaches to Ultra-trace and concordance of Ultra with bacteriological-positive PTB were assessed. Results: Altogether, 1,083 participants (104 ‘Xpert-positive’; 979 ‘Xpert-negative and CXR-suggestive’) were enrolled. All Xpert-positives and 900 (92%) Xpert-negatives were concordant with Ultra, however, seventy-nine (8.1%) Xpert-negative specimens tested positive with Ultra; 37 (46.8%) were categorically positives, and 42 (53.2%) were Ultra-trace. Sixteen of the 42 were retested, of whom eight (50.1%) Ultra-trace turned categorically positive, leading to 45 (4.6%) additionally detected by Ultra. Ultra sensitivity and specificity were 93.9% and 94.6%, and it additionally detected 5.4% more TB patients with a concordance of 94.6% (kappa, □=0.78) compared to any bacteriologically positive specimen (microscopy, culture, or Xpert). Conclusion: Ultra exhibited improved detection and accuracy among Xpert-negatives in a cohort with a high likelihood of PTB.

Background. Leprosy is a chronic disease caused by Mycobacterium leprae. It results in significant deformities and impairments which involve the peripheral nerves and skin. Even though leprosy has been declared as being eliminated as a major public health problem in India on December 2005 there are many people who have significant morbidity due to the disease. This study was done to determine the clinical profile and deformities in all leprosy cases in one of the Government leprosy rehabilitation homes in Tamilnadu. Aims. The study was made to describe the pattern of deformities among the leprosy affected persons in a Government Rehabilitation home in Sub urban parts of Chennai and to describe the rehabilitation procedures performed in the inmates to improve their Activities of daily life (ADL). Methods. This was a descriptive cross-sectional study of leprosy cases done at a Government Rehabilitation home. Results. A number of 130 cases were included in the study. Maximum cases belonged to the age group of >60 years and males were more than females. Among those included in the study 7.7 % had leonine facies and 38.47% had madarosis.73.07 % had trophic ulcer and 53.8% had auto amputation of digits. Claw hand was the most common deformity found in 38.47% followed by ape thumb. Corneal opacity was found in 15.38% of cases. Trophic ulcers are treated by using pressure relieving footwear made of MCR material and teaching them to avoid pressure points by modifying their posture. Claw hand and ape thumb deformity are rehabilitated by using stretching exercises and use of splints or braces. Conclusions. Though there are significantly lesser new infections due to lepra bacilli those already infected face significant deformities affecting their quality of life. Occupational therapy and a stretch exercises are of extreme importance as they prevent further worsening of the deformity also. Several efforts are being taken by health care authorities to reduce the burden faced by them and improve their quality of life by providing vocational and psychological support. [ABSTRACT FROM AUTHOR]

Background: Childhood leprosy is an indicator of ongoing transmission of the disease. The prevalence rate of pediatric leprosy is considered an important epidemiological index for determining the level of transmission of the disease. Our aim was to estimate the proportion of leprosy cases among children aged 0–14 years in our tertiary care hospital. Methods: A retrospective study was carried out for a period of 4 years from January 2017 to December 2020. Secondary data were collected from leprosy records pertaining to childhood leprosy (aged between 0 and 14 years). Only new cases presented during the period were included. Details of the patients such as age, sex, family history, number and site of lesions, nerve involvement, reactions, and deformities were noted. Slit-skin smear and biopsy findings were tabulated and descriptive analysis was done. Results: Fifty-five cases (9.54%) of childhood leprosy were diagnosed. Majority of the cases were in the age group of 10–14 years. The most common leprosy type was borderline tuberculoid found in 42 patients (76.36%). Forty-nine patients (89.09%) had paucibacillary (PB) and 6 (10.91%) had a multibacillary type. The most common presenting symptom was patch (61.8%). Eleven patients had a family history. Clinicopathological correlation was observed in 50 (90%) patients. Lepra reactions were seen in six (10.9%) patients and two deformities in three patients. Conclusion: The proportion of pediatric leprosy cases was 11.61% in 2017 and decreased to 6.45% in 2020. PB type is the most common type. To achieve zero childhood leprosy cases, thorough follow-up and contact tracing of adult leprosy patients, early diagnosis of childhood leprosy to prevent disabilities is the need of the hour. [ABSTRACT FROM AUTHOR]

Background: Genital tuberculosis is one of the leading causes of female infertility. Paucibacillary nature of the disease in the female genital system often makes its diagnosis difficult. No single test has been able to accurately diagnose genital tuberculosis. In this study we aim to compare conventional diagnostic tests for tuberculosis like Acid Fast Bacilli (AFB) Staining, Lowenstein Jensen (LJ) Culture and Histopathology with newer tests like PCR, MGIT 960, GeneXpert. Methods: This study included 67 infertile women from Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. They were subjected to detailed history and routine investigations, namely Haemogram, ESR, Mantoux test, Chest X-ray and pelvic ultrasound to look for the findings of tuberculosis. A premenstrual endometrial aspirate was taken and was subjected to the AFB Staining, LJ Culture, Histopathology, PCR, MGIT 960, Gene Xpert, and the test results were compared. Result and Conclusion: 35.8% (24/67) of women were diagnosed with genital tuberculosis using the diagnostic criteria. With culture as the gold standard, the positivity of genital TB was 19.4% (13/67). Majority of infertile patients with low index of suspicion clinically were positive for genital tuberculosis. Therefore, all the patients of infertility should be routinely evaluated for genital tuberculosis. PCR and MGIT 960 have shown promising results in the newer methods. LJ culture and histopathology are still the most reliable and available diagnostic methods. The usefulness of AFB Staining and GeneXpert remains questionable. [ABSTRACT FROM AUTHOR]

• The newly developed droplet digital PCR (ddPCR) is a sensitive and robust assay for Mycobacterium tuberculosis quantification. • ddPCR outperformed Xpert in smear-negative pulmonary TB detection by respiratory specimens. • This ddPCR improves diagnosis and therapeutic effect evaluation of smear-negative pulmonary TB. Smear-negative pulmonary TB (PTB) is difficult to diagnose. Current diagnosis and treatment monitoring methods have inherent limitations. Droplet digital PCR (ddPCR) is a new technique with high sensitivity. This study presents a novel ddPCR for rapid and sensitive identification of Mycobacterium tuberculosis (MTB). MTB DNA was detected in respiratory specimens from suspected PTB cases using ddPCR assay, which was directed at two different locations within IS 6110. We, for the first time, evaluated the clinical diagnostic ability of this ddPCR for paucibacillary smear-negative PTB. A total of 605 PTB suspects were recruited, including 263 patients with confirmed PTB (84.03% from smear-negative PTB) and 342 without PTB. The sensitivity and specificity of IS 6110 ddPCR were 61.22% (95% confidence interval (CI) 55.00-67.10%) and 95.03% (95% CI 92.20-97.10%) for total PTB and 57.92% (95% CI 51.10-64.50%) and 94.57% (95% CI 91.20-96.90%) for smear-negative PTB. ddPCR assay outperformed Xpert MTB/RIF (53.08% vs 28.46%, P = 0.020) in smear-negative PTB detection. Furthermore, effective anti-TB treatment was linked to significantly lower IS 6110 copies detected by ddPCR. Herein, we developed and validated a highly sensitive and robust ddPCR assay for MTB quantification in respiratory specimens, which improves diagnosis and therapeutic effect evaluation of smear-negative PTB. [ABSTRACT FROM AUTHOR]

Background Leprosy occurs due to primary M. leprae infection that attacks the peripheral nerves. Limited resources directly links the bacterial index (BI) with the grade of disability in leprosy patients in Indonesia, even though the problem of disability greatly affects quality of life of patients. Methods A cross-sectional retrospective study approach was conducted. Total sampling technique was performed from medical records of patients with diagnosis of PB or MB leprosy, accompanied by grade 0, 1 or 2 disability. Correlation analysis test was performed to determine the correlation between BI and grade of disability in leprosy patients. Results A total of 278 patients were included in this study, divided into 13 patients (4.7%) of PB leprosy and 265 patients (95.3%) of MB leprosy. Significant results were obtained in 5 out of 9 groups: (a) hand group in PB+MB leprosy (p value: 0.047); (b) foot group in PB+MB leprosy (p value: 0.002); (c) foot group in PB leprosy (p value: 0.000); (d) hand group in MB leprosy (p value: 0.021); and (e) foot group in MB leprosy (p value: 0.006). Conclusion Positive correlations between BI and grade of disability were found in 56% of the analysis groups. [ABSTRACT FROM AUTHOR]

Background: Leprosy patients are classified into paucibacillary and multibacillary types on the basis of the number of skin lesions for the purpose of therapy. Patients with 1–5 skin lesions are clinically categorized as paucibacillary for treatment purposes. Aim: To study paucibacillary leprosy cases and compare clinical details with histopathological findings. Materials and methods: Three and half year study involving 130 patients of paucibacillary cases of leprosy diagnosed clinically and based on the 1–5 skin lesions was included in this study after ethical clearance and taking informed consent from patients. A number of skin lesions were recorded. Skin biopsies were taken in all patients. Biopsies were evaluated for the type of pathology and acid fast bacilli (AFB) status. Results: Of 130 patients, 81(62.3%) were males and 49(37.6%) were females. Majority of the clinically classified cases were borderline tuberculoid leprosy. The histological diagnoses were: TT 19(14.6%), BT 40(30.7%), IL 51(39.2%) and No evidence of leprosy 20(15.3%). AFB were found in 3(15.3%) out of 130 skin biopsies and all were borderline tuberculoid leprosy. Conclusion: Tissue diagnosis play a significant role in the diagnosis of leprosy. Early and borderline cases of leprosy poses a diagnostic difficulty to label only on clinical basis, so histopathological evaluation is must for confirming the diagnosis in doubtful cases of leprosy.

Background : Tuberculosis (TB) is common form of communicable disease in India. Abdominal TB is one of the most common yet misdiagnosed forms of extrapulmonary TB. It is missed due to its similarity to other conditions such as Crohn's disease and nonspecific clinical presentation. Methods: Medical records of 317 patients who were diagnosed with abdominal TB from August 2015 to December 2020 were reviewed retrospectively from our prospectively maintained database. Results: Among 317 patients, 167 (52.7%) were male. Median age of presentation was 45 (8–85) years. Luminal involvement was seen in most of the patients (n = 157, 49.5%), followed by peritoneal (n = 63, 19.8%), mixed (n = 42, 13.2%), solid visceral (n = 30, 9.4%), and nodal (n = 25, 7.8%) involvement. Two hundred and sixty-one (82.3%) showed complete response. Seven (2.2%) patients died and 5 (1.6%) patients lost to follow-up. Median duration of treatment was 28 (25–52) weeks. Drug-induced liver injury was identified in 30 (9.5%) patients. Median follow-up duration was 32 (1–70) months. Conclusion: Abdominal TB is quite a diagnostic challenge due its vague clinical symptoms, nonspecific radiological features, and poor sensitivity and specificity of diagnostic tests. Hence, clinicians should have a high index of suspicion to diagnose and treat this treatable yet lethal condition promptly. Most cases respond very well to medical management and a small fraction requires surgical intervention if diagnosed early.

• Diagnostic accuracy of Xpert Ultra (Ultra) is high • Largest study of Ultra in Xpert-negative specimens for highly suggestive TB • One-fourth of Ultra-positives were "trace call" • Repeating initial "trace call" improves specificity without conceding sensitivity • 15 Xpert-negative/Ultra-positive of 63 clinically diagnosed, improved on anti-TB drugs The World Health Organization is considering substituting Xpert MTB/RIF (Xpert) with Xpert MTB/RIF Ultra (Ultra) for tuberculosis (TB) diagnosis, but supportive evidence is scarce, particularly among people more likely (presumptive) to have paucibacillary pulmonary TB (PTB). During January-July 2018, presumptive PTB patients visiting TB Screening and Treatment Centres of Dhaka for routine chest X-ray (CXR) and conventional Xpert were enrolled. Sputum specimens were additionally tested with microscopy, culture, and Ultra. Specimens with "Trace call" by Ultra (Ultra-trace) were retested. Yield and diagnostic accuracy using various approaches to Ultra-trace and concordance of Ultra with bacteriological-positive PTB were assessed. Altogether, 1,083 participants (104 'Xpert-positive'; 979 'Xpert-negative and CXR-suggestive') were enrolled. All Xpert-positives and 900 (92%) Xpert-negatives were concordant with Ultra, however, seventy-nine (8.1%) Xpert-negative specimens tested positive with Ultra; 37 (46.8%) were categorically positives, and 42 (53.2%) were Ultra-trace. Sixteen of the 42 were retested, of whom eight (50.1%) Ultra-trace turned categorically positive, leading to 45 (4.6%) additionally detected by Ultra. Ultra sensitivity and specificity were 93.9% and 94.6%, and it additionally detected 5.4% more TB patients with a concordance of 94.6% (kappa, □=0.78) compared to any bacteriologically positive specimen (microscopy, culture, or Xpert). Ultra exhibited improved detection and accuracy among Xpert-negatives in a cohort with a high likelihood of PTB. [ABSTRACT FROM AUTHOR]

Objectives: To characterise and describe the diagnostic utility of Endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) in intrathoracic tuberculosis in a cohort of patients with mediastinal lymphadenopathy of unknown aetiology.Methods: Consecutive patients with intrathoracic lymphadenopathy undergoing EBUS-TBNA between 2012 and 2016 were identified. Demographic data, biopsy cytopathology and mycobacteriology results, HIV and vitamin D status, susceptibility results and final diagnoses were recorded. Pre- and post-procedure probability scores were assigned to each case to reflect the probability of tuberculosis.Results: 315 cases were identified; 54 (17.1%) had tuberculosis and 261 (82.9%) had a non-tuberculosis diagnosis. amongst TB cases, the sensitivity of EBUS-TBNA was 59.3% (95% CI 45.06-72.14), specificity 100% (95% CI 98.19-100) and the negative predictive value (NPV) was 92.23% (95% CI 88.31-94.95). 19/54 (35%) TB cases were confirmed by EBUS mycobacterial culture and 13/54 (24.1%) by cytopathology.  33 (61.1%) of the TB cases, had a low to medium pre-test probability score assigned prior to EBUS-TBNA. Amongst EBUS culture-confirmed cases, we found a resistance rate of 10.5% to one or more first line TB drugs, with one case of multi-drug resistant TB.Conclusions: We confirmed the utility of EBUS-TBNA in the diagnosis of intrathoracic tuberculosis in an undifferentiated cohort of patients with mediastinal lymphadenopathy of unknown aetiology and advocate sending samples for mycobacterial culture in all cases in high tuberculosis incidence areas. [ABSTRACT FROM AUTHOR]

Background : Tuberculosis (TB) is common form of communicable disease in India. Abdominal TB is one of the most common yet misdiagnosed forms of extrapulmonary TB. It is missed due to its similarity to other conditions such as Crohn's disease and nonspecific clinical presentation. Methods: Medical records of 317 patients who were diagnosed with abdominal TB from August 2015 to December 2020 were reviewed retrospectively from our prospectively maintained database. Results: Among 317 patients, 167 (52.7%) were male. Median age of presentation was 45 (8–85) years. Luminal involvement was seen in most of the patients (n = 157, 49.5%), followed by peritoneal (n = 63, 19.8%), mixed (n = 42, 13.2%), solid visceral (n = 30, 9.4%), and nodal (n = 25, 7.8%) involvement. Two hundred and sixty-one (82.3%) showed complete response. Seven (2.2%) patients died and 5 (1.6%) patients lost to follow-up. Median duration of treatment was 28 (25–52) weeks. Drug-induced liver injury was identified in 30 (9.5%) patients. Median follow-up duration was 32 (1–70) months. Conclusion: Abdominal TB is quite a diagnostic challenge due its vague clinical symptoms, nonspecific radiological features, and poor sensitivity and specificity of diagnostic tests. Hence, clinicians should have a high index of suspicion to diagnose and treat this treatable yet lethal condition promptly. Most cases respond very well to medical management and a small fraction requires surgical intervention if diagnosed early. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium leprae is a noncultivable mycobacteria, and diagnosis of the disease is based on its clinical and histopathological characteristics and finding the bacteria in skin scrapings and in biopsies taken from the patients. The aim of this study was to shed light on the clinical classification (based on the number of skin lesions) used extensively in the field where patients classified as paucibacillary (PB) were positive on skin smears and histopathology leading to treatment failure and drug resistance. Methods: In this study, we enrolled untreated 62 leprosy patients with 1–5 skin lesions and did a detailed bacterio-histopathological analysis by slit-skin smears (SSSs) and histopathology. Results: Of 62 patients analyzed, 15 patients came out to be multibacillary (MB) and 47 were PB by SSS and histopathology. Conclusion: The findings of the present study showed that the WHO classification of leprosy based on the number of lesions seems to be inappropriate as it considers a number of MB lesions as PB only, thus misleading the treatment strategies. Hence, it is essential that a comprehensive clinicobacteriological assessment of leprosy cases should be done to ensure the appropriate bacillary status and guiding the appropriate treatment strategy.

Background The prevalence of leprosy has drastically reduced globally after the introduction of multidrug therapy. However, it continues to be a major public health challenge in India. The present study was conducted to evaluate the clinical and epidemiological profile of adult leprosy patients attending a tertiary care hospital in eastern India over a period of six months. Methods A retrospective record-based study was carried out to collect clinical and demographic data of patients over 18 years of age attending the leprosy clinic of a tertiary care institution in Kolkata, West Bengal, India, from 1st January 2019 to 30th June 2019. The data collected were tabulated and analyzed using appropriate statistical methods. Results 132 adult leprosy patients attended the clinic during the study period. Most of them were between 31-45 years of age, with a predominance of male patients (68.2%) and patients from an urban background (62.9%). A high prevalence (87.1%) of multibacillary leprosy was noted and the commonest type was borderline tuberculoid (66.7%). Prevalence of borderline lepromatous and lepromatous leprosy showed a rising trend above 45 years of age. 22% patients presented with disabilities, with significant predilection for older age groups, multibacillary disease and towards the lepromatous spectrum (P = 0.0042, 0.0424 and < 0.0001 respectively). Lepra reactions were noted in 13.6% patients at presentation. Conclusion Our findings highlight the need for implementation of sustained effective measures for early diagnosis and treatment of leprosy in order to prevent disabilities, while improving awareness to ensure appropriate health seeking behavior. [ABSTRACT FROM AUTHOR]

Background: At present, the WHO recommends fixed duration multidrug therapy (FD-MDT) for the treatment of leprosy, in which treatment is provided for a fixed duration regardless of clearance of skin lesions or bacterial status of the patient. There is divided opinion regarding the efficacy of FD-MDT; especially for paucibacillary Hansen's disease, in which treatment is provided for 6 months. In addition, there is a paucity of literature on clinical and histopathological features of treated leprosy. Objectives: The objectives of this study were to prospectively observe the effects of MDT on clinical and histopathological features in paucibacillary leprosy and to assess the efficacy, safety and tolerability of MDT-paucibacillary (PB) regimen. Materials and Methods: A total of 52 new cases of PB leprosy diagnosed by clinicopathological correlation and slit skin smear were administered standard WHO PB-MDT for 6 months. Patients were reviewed at 3rd month and 6th month of therapy and 3 months posttherapy for their clinical and histopathological assessment. Results: Among 52 new cases of PB-leprosy 43 patients (mean age 31.74 ± 12.2 years, m:f 1.53:1) completed the study as per protocol. Fourteen percent patients recovered completely, 76.7% patients had a residual patch at the end. Number of lesions reduced significantly 2nd follow-up onwards while the lesional size showed significant decrease 1st follow-up onward. Nerve palpability also reduced significantly at treatment completion. Histological improvement was appreciable; lymphocytic infiltration reduced significantly 2nd follow-up onward and presence of granuloma 1st FU onward. Only four patients complained of occasional, uneventful epigastric pain during the study. Conclusion: Although the frequency of persistence of lesions after completion of therapy was high, histological evidence of activity was present in a minority (7%). Thus, the standard WHO MDT-PB regimen was found to be effective, safe and well-tolerated.

• A novel TB diagnostic model containing TB DNA targeted NGS and machine learning. • This diagnostic model provides greater detection sensitivity for paucibacillary TB. • Plasma cfDNA is an appropriate sample type for TBM diagnosis. Existing diagnostic approaches for paucibacillary tuberculosis (TB) are limited by the low sensitivity of testing methods and difficulty in obtaining suitable samples. An ultrasensitive TB diagnostic strategy was established, integrating efficient and specific TB targeted next-generation sequencing and machine learning models, and validated in clinical cohorts to test plasma cfDNA, cerebrospinal fluid (CSF) DNA collected from tuberculous meningitis (TBM) and pediatric pulmonary TB (PPTB) patients. In the detection of 227 samples, application of the specific thresholds of CSF DNA (AUC = 0.974) and plasma cfDNA (AUC = 0.908) yielded sensitivity of 97.01 % and the specificity of 95.65 % in CSF samples and sensitivity of 82.61 % and specificity of 86.36 % in plasma samples, respectively. In the analysis of 44 paired samples from TBM patients, our strategy had a high concordance of 90.91 % (40/44) in plasma cfDNA and CSF DNA with both sensitivity of 95.45 % (42/44). In the PPTB patient, the sensitivity of the TB diagnostic strategy yielded higher sensitivity on plasma specimen than Xpert assay on gastric lavage (28.57 % VS. 15.38 %). Our TB diagnostic strategy provides greater detection sensitivity for paucibacillary TB, while plasma cfDNA as an easily collected specimen, could be an appropriate sample type for PTB and TBM diagnosis. [ABSTRACT FROM AUTHOR]

Vitamin D, together with its nuclear receptor (VDR), plays an important role in modulating the immune response, decreasing the inflammatory process. Some polymorphisms of the VDR gene, such as BsmI (G>A rs1544410), ApaI (G>T rs7975232), and TaqI (T>C rs731236) could affect its stability and mRNA transcription activity, while FokI T>C (rs2228570) gives a truncated protein with three fewer amino acids and more efficiency in binding vitamin D. This study evaluated these four polymorphisms in the immunopathogenesis of leprosy in 404 patients and 432 control individuals without chronic or infectious disease in southern Brazil. When analyzing differences in the allele and genotype frequency of polymorphisms between patients (leprosy per se, multibacillary, and paucibacillary clinical forms) and controls, we found no statistically significant association. Regarding haplotype analysis, the bAt haplotype was associated with protection from leprosy per se (P = 0.004, OR = 0.34, CI = 0.16–0.71) and from the multibacillary clinical form (P = 0.005, OR = 0.30, CI = 0.13–0.70). In individuals aged 40 or more years, this haplotype has also showed protection against leprosy per se and multibacillary (OR = 0.26, CI = 0.09–0.76; OR = 0.26, CI = 0.07–0.78, respectively), while the BAt haplotype was a risk factor for leprosy per se in the same age group (OR = 1.34, CI = 1.04–1.73). In conclusion, despite having found no associations between the VDR gene polymorphisms with the development of leprosy, the haplotypes formed by the BsmI, ApaI, and TaqI polymorphisms were associated with leprosy per se and the multibacillary clinical form.

Vitamin D, together with its nuclear receptor (VDR), plays an important role in modulating the immune response, decreasing the inflammatory process. Some polymorphisms of the VDR gene, such as Bsm I (G>A rs1544410) , Apa I (G>T rs7975232), and Taq I (T>C rs731236) could affect its stability and mRNA transcription activity, while Fok I T>C (rs2228570) gives a truncated protein with three fewer amino acids and more efficiency in binding vitamin D. This study evaluated these four polymorphisms in the immunopathogenesis of leprosy in 404 patients and 432 control individuals without chronic or infectious disease in southern Brazil. When analyzing differences in the allele and genotype frequency of polymorphisms between patients (leprosy per se , multibacillary, and paucibacillary clinical forms) and controls, we found no statistically significant association. Regarding haplotype analysis, the bAt haplotype was associated with protection from leprosy per se (P = 0.004, OR = 0.34, CI = 0.16–0.71) and from the multibacillary clinical form (P = 0.005, OR = 0.30, CI = 0.13–0.70). In individuals aged 40 or more years, this haplotype has also showed protection against leprosy per se and multibacillary (OR = 0.26, CI = 0.09–0.76; OR = 0.26, CI = 0.07–0.78, respectively), while the BAt haplotype was a risk factor for leprosy per se in the same age group (OR = 1.34, CI = 1.04–1.73). In conclusion, despite having found no associations between the VDR gene polymorphisms with the development of leprosy, the haplotypes formed by the Bsm I, Apa I, and Taq I polymorphisms were associated with leprosy per se and the multibacillary clinical form. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the diagnostic performance of Xpert MTB/RIF Ultra (Xpert Ultra) in comparison to Xpert MTB/RIF (Xpert) for the detection of paucibacillary tuberculosis (TB).Methods: Smear-negative sputum, pleural fluid and cerebrospinal fluid (CSF) were collected from TB suspects at Beijing Chest Hospital (Beijing, China) and were examined using smear, Xpert and culture. Xpert Ultra was tested using specimens stored at -80 °C. Drug susceptibility testing (DST) was conducted for all of the isolates recovered. The performances of Xpert Ultra and Xpert were evaluated using composite reference standard (CRS) as gold standard, which included clinical, laboratory, histopathological, radiological and follow-up features.Results: Totally 689 cases were included. The direct head-to-head diagnostic performance comparison showed higher sensitivity of Xpert Ultra in contrast with Xpert among 292 smear-negative pulmonary TB (PTB) (70.89% vs 57.88%, P = 0.001), 108 tuberculous pleurisy (61.11% vs 34.26%, P<0.001), and 43 tuberculous meningitis (44.19% vs 18.60%, P = 0.011). The percentage of definite PTB, tuberculous pleurisy and tuberculous meningitis increased from 67.12% to 78.77%, 61.11% to 69.44% and 23.26% to 51.16%, respectively after integrating Xpert Ultra outcomes. The specificity of Xpert Ultra and Xpert was 96.75% (238/246) and 98.37% (242/246), respectively. Xpert Ultra and Xpert performed similarly in detecting rifampicin resistance.Conclusion: Xpert Ultra has higher sensitivity but relatively reduced specificity compared with Xpert in diagnosis of paucibacillary TB. Performing Xpert Ultra would improve the definite diagnosis of smear-negative pulmonary tuberculosis, tuberculous pleurisy and tuberculous meningitis. [ABSTRACT FROM AUTHOR]

Background: Mycobacterium leprae is a noncultivable mycobacteria, and diagnosis of the disease is based on its clinical and histopathological characteristics and finding the bacteria in skin scrapings and in biopsies taken from the patients. The aim of this study was to shed light on the clinical classification (based on the number of skin lesions) used extensively in the field where patients classified as paucibacillary (PB) were positive on skin smears and histopathology leading to treatment failure and drug resistance. Methods: In this study, we enrolled untreated 62 leprosy patients with 1–5 skin lesions and did a detailed bacterio-histopathological analysis by slit-skin smears (SSSs) and histopathology. Results: Of 62 patients analyzed, 15 patients came out to be multibacillary (MB) and 47 were PB by SSS and histopathology. Conclusion: The findings of the present study showed that the WHO classification of leprosy based on the number of lesions seems to be inappropriate as it considers a number of MB lesions as PB only, thus misleading the treatment strategies. Hence, it is essential that a comprehensive clinicobacteriological assessment of leprosy cases should be done to ensure the appropriate bacillary status and guiding the appropriate treatment strategy. [ABSTRACT FROM AUTHOR]

Background: 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). Aims: To compare BIS with BIG on skin biopsy in consecutive untreated cases of leprosy. Materials and Methods: 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. Results: The BIG was positive in all cases where the BIS was positive. Significantly, BIG was positive in three cases of borderline tuberculoid leprosy with

Objectives: To evaluate the diagnostic value of targeted next generation sequencing (tNGS) in childhood tuberculosis (TB) and compare the accuracy with Xpert MTB/RIF method., Methods: Children aged ≤18 years with symptoms suggestive of TB during July 2021 to December 2022 at Beijing Children's Hospital were included, and the performances of tNGS and Xpert were evaluated., Results: A total of 103 children with suspected TB were recruited, including 72 discharge diagnosis of TB and 31 non-TB cases. The mean age was 7.37 ± 4.77 years, and 62.1 % were male. The most common type of specimens was gastric aspirate (GA) (59, 57.3 %). Among all the 72 TB patients, tNGS showed higher sensitivity than Xpert, but the difference was not significant (34.7 %, 25/72 vs 20.8 %, 15/72; P  = 0.063). The specificities of tNGS and Xpert were 87.1 % (27/31) and 96.8 % (30/31), respectively ( P  = 0.162). Among different types of specimen, the highest sensitivity of tNGS on sputum and pus was observed (80.0 %, 4/5), followed by pleural effusion (50.0 %, 2/4). One rifampin resistance and one protionamide resistance were detected in bacteriologically confirmed TB by tNGS., Conclusion: tNGS had a higher sensitivity but lower specificity compared to Xpert in diagnosis of children TB. tNGS yielded higher sensitivity than Xpert on gastric aspirate and sputum and pus., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: At present, the WHO recommends fixed duration multidrug therapy (FD-MDT) for the treatment of leprosy, in which treatment is provided for a fixed duration regardless of clearance of skin lesions or bacterial status of the patient. There is divided opinion regarding the efficacy of FD-MDT; especially for paucibacillary Hansen's disease, in which treatment is provided for 6 months. In addition, there is a paucity of literature on clinical and histopathological features of treated leprosy. Objectives: The objectives of this study were to prospectively observe the effects of MDT on clinical and histopathological features in paucibacillary leprosy and to assess the efficacy, safety and tolerability of MDT-paucibacillary (PB) regimen. Materials and Methods: A total of 52 new cases of PB leprosy diagnosed by clinicopathological correlation and slit skin smear were administered standard WHO PB-MDT for 6 months. Patients were reviewed at 3rd month and 6th month of therapy and 3 months posttherapy for their clinical and histopathological assessment. Results: Among 52 new cases of PB-leprosy 43 patients (mean age 31.74 ± 12.2 years, m:f 1.53:1) completed the study as per protocol. Fourteen percent patients recovered completely, 76.7% patients had a residual patch at the end. Number of lesions reduced significantly 2nd follow-up onwards while the lesional size showed significant decrease 1st follow-up onward. Nerve palpability also reduced significantly at treatment completion. Histological improvement was appreciable; lymphocytic infiltration reduced significantly 2nd follow-up onward and presence of granuloma 1st FU onward. Only four patients complained of occasional, uneventful epigastric pain during the study. Conclusion: Although the frequency of persistence of lesions after completion of therapy was high, histological evidence of activity was present in a minority (7%). Thus, the standard WHO MDT-PB regimen was found to be effective, safe and well-tolerated. [ABSTRACT FROM AUTHOR]

The present study analysed the concordance among four different molecular diagnostic methods for tuberculosis (TB) in pulmonary and blood samples from immunocompromised patients. A total of 165 blood and 194 sputum samples were collected from 181 human immunodeficiency virus (HIV)-infected patients with upper respiratory complaints, regardless of suspicious for TB. The samples were submitted for smear microscopy, culture and molecular tests: a laboratory-developed conventional polymerase chain reaction (PCR) and real-time quantitative PCR (qPCR) and the Gen-Probe and Detect-TB Ampligenix kits. The samples were handled blindly by all the technicians involved, from sample processing to results analysis. For sputum, the sensitivity and specificity were 100% and 96.7% for qPCR, 81.8% and 94.5% for Gen-Probe and 100% and 66.3% for Detect-TB, respectively. qPCR presented the best concordance with sputum culture [kappa (k) = 0.864)], followed by Gen-Probe (k = 0.682). For blood samples, qPCR showed 100% sensitivity and 92.3% specificity, with a substantial correlation with sputum culture (k = 0.754) and with the qPCR results obtained from sputum of the corresponding patient (k = 0.630). Conventional PCR demonstrated the worst results for sputa and blood, with a sensitivity of 100% vs. 88.9% and a specificity of 46.3% vs. 32%, respectively. Commercial or laboratory-developed molecular assays can overcome the difficulties in the diagnosis of TB in paucibacillary patients using conventional methods available in most laboratories.

Leprosy has been considered a curable disease after the implementation of multidrug therapy (MDT), which has been proven to be safe and effective, by bringing about a significant change in the global and national scenario of leprosy by upgrading the control of leprosy to the next stage of eradication. Since its introduction, the MDT regimens for the treatment of leprosy have undergone several changes especially with regard to the duration of treatment. The advantages of shortened duration of treatment need to be balanced against the risk of relapse and a lot of controversies exist pertaining to this aspect. The fixed-duration (FD) therapy is not popular among academicians and private practitioners who prefer precise diagnosis and treatment with superior MDT regimens and for a longer duration. On the contrary, from a public health-care point of view, precise diagnosis and a longer treatment schedule are not cost effective and not feasible to be implemented in elimination programs. Hence, a fine balance needs to be maintained between achieving a cure for the patient and protecting the society at risk, and this review discusses the various limitations and opportunities of FD therapy with a note on the newer MDT regimens.

Introduction The number of leprosy patients is increasing in Nepal even after declaration of elimination in 2010. The objective of this study was to review the status of leprosy after declaration of elimination in Nepal and to identify challenges to sustain elimination. Methods This was retrospective study conducted by reviewing the annual data published by Department of Health Services, Ministry of Health, Government of Nepal from 2010 through 2018. In addition, one year hospital based data (2017/18) was retrieved from records of Department of Dermatology and Venereology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results The prevalence of leprosy was found to be 0.77/10,000 population in 2010 and 0.99/10,000 in 2018. The numbers of multibacillary (MB) cases (remained more than 50%) outnumbered paucibacillary (PB) cases throughout eight years. Conclusion The prevalence of leprosy is gradually increasing in Nepal with more number of multibacillary cases detected in post-elimination era. [ABSTRACT FROM AUTHOR]

El desconocimiento de la lepra es común en la población general al igual que entre los médicos y el personal de la salud. Se cree que esta enfermedad ya no existe; tal vez su imagen bíblica y milenaria refuerce la idea de su eliminación. Sin embargo, la lepra continúa siendo un problema de salud pública en varios países; entre los más afectados están India y Brasil. Después del inicio de la poliquimioterapia (PQT) en la novena década del siglo XX la prevalencia de la lepra disminuyó considerablemente pero no ocurrió lo mismo con la incidencia, lo que se atribuye al poco impacto de dicho tratamiento sobre el control de la transmisión y a la existencia de un reservorio aún no identificado con exactitud. Los convivientes de los leprosos tienen alto riesgo de sufrir la enfermedad en cualquier momento de la vida, pero hasta ahora no se ha podido determinar cuáles convivientes infectados desarrollarán la enfermedad. En Colombia se informan de 400 a 550 casos de lepra cada año, lo cual sugiere que la transmisión del Mycobacterium leprae continúa a pesar de que el país está considerado en la fase de poseliminación.Este artículo presenta una revisión histórica de la lepra desde los primeros informes disponibles hasta los avances moleculares más recientes. Incluye cómo ha evolucionado la comprensión de la enfermedad, su caracterización clínica, las medidas de control y saneamiento, el tratamiento y la epidemiología.

Background: 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. Aim: 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. Materials and Methods: 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. Results: 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. Conclusion: 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.