Out of 116 cases, slitskin smears were available for 43 cases and were positive in 23 cases. Mycobacterial cell walls contain a waxy substance composed of mycolic acids. The sensitivity detection of acid fast bacilli remains poor because it requires about. Leprosy, or hansens disease, is an infectious disease caused by mycobacterium leprae m. When lepra was suspected, a dna extract was sent to the fontilles sanatorium, where dna from m. Lepromatous leprosy associated with erythema nodosum. The appropriate ness of this name is denied by wade, as will be seen. The histiocytes show epithelioid cell changes, epitheloid cell. Principle mycobacterial cell walls contain a waxy substance composed of mycolic acids. Skinbiopsies from all patients clinically suspected as leprosy were studied to confirm the diagnosis, histopathologically, and to know bacillary load by fite. Fiftysix skin biopsies were obtained from patients having leprosy, particularly the paucibacillary type. Correlation between clinical, bacteriological, and morphological features is required for accurate classification of hansens disease. Sixteenyearold boy from nigeria with a rash journal of. Kinyoun stain kinyoun stain is a method of staining acid fast microorganisms, specifically mycobacterium and nocardia and cryptosporidium oocyst.
S100 is an acidic calciumbinding protein present in the schwann cells of nerves. Changes in the skin may include nodules, hypopigmented macules, sores, and skin thickening. Author summary leprosy is one of the oldest reported infectious diseases in the history of humanity, with a remarkably high rate of active transmission still reported annually, but mainly in resourcelimited endemic countries. It is responsible for extensive morbidity and often poses a diagnostic challenge. This study aims to highlight the clinicopathological features of hansens neuritis hn. Melkerssonrosenthal syndrome should be considered in all cases of isolated eyelid edema and a diagnostic. Pdf fitefaraco staining in combination with multiplex. Leprosy is a chronic infectious disease caused by mycobacterium leprae m. The mode of transmission is postulated to be through respiratory droplets and nasal secretions. Fitefaraco staining in combination with multiplex polymerase chain reaction. Fitefaraco staining protocol for leprosy bacilli staining. No acidfast organisms in sections of skin biopsy were seen ziehlneelson and fitefaraco stained methods. Ellis and zabrowarny stain fite faroco stain wade fite stain modified bleach zn method coopers modifications 5.
Detection of mycobacterium leprae in formalinfixed paraffinembedded sample by fite faraco staining and polymerase chain reaction. The authors studied 66 wild ninebanded armadillos from brazil. Detection of mycobacterium leprae in formalinfixed. Original research article histopathological study of. Histology special stain methods, techniques, protocols. Fite faraco staining is a histochemical staining procedure with ziehl nielsen carbol fuchsin solution to a microscopic slide prepared with a peanut oil.
The patient was treated with dapsone, rifampin, and clofazimine under the guidance of the national. The patients left earlobe was thickened and anesthetic. Satellite erythematous papules were observed on her neck. However, the absence of palpable lymph nodes, loss of distal. Role of fluorescent microscopy in detecting mycobacterium. Detection of mycobacterium leprae in tissue sections using auramine o fluorescent stain versus modified fitefaraco. In this report, we want to know whether the fite faraco technique has same accuracy with pcr technique for detecting afb in ffpe block. In this retrospective study, cases of histologically diagnosed hn. Leprosy presenting as remitting seronegative symmetrical. Lepromatous leprosy associated with erythema nodosum leprosum.
Positivity rates and mean bacteriological index with fluorescent stain was higher 43. Detection of mycobacterium leprae in formalinfixed paraffinembedded sample by fitefaraco staining and polymerase chain reaction willy sandhika, dinar adriaty, indropo agusni pages 231236. The fite faraco technique for detection of mycobacteria was negative. The primary tool for leprosy transmission prevention is diagnosing the disease at an early stage. Fite faraco technique for afb detection still has a place for simple method detection of afb10. The culture on lowenstein medium at 30c showed creamy, nonpigmented colonies of afb, identified as m. A 52 yearold man presented with a 10year history of scaly lesions on the elbows.
The majority of cases came from usa 8, columbia 3, nigeria 3, brazil 3, congo 2, panama 2, india 2and philippines 1. Pdf utility of fitefaraco stain for both mast cell count. Fitefaraco staining in combination with multiplex polymerase. Fite faraco staining for tissue sections sections were deparaffinized with two changes of 12 min each of xylenepeanut oil and stained in carbol fuchsin stain for 30 min, washed in running tap water, decolorized by 5% h 2 so 4 differentiated in 25% ethanol followed by washing again under running tap water. The fitefaraco technique for detection of mycobacteria was negative. The patient was treated with clarithromycin, in doses of 500 mg each 12 h for 5 months. Ziehlneesen or fitefaraco acidfast staining of the ocular tissues was used and pcr and immunofluorescence were not used. Ziehlneelsen stains may be negative, and fite faraco is the best method to identify it. Visualization of invading organisms into the peripheral nerves is pathognomonic for an m. Remember there is a purely neural presentation in which cutaneous skin lesions of leprosy are not present see chapter 2. A new approach to leprosy diagnosis abu hena hasanoor reja 1, nibir biswas 2, supratik biswas 1, sarbani dasgupta 3, imran hussain chowdhury 1, surajita banerjee 4, tapas chakraborty 5, pijush kumar dutta 6, basudev bhattacharya 1 1 department of biochemistry, institute of post graduate medical education and. Detection of mycobacterium leprae in formalinfixed paraffinembedded sample by fitefaraco staining and polymerase chain reaction by willy sandhika, dinar adriaty and indropo agusni download.
Differential diagnosis of leprosy international textbook. Acidfastness is a physical property of certain bacterial and eukaryotic cells, as well as some subcellular structures, specifically their resistance to decolorization by acids during laboratory staining procedures. With histopathological examination, leprosy presents as granulomatous inflammation that may mimic other granulomatous diseases including tuberculosis, sarcoidosis, leishmaniasis, and subcutaneous fungal infections. Discussion the results show that fluorescence mi croscopy is less advantageous than the fite faraco technic for finding leprosy bacilli in tissue sections, the positivity being 33. These granules were spherical, and stained somewhat paler red than the acidfast myco. Diagnosis of hn depends on astute search for skin lesions, nerve thickening or tenderness, sensory or motor symptoms, histopathological examination, and demonstration of lepra bacilli. The method is simple, cheap and at no high cost requirement yet the weakness is being less sensitive. Follow same guidelines as the kinyouins carbol fuchsin for best results. To compare the efficacy of auramine rhodamine stain with ziehlneelsen and modified fite. In the present study out of 80 cases of leprosy, stained with fitefaraco stain 29 i.
Detection of mycobacterium leprae in formalinfixed paraffinembedded sample by fitefaraco staining and polymerase chain reaction. Pdf utility of fitefaraco stain for both mast cell. Once stained as part of a sample, these organisms can resist the acid andor ethanolbased decolorization procedures common in. Unusual presentation of multibacillary nodular leprosy. Numerous mycobacteria, some forming globi fitefaraco x100 erythroderma as a manifestation of leprosy 91 an bras dermatol. Fitefaraco for mycobacterium leprae, gomorimethenamine silver for fungi, and brownhopps for bacteria. Science and education publishing is an academic publisher of open access journals. Fitefaraco staining is a histochemical staining procedure with ziehl nielsen carbol fuchsin solution to a microscopic slide prepared with a peanut oil. Prepared by roy ellis imvs division of pathology the queen elizabeth hospital woodville road, woodville, south australia 5011 novaultra special stain kits principle. A 31yearold indian man presented with drooping of the right eyelid since 1 month, slight deviation of the angle of the mouth to the right since 20 days, difficulty in swallowing initially with regard to solids, and later on with regard to liquids since 15 days, nasal regurgitation since 15 days and a nasal twang since 15 days. Known to afflict humanity since 600 years bc, it is a noncultivable, obligate intracellular, weakly acid fast pathogen.
Physical examination found sharply marginated, pinkishbrown, verrucous plaques on the bilateral extensor elbows fig 1. Pdf detection of mycobacterium leprae in formalinfixed. Once stained as part of a sample, these organisms can resist the acid andor ethanolbased decolorization procedures common in many staining protocols, hence the name acidfast. However, this is challenging in resourcelimited diseaseendemic. Tuberculoid leprosy and type 1 lepra reaction sciencedirect. Download the pdf to view the article, as well as its associated figures and tables. The patient was diagnosed with paucibacillary leprosy and treatment with rifampin 600 mg month and dapsone 100 mg day was prescribed for 6. Differential diagnosis of leprosy international textbook of. Histopathological examination of skin lesion is the gold standard for diagnosis. The principle of protecting the acidfastness of the organisms.
Aug 21, 20 article in pdf 6,257 kb this prospective study evaluates the ability of fite faraco staining ff staining and multiplex keywords. Aug 21, 20 article in pdf 6,257 kb this prospective study evaluates the ability of fitefaraco staining ff staining and multiplex keywords. Fite faraco staining in combination with multiplex polymerase chain reaction. Hansens neuritis revisited a clinicopathological study. The ziehlneelsen, fitefaraco, periodic acid schiff pas and pasdiastase stainings were negative. Abstract george liddle fite, md, a senior editor of jama from early 1965 until late 1974 and a developer of the fitefaraco stain for demonstrating lepra. Ziehlneesen or fite faraco acidfast staining of the ocular tissues was used and pcr and immunofluorescence were not used. Clinicohistological correlation in hansens disease. He denied prior evaluation or treatment of these areas. Lepromatous leprosy hansens disease the diagnosis of lepromatous leprosy hansens disease was confirmed on the basis of the histological appearance of numerous bacilli on fitefaraco staining figure 4 and the invasion of histiocytes into peripheral nerves figure 3. A ziehlneelsen stain and harada modified allochrome method also may be used.
Methodologyprincipal findings in this comparative study, the performance of the fluorescent auramine o ao staining and polymerase chain reaction pcr was assessed with different skin samples using. Mar 01, 2012 because these mycobacteria are only partially acidfast, a modified acidfast bacilli staining method known as fite faraco, which uses peanut oil, is necessary to identify organisms under direct microscopy figure 4. We evaluated the possible role of fluorescent microscopy in this direction which is increasingly used for rapid screening. It also publishes academic books and conference proceedings. In the case of an elderly patient presenting with weight loss and deckchair sign, the main hypothesis was cutaneous lymphoma. Leprosy affecting the nerve solely or with concomitant skin lesions is not an uncommon condition in clinical practice. Hansen disease, also known as leprosy, is a chronic inflammatory disease caused by mycobacterium leprae and mycobacterium lepromatosis.
Evaluation of fluorescent staining for diagnosis of. Acidfast bacilli, fitefaraco staining, hematoxylin and eosin staining, multiplex ing to improve this technique, fite, cambre and turner 4 hit upon a method which lillie 6 calls the fitefaraco. Evaluation of fluorescent staining for diagnosis of leprosy. The identification of mycobacteria in tissue sections can be made through a microscopic examination with fitefaraco staining or pcr method. Abstract george liddle fite, md, a senior editor of jama from early 1965 until late 1974 and a developer of the fitefaraco stain for demonstrating lepra bacilli in paraffin sections, is dead at the age of 89 years. We compared the sensitivity of the fluorescent method with that of he modified fitefaraco method in the detection of mycobacterium leprae in tissue sections.
Per the stains file there are several variations of fite, like fitefaraco staining and wade fite staining which mainly differ in the dewaxing. The property of acid fastness is related to the carbon chain length of the mycolic acid found in any particular species lyon h 1991. Detection of mycobacterium leprae in formalinfixed paraffinembedded sample by fite faraco staining and polymerase chain reaction willy sandhika, dinar adriaty, indropo agusni pages 231236. Large infiltrated erythematous and scaly plaque on the. Utility of fitefaraco stain for both mast cell count and bacillary index in skin biopsies of leprosy patients article pdf available in indian journal of leprosy 843. Light polarization for foreign bodies was also performed. Detection of mycobacterium leprae in formalinfixed paraffin. Evaluation of auramine o staining and conventional pcr for. Histologically, foamy or undifferentiated macrophages predominate the field.
His past history was not significant, with no history of fever. A type iii hypersensitivity reaction may occur, resulting in. Does a biopsy of such sites show the presence of the mycobacteria with fite faraco stain, especially in the nerves and arrector pilaris muscles, and a distinctive histologic distribution of the granulomatous infiltrate. A physical examination revealed a gross infiltrated erythematous and scaly plaque with poorly defined edges that measured 18 cm in diameter.
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