Analytical Study of Histopathological and Haematological Analysis with Epidemiological Evidences Among Type-I and Type-II Lepra Reactions

Abstract

Introduction: Leprosy is still a burden to India, even though it is under control but still it persists due to decreased level of immune defense mechanism against the infection. Immune mechanism plays a vital role in treatment and in producing some adverse lepra reactions. So it is indeed to analyse the lepra reaction using varying parameter such as histopathological and haematological examination which pave a way for early detection and control of disease in future. Aim: To study the histopathological pattern among patients of leprosy patients with lepra reactions and to compare the histopathological, hematological and epidemiological variation among the patients of type-I and type-II lepra reactions. Materials and Methods: This study was proposed and conducted in the Chengalpattu Medical College Hospital and Central Leprosy Teaching and Research Institute (CLTRI). A retrospective study of clinico-pathological analysis of 30 skin biopsies of patients with lepra reaction visiting a tertiary care centre and CLTRI for three months duration during the year of 2017 was done. The skin biopsies were immediately fixed in 10% formalin and processed routinely. Four microns sections were taken from the tissues and stained with haematoxylin and eosin and findings were recorded. Sections were also stained with special stain using AFB staining for detection of Lepra bacilli which would be very helpful to rule out lepra reactions. Each section was analysed for the presence of histopathological findings of type 1 and type 2 reactions. The results and observations were tabulated and analysed for their significance. Results: Histopathological observations were tested by applying test of significance for statistical significance. It was noted that significant association between presence of neutrophilic infiltration in granuloma was noted in type-II reaction. While lymphocytes in perigranuloma was significantly observed in type-I lepra reactions. Intra-granuloma lymphocytes were significantly higher in type-I lepra reaction. It was also noted that fibrin in granuloma is present in significantly higher number among type-II lepra reactions. Conclusion: The study concludes that significant histopathological features of type-I lepra reactions are Giant cells in granuloma, Perigranuloma lymphocytes in granuloma, Oedema within granuloma, Exocytosis, and parakeratosis in epidermis. The significant histopathological features of type-II lepra reactions are Neutrophil infiltrated granuloma, fibrin in granuloma, fibrin within the vessel wall and intraepidermal pustules.

Keywords

• granuloma
• lymphocyte
• skin biopsy