European Journal of Molecular & Clinical Medicine

Abstract

Background: The bacteriological and morphological status of leprosy patients is assessed by Slit Skin Smear (SSS) method. Bacteriological index (BI) is the semi quantitative index for measuring bacterial load and morphological index (MI) is for assessment of chemotherapeutic efficacy and bacterial resistance.
Aims: To evaluate Bacteriological index and Morphological index on Slit Skin Smear in world health organization (WHO) recommended sites vs other reported hidden sites in untreated and relapsed cases of leprosy.
Methods: 75 patients with biopsy proven leprosy, not on treatment or relapsed cases, irrespective of age, sex and duration of disease were included. Smears were taken from 3 WHO recommended sites (two lesional sites and one ear lobe) and 5 other reported hidden sites (left ear lobe, right hand middle phalynx, right elbow, left eyebrow and left foot great toe).  Slides were stained using Ziehl-Nelson method. BI and MI were evaluated using Ridley's algorithmic scale.
Results: Ear lobes gave uniformly higher values of BI and MI as compared to elbows, fingers and toes. Slit Skin Smear was found to be positive from only peripheral sites in 8 patients. While in 5 cases were positive only from the lesional sites whereas 2 patients out of 75 were positive only from earlobes. Morphological indices were better observed in untreated cases. Ear lobules gave higher morphological index. Maximum number showed bacilli in the lesions and ear lobules followed by toes, elbow, eyebrows and fingers. In 25 out of 75 patients, no bacilli could be seen at any sites.
Conclusion: In a few cases bacilli were seen only in peripheral hidden sites while the WHO recommended sites were negative. Thus, it is important to take SSS from hidden sites.