Reliability of direct skin smear microscopy in leprosy

Skin smear direct microscopy is an important tool for diagnosis of leprosy. The study was planned to understand the reproducibility of skin smear reading by a trained technician. Skin smears were collected from known patients of leprosy from the field area. They were stained for acid fast bacilli following the standard cold staining procedure and were read following the Ridley scale. A sample of smears was re-examined on two occasions by the same technician, following blind procedure. There was a systematic under reading on the second occasion, which was attributed to the defective storage of the slides. However, the agreement between second and third examinations was very good (Concordance 81.34%, Kappa 0.74). The finding was confirmed on a repeat examination. It can be concluded that the Direct Skin Smear Microscopy is a reliable and reproducible technique under experimental conditions.