Contribution of nasal biopsy to leprosy diagnosis.
BACKGROUND
The nasal mucosa plays the main role as the entry and the exit of leprosy bacilli and the nasal involvement may precede the skin lesions by several years. Nasal biopsy has been used in research but its clinical application has not been described. We evaluated the contribution of the nasal biopsy for the diagnosis of leprosy and its correlation to skin biopsy and skin smear in untreated patients.


METHODS
We evaluated changes in nasal biopsy in 227 leprosy patients. Patients were clinically classified and skin and nasal biopsies and skin smear were performed.


RESULTS
Nasal biopsy showed positivity in 100% of the lepromatous spectrum decreasing toward the tuberculoid (TT) pole. Patients with TT or indeterminate forms did not present any nasal alterations, showing that they are the true paucibacillary forms. Also, the nasal biopsies of two patients were the only exam to show positivity. The bacillary index of the nasal biopsy was strongly correlated to skin biopsy and slit-skin smear. Additionally, the agreement among the exams was good, revealing the reliability of the nasal biopsy in leprosy diagnosis.


CONCLUSIONS
The present study showed a rate of 48% of positivity in nasal biopsy of untreated patients, correlating well with skin biopsy and skin smear. Thus, the method in leprosy diagnosis and clinical form classification has shown great reliability.
Melo Naves
Marcell
M
Division of Otorhinolaryngology, National Reference Center for Sanitary Dermatology and Leprosy, Clinical Hospital, Faculty of Medicine, Federal University of Uberlândia, Minas Gerais, Brazil.
Gomes Patrocinio
Lucas
L
Patrocinio
José Antonio
JA
Naves Mota
Flávia Marques
FM
Diniz de Souza
Antônio
A
Negrão Fleury
Raul
R
Bernardes Goulart
Isabela Maria
IM
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D018450:Disease Progression; D042241:Early Diagnosis; D006801:Humans; D007918:Leprosy / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology*; D008875:Middle Aged; D009166:Mycobacterium leprae; D009297:Nasal Mucosa / Q000382:microbiology / Q000473:pathology*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D012867:Skin / Q000382:microbiology / Q000473:pathology*