Background: Leprosy usually remains underdiagnosed or over-diagnosed due to a high dependency on clinical expertise. Leprosy requires a simple easy-to-perform laboratory test that guides clinicians to come to a conclusion with clinical correlation. Punch biopsy is the gold standard but it requires a biopsy facility in a hospital setting. Molecular diagnosis is out of reach even in resource-rich setups due to the non-availability of commercial kits. In this context slit-skin smear (SSS) might be an easier alternative to guide clinicians for a quality diagnosis, especially in peripheral hospitals.
Aims and Objectives: To determine diagnostic sensitivity and specificity of SSS with respect to punch biopsy.
Materials and Methods: The present study is an observational cross-sectional study conducted in a teaching institute in peripheral West Bengal. Two samples from clinically suspected patients of leprosy were collected for SSS and punch biopsy. Tests were performed as per standard laboratory protocol. Positive cases were informed to the clinician and treated as per World Health Organization treatment guidelines. SSS was compared to a punch biopsy with respect to sensitivity, specificity, positive predictive value, and negative predictive value.
Results: Twenty-five among 59 clinically suspected cases were positive by either two tests or only one test. Twenty-one were males and four were female. Thirty-six was the median age distribution in positive cases 19 cases were positive by both SSS and punch biopsy, five by punch biopsy only, and one by SSS only. Sensitivity and specificity were 79.17% and 97.14%, respectively.
Conclusion: SSS is not inferior to punch biopsy even in paucibacillary cases. It is a simple easy-to-perform test but requires training and awareness in medical personnel to make it a front-line weapon to combat continuous leprosy transmission in the community.
Key words: Leprosy; Slit-skin Smear; Punch Biopsy; Positivity
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