title: Evaluation of Polymerase Chain Reaction (PCR) with Slit Skin Smear Examination (SSS) to Confirm Clinical Diagnosis of Leprosy in Eastern Nepal.
abstract: Detection of Mycobacterium leprae in slit skin smear (SSS) is a gold standard technique for the leprosy diagnosis. Over recent years, molecular diagnosis by using PCR has been increasingly used as an alternative for its diagnosis due to its higher sensitivity. This study was carried out for comparative evaluation of PCR and SSS microscopy in a cohort of new leprosy cases diagnosed in B. P. Koirala Institute of health Sciences, Dharan, Nepal.
  
  
  
  In this prospective crossectional study, 50 new clinically diagnosed cases of leprosy were included. DNA was extracted from SSS and PCR was carried out to amplify 129 bp sequence of M. leprae repetitive element. Sensitivity of SSS and PCR was 18% and 72% respectively. Improvement of 54% case detection by PCR clearly showed its advantage over SSS. Furthermore, PCR could confirm the leprosy diagnosis in 66% of AFB negative cases indicating its superiority over SSS. In the paucibacillary (PB) patients, whose BI was zero; sensitivity of PCR was 44%, whereas it was 78% in the multibacillary patients.
  
  
  
  Our study showed PCR to be more sensitive than SSS microscopy in diagnosing leprosy. Moreover, it explored the characteristic feature of PCR which detected higher level of early stage(PB) cases tested negative by SSS. Being an expensive technique, PCR may not be feasible in all the cases, however, it would be useful in diagnosis of early cases of leprosy as opposed to SSS.
authors.affiliation: Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Shraddha
authors.identifier: 0000-0002-7375-4810
authors.initials: S
authors.lastname: Siwakoti
authors.affiliation: Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Keshav
authors.initials: K
authors.lastname: Rai
authors.affiliation: Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Narayan Raj
authors.initials: NR
authors.lastname: Bhattarai
authors.affiliation: Department of Dermatology and STD, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Sudha
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Microbiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: Basudha
authors.initials: B
authors.lastname: Khanal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003430:Cross-Sectional Studies; D004269:DNA, Bacterial / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007918:Leprosy / Q000175:diagnosis*; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009166:Mycobacterium leprae / Q000302:isolation & purification*; D009390:Nepal; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012867:Skin / Q000382:microbiology*; D055815:Young Adult
chemical_list: D004269:DNA, Bacterial