Cutaneous infections and infestations

We report a case of Histoid Leprosy in a 52-year-old man presenting with a massive bacillary load (Bacteriological Index 6+, Morphological Index 95%). Following four weeks of WHO-recommended multidrug therapy, repeat slit-skin smears demonstrated complete bacillary fragmentation (Morphological Index 0%), despite a persistently elevated Bacteriological Index. This case illustrates the critical distinction between bacterial load and viability, emphasising the Morphological Index as the most sensitive indicator of early therapeutic efficacy in multibacillary leprosy.