title: Use of fine needle aspirate from peripheral nerves of pure-neural leprosy for cytology and PCR to confirm the diagnosis: a pilot study.
abstract: BACKGROUND
  The diagnosis of pure neural leprosy (PNL) remained subjective because of over-dependence of clinical expertise and a lack of simple yet reliable diagnostic tool. The criteria for diagnosis, proposed by Jardim et al., are not routinely done by clinicians in developing country as it involves invasive nerve biopsy and sophisticated anti-PGL-1 detection. We conducted a study using fine needle aspiration cytology (FNAC) coupled with Ziehl Neelsen staining (ZN staining) and Multiplex-Polymerase Chain Reaction (PCR) specific for M. leprae for an objective diagnosis of pure neural leprosy (PNL), which may be simpler and yet reliable.
  
  
  OBJECTIVE
  The aim of the study is to couple FNAC with ZN staining and multiplex PCR to diagnose pure neural leprosy patients rapidly, in simpler and yet reliable way.
  
  
  METHODS
  Thirteen patients of PNL as diagnosed by two independent consultants were included as case, and 5 patients other than PNL were taken as control in the study. Fine needle aspiration was done on the affected nerve, and aspirates were evaluated for cytology, ZN staining and multiplex-PCR.
  
  
  RESULTS
  Out of the 13 cases where fine needle aspiration was done, M. leprae could be elicited in the nerve tissue aspirates in 5 cases (38.4%) with the help of conventional acid-fast staining and 11 cases (84.6%) with the help of multiplex PCR. On cytological examination of the aspirates, only 3 (23%) cases showed specific epithelioid cells, whereas 8 (61.5%) cases showed non-specific inflammation, and 2 (15.3%) cases had no inflammatory cells.
  
  
  CONCLUSIONS
  Our study demonstrates that in the field of laboratory diagnosis of PNL cases, FNAC in combination with ZN staining for acid-fast bacilli (AFB) and Multiplex-PCR can provide a rapid and definitive diagnosis for the majority of PNL cases. FNAC is a less-invasive, outdoor-based and simpler technique than invasive nerve biopsy procedure. Thus, this study may enlighten the future path for easy and reliable diagnosis of PNL.
authors.affiliation: Department of Dermatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Abu Hena Hasanoor
authors.initials: AH
authors.lastname: Reja
authors.forename: Abhishek
authors.initials: A
authors.lastname: De
authors.forename: Supratik
authors.initials: S
authors.lastname: Biswas
authors.forename: Amitabha
authors.initials: A
authors.lastname: Chattopadhyay
authors.forename: Gobinda
authors.initials: G
authors.lastname: Chatterjee
authors.forename: Basudev
authors.initials: B
authors.lastname: Bhattacharya
authors.forename: Aarti
authors.initials: A
authors.lastname: Sarda
authors.forename: Ishad
authors.initials: I
authors.lastname: Aggarwal
mesh_terms: D000293:Adolescent; D000328:Adult; D044963:Biopsy, Fine-Needle / Q000706:statistics & numerical data; D003581:Cytodiagnosis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015441:Leprosy, Tuberculoid / Q000175:diagnosis* / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000235:genetics* / Q000302:isolation & purification; D010525:Peripheral Nerves / Q000473:pathology*; D010865:Pilot Projects; D016133:Polymerase Chain Reaction / Q000706:statistics & numerical data*; D055815:Young Adult