Tingkat Kesesuaian Gambaran Klinik dan Histopatologik Serta Positivitas CD4 dan CD8 pada Spektrum Penyakit Kusta Menurut Klasifikasi Ridley-Jopling

Background Leprosy (Hansen’s Disease) is a chronic infectious disease caused by Mycobacterium leprae. The varied manifestations of the disease might depend on the immune status of the host. Ridley-Jopling classified cases based on clinical, histopathological, bacteriological and immunologicalfeatures as TT (tuberculoid leprosy), BT (borderlinetuberculoid), BB (mid-borderline), BL (borderline lepromatous), LL (lepromatousleprosy). Because many centres of health in this country lack the fascility to perform laboratory diagnostic, so clinical diagnostic based on WHO (World Health Organization) classification Paucibacillary and Multibacillary dichotomy may be sufficient. The purpose of this study is to analyze the concordance level between clinical and histopathological diagnosis and correlation of the immunological respons represented by the expression of CD4+ and CD8+T lymphocyte among the spectrum of leprosy. Material and methods A cross sectional study was performed in 159 new leprosy patients with no reaction phase in the National General Central Hospital, Jakarta during 2007-2009 and the archival slides were reviewed. They were stained with Hematoxylin dan Eosin and modified Fite- Faraco staining for identification of Mycobacterium leprae. Immune status of the patients was determined by immunohistochemistry staining with expression of CD4+ and CD8+ T cell lymphocyte. Results 159 new cases of leprosy with no reaction phase consisted of 88 males and 71 females. Discrepancy between clinical and histopathological diagnosis was seen in 47.8% of cases. Major discrepanciescomprised 22%, and minor discrepancies 25.8%. There was no statistically significant relationship between positivity of CD4+ (p>0.05) and CD8+ (p>0.05) with respect to leprosy spectrum.There was statistically significant relationship between Bacteriological Index (BI) and spectrum of leprosy (p<0.05). Conclusion Concordance in clinico-pathological diagnoses of leprosy were found in52.2%. There was no statistically significant relationship between positivityof CD4+ and CD8+T lymphocyte with respect to leprosy spectrum. There was a statistically significant relationship between Bacteriological Index (BI) and spectrum of leprosy.