Diagnostic utility of polymerase chain reaction in Hansen’s disease: Correlation with clinical and histopathological findings

Abstract

Background: Leprosy (Hansen’s disease), caused by Mycobacterium leprae, remains a source of morbidity, disability, and stigma despite India achieving elimination as a public health problem in 2005–2006. Early diagnosis is critical for timely treatment and prevention of transmission. Histopathology is a standard diagnostic tool, but may be limited in early or borderline lesions. Polymerase chain reaction (PCR) offers a sensitive molecular method for detecting M. leprae. Aims and Objectives: This study aimed to evaluate PCR’s diagnostic accuracy compared with histopathology and to assess the clinicopathological profile of leprosy cases in a tertiary care centre. Materials and Methods: A prospective comparative study was conducted from January 2021 to December 2022, enrolling 103 clinically diagnosed leprosy patients. Skin punch biopsies were subjected to histopathological examination and PCR analysis. Clinicopathological correlation and agreement between histopathology and PCR were assessed. Results: Most patients were aged 26–35 years, with male predominance. Extremities were the commonest sites of involvement. Clinically, borderline tuberculoid was most frequent, while borderline lepromatous predominated histologically. Overall clinicohistopathological concordance was 89%, highest in lepromatous leprosy. Histopathology and PCR findings were concordant in 89.4% of cases. Combined use of both modalities improved diagnostic accuracy to 95%. Conclusion: PCR is a valuable adjunct to histopathology, particularly in indeterminate and borderline cases where conventional methods may be inconclusive. Integrating PCR with routine evaluation enhances diagnostic accuracy, enabling earlier diagnosis and treatment, thereby reducing disability and stigma associated with Hansen’s disease.