Leprosy Mailing List – July 9, 2014
Ref.: (LML) Staining of M. leprae versus M. tuberculosis and decolorized with hydrochloric acid
From: Ben Naafs,
Dear dr Schreuder,
I like to share an important supportive finding confirming and reinforcing dr Jaison Barreto’s remark on the staining of M. leprae.
Like each year I teach at the Regional Dermatology Training Centre (RDTC) in Moshi Tanzania, which is a WHO reference center for leprosy. We train Dermatology residents and students in an Advanced Diploma in Dermatology and Venereology (ADDV) in African Dermatology, STD and leprosy.
Case report:
A 65 years old man visited the center because he was diagnosed with a positive skin smear in a former leprosarium where the old laboratory technician did a skin smear and found him to be 2+ positive. Since the knowledge on clinical leprosy, even in an endemic country like Tanzania, is disappearing, the Health Officer searched for conformation at the RDTC. There the attending clinician thought it could be leprosy and wanted this confirmed with a smear. The local facilities were out of order and he asked the International TB research center to do the staining and got the results back. Smear negative.
I was asked to see the patient: Clinically clearly a subpolar leprosy patient. I asked again a smear and checked the way the staining was done. The TB technician coming from and trained in a western country decolorized with 3% hydrochloric acid like for M.TB, instead of 1% hydrochloric acid for a short time for M. leprae. The repeated smear, now with only 1% gave a BI: 4, showing that the smear for leprosy should be different from that for tuberculosis. It is well possible that since the interest in leprosy following the proclaimed elimination of this disease is diminished, many leprosy patients have erroneously been misclassified or misdiagnosed.
With regards,
dr Ben Naafs
LML - S Deepak, B Naafs, S Noto and P Schreuder
LML blog link: http://leprosymailinglist.blogspot.it/
Contact: Dr Pieter Schreuder << editorlml@gmail.com
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