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CORRESPONDENCE
Year : 2017  |  Volume : 62  |  Issue : 6  |  Page : 671
Mycobacterium leprae or tuberculosis: A diagnostic dilemma


Clinical Division, Central Health Services, Central Leprosy Teaching and Research Institute, Chengalpattu, Tamil Nadu, India

Date of Web Publication24-Nov-2017

Correspondence Address:
Pugazhenthan Thangaraju
Clinical Division, Central Health Services, Central Leprosy Teaching and Research Institute, Chengalpattu, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_472_17

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How to cite this article:
Thangaraju P, Venkatesan S, Sivashanmugam E, Showkath Ali M K. Mycobacterium leprae or tuberculosis: A diagnostic dilemma. Indian J Dermatol 2017;62:671

How to cite this URL:
Thangaraju P, Venkatesan S, Sivashanmugam E, Showkath Ali M K. Mycobacterium leprae or tuberculosis: A diagnostic dilemma. Indian J Dermatol [serial online] 2017 [cited 2019 Oct 14];62:671. Available from: http://www.e-ijd.org/text.asp?2017/62/6/671/219221




Sir,

With great interest, we read the case report “Dual infection with Mycobacterium tuberculosis (TB) and Mycobacterium leprae at the same site in an immunocompetent patient: An unusual presentation” by Ghosh et al. [1] We certainly moved with the case and praised the authors in bringing the difficulty in diagnosing and managing a case of dual infected mycobacterium cases that need two spectrum of management except for rifampicin.

We have certain queries and clarification that can help us in understanding the case. First, as per the title, we could not be able to understand the term “dual infection at same site” as we could be able to find tubercle bacilli at plantar ulcer and leprae bacilli in skin smear of routine WHO sites and as both were in different area. It is also nicely discussed that the ulcer in the plantar area is the consequence of nerve damage by bacilli.

In the article, there is a mention of two terms “biological indicator and myocardial infarction.” We strongly feel that it is “bacteriological index and morphological index” instead of above-mentioned terminology as it is important, of specific to leprosy, and being an article by Indian dermatology, almost all scientific medical professionals will emphasize in these terminologies.

Regarding diagnosis, we feel it is a case of mid-borderline leprosy instead of a borderline tuberculoid case as the slit skin smear is 5+ with high morphological index.

The diagnosis of cutaneous TB was based on smear, BACTEC culture, and Mantoux positive that could fairly make a diagnosis; we still feel to reconsider it. Among the above-mentioned three laboratory findings, two tests (smear and Mantoux) could be positive in leprae also. We certainly accept the authors' mention on the logistic difficulty in doing polymerase chain reaction (PCR) for Mycobacterium leprae or TB.

The healing response of ulcer to antitubercular regimen is may be because of the additional antibiotics in the tubercular regimen. We also understood that BACTEC culture will never be positive in case of leprae as in vitro culture is difficult with leprae, and we were also moved with the possibility of TB only.

Since we in our institute (Central Leprosy Teaching and Research Institute) encountered with the similar situation in a case of sputum positive for acid-fast bacilli in leprosy multibacillary multidrug therapy completed patient. We suspected it is a case of pulmonary TB. As a shocking and surprise, we got the diagnosis of lepra bacilli in sputum by PCR and same was rechecked with TB-positive control that was found to be negative.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ghosh R, Barua JK, Garg A, Barman BP. Dual infection with Mycobacterium tuberculosis and Mycobacterium leprae at same site in an immunocompetent patient: An unusual presentation. Indian J Dermatol 2017;62:548.  Back to cited text no. 1
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