Leprosy diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
The diagnosis of leprosy requires at least 1 of 3 criteria to be present: 1) loss of sensation of a hipopigmented skin patch, 2) a thickened peripheral nerve concomitantly with weakness or loss of sensation of the area, and/or 3) confirmation of mycobacterium leprae in a skin smear.
Diagnostic Criteria
According to the WHO, the diagnosis of leprosy requires at least 1 of 3 criteria to be present::[1]
- Confirmed loss of sensation of a hypopigmented or erythematous skin patch. At this point is also important to count the number of skin lesions, in order to classify the type of leprosy, so that adequate therapy regimen may be started.
- A thickened peripheral nerve, with concomitant loss of sensation and/or weakness of the muscles it stimulates.
- Confirmation of acid-fast bacilli in the skin smear, although most people with leprosy will have a negative smear.
Sensitivity
The sensitivity of the diagnosis when all 3 criteria are met is reported to be 97%.[2][3]
Diagnosis When Criteria are Met
If a patient does not meet any of the above criteria, three options are available:[1]
- Discuss the case with a colleague specialized in leprosy and refer these cases to a healthcare center specialized in the condition.
- Reevaluate the diagnosis, considering the possibility of another skin disease.
- Reevaluate within 3 to 6 months. In cases of leprosy, a loss of sensation may be observed and multidrug therapy would be indicated.
In the absence of loss of sensation in the skin lesions and the absence of enlarged nerves, but with suspicious signs such as nodules or swellings on the face and/or earlobes, a skin smear test should be performed. A positive skin smear will confirm the diagnosis of leprosy, while a negative result, without other cardinal signs, would decrease the probability of leprosy, in which case an alternative diagnosis should then be considered.[1]
Psychosocial Impact of the Diagnosis of Leprosy
A reasonable degree of certainty is required before communicating the diagnosis of leprosy given the potential impact of the diagnosis of leprosy on the patient and the community.[1]
References
- ↑ 1.0 1.1 1.2 1.3 "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).
- ↑ Eichelmann, K.; González González, S.E.; Salas-Alanis, J.C.; Ocampo-Candiani, J. (2013). "Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment". Actas Dermo-Sifiliográficas (English Edition). 104 (7): 554–563. doi:10.1016/j.adengl.2012.03.028. ISSN 1578-2190.
- ↑ Moschella SL (2004). "An update on the diagnosis and treatment of leprosy". J Am Acad Dermatol. 51 (3): 417–26. doi:10.1016/j.jaad.2003.11.072. PMID 15337986.