Leprosy
mailing list – February 20th, 2005
Ccn:
all.
Ref.: slit-skin smear examination
and differential diagnosis of
relapse versus reaction.
From:
P K Das, Amsterdam, The
Netherlands.
Dear Dr Rea,
It is nice to read your
contribution in
Salvatore Noto
’s column (lml Feb. 17th,
2005). Indeed, I had been following the “to and fro
communication” with interest, which happens to be between experts
concerned about the true usefulness of MI and BI in the clinical
decision on the cure and maintenance of leprosy patients.
My understanding (may be, I am
wrong) from these discussions, is that both MI / BI are meant for MB
and not PB patients. In this context your present comments about the
“solid staining” of bacilli in the form of beads (instead of rod
shaped?) is the evidence for relapse (not reaction?).
Regarding the similar concern,
I am pleased to inform you that we have/had been kept busy trying to
sort out the molecular/immune histological parameters for differential
diagnosis of relapse versus reaction by using the methods of combined
immune staining of bacilli specific antigenic determinants and NASBA/other
relevant molecular identification of bacilli specific genomic
components in the lesional biopsies. Although we have/had some
successes (refs: Verhaaagen. C. Am J Pathol 1999,154:1793-1804; van
der Vilet G.M.E. Int. J. Lepr 1996 64:396-403; van den Bos I.C. 1999, Lepr. Rev. 7:, 272-280.), I am not 100% happy to advocate
such approaches for routine PA diagnostic use, since the hard data
concerning the clinical decision is not always available.
After
reading your present short communication in this column I would like
to request you if you can send me the photograph of the histological
slides illustrating your point which could serve as a reference in
establishing our data which can then be discussed with the clinicians.
Please, note that in
Amsterdam
we do not evaluate the skin smear for BI we only perform MI.
Looking
forward to hearing from you,
Kindest
regards,
P.
K. Das
Department
of Pathology
AMC-UvA,
Meibergdreef9
1105AZ
Amsterdam
The
Netherlands
e.mail:
p.k.das@amc.uva.nl.
Fax : +31-(0)20-6960389
