Leprosy classification: Difference between revisions

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* Multibacillary Hansen's disease is associated with symmetric skin [[lesion]]s, [[nodule]]s, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and [[epistaxis]] (nose bleeds) but typically detectable nerve damage is late.
* Multibacillary Hansen's disease is associated with symmetric skin [[lesion]]s, [[nodule]]s, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and [[epistaxis]] (nose bleeds) but typically detectable nerve damage is late.
There are several different approaches for classifying leprosy; however, parallels exist.
* The [[World Health Organization]] system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria<ref>{{cite web |author=Smith DS | url=http://emedicine.medscape.com/article/220455-overview |title=Leprosy: Overview | work=eMedicine Infectious Diseases |date=2008-08-19|accessdate=2010-02-01}}</ref> ("[http://en.wiktionary.org/wiki/paucus#Latin pauci-]" refers to a low quantity.)
* The SHAY scale provides five gradations.<ref name="pm hippopotamus id15176024">{{cite journal |author=Singh N, Manucha V, Bhattacharya SN, Arora VK, Bhatia A |title=Pitfalls in the cytological classification of borderline leprosy in the Ridley-Jopling scale |journal=Diagn. Cytopathol. |volume=30 |issue=6 |pages=386–8 |year=2004 |month=June |pmid=15176024 |doi=10.1002/dc.20012 |url= }}</ref><ref name="pmid5950347">{{cite journal |author=Ridley DS, Jopling WH |title=Classification of leprosy according to immunity. A five-group system |journal=Int. J. Lepr. Other Mycobact. Dis. |volume=34 |issue=3 |pages=255–73 |year=1966 |pmid=5950347 |doi= |url= }}</ref>
* The [[ICD-10]], though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry.<ref name="news-medical">"What Is Leprosy?" THE MEDICAL NEWS | from News-Medical.Net - Latest Medical News and Research from Around the World. Web. 20 Nov. 2010. <http://www.news-medical.net/health/What-is-Leprosy.aspx>.</ref>
* In [[Medical Subject Headings|MeSH]], three groupings are used.
{| class="wikitable"
|-
! WHO
! Ridley-Jopling
! [[ICD-10]]
! [[Medical Subject Headings|MeSH]]
! Description
! [[Lepromin]] test
! Immune target
|-
| Paucibacillary
| tuberculoid ("TT"), borderline tuberculoid ("BT")
| A30.1, A30.2
| Tuberculoid
| It is characterized by one or more [[Hypopigmentation|hypopigmented]] skin [[macule]]s and anaesthetic patches, where skin [[Wikt:sensation|sensations]] are lost because of damaged peripheral nerves that have been attacked by the human host's immune cells.
| Positive
| bacillus (Th1)
|-
| Multibacillary
| midborderline or borderline ("BB")
| A30.3
| Borderline
| Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become more like lepromatous leprosy or may undergo a reversal reaction, becoming more like the tuberculoid form.
|
|
|-
| Multibacillary
| borderline lepromatous ("BL"), and lepromatous ("LL")
| A30.4, A30.5
| Lepromatous
| It is associated with symmetric skin [[lesion]]s, [[Nodule (medicine)|nodules]], [[Plaque (dermatology)|plaque]]s, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and [[epistaxis]] (nose bleeds), but, typically, detectable nerve damage is late.
| Negative
| plasmid inside bacillus  {{Citation needed|date=January 2011}} (Th2)
|}
Hansen's disease may also be divided into the following types:<ref name="Andrews">{{cite book |author=James, William D.; Berger, Timothy G.; et al. |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |location= |year=2006 |pages= |isbn=0-7216-2921-0 |oclc= |doi= |accessdate=}}</ref>{{Rp|344-346|date=November 2012}}
* Early and indeterminate leprosy
* [[Tuberculoid leprosy]]
* [[Borderline tuberculoid leprosy]]
* [[Borderline leprosy]]
* [[Borderline lepromatous leprosy]]
* [[Lepromatous leprosy]]
* [[Histoid leprosy]]
* [[Diffuse leprosy of Lucio and Latapí]]


Contrary to popular belief, Hansen's bacillus does not cause rotting of the flesh; rather, a long investigation by [[Paul Wilson Brand|Paul Brand]] yielded that insensitivity in the limbs extremities was the reason why unfelt wounds or lesions, however minute, lead to undetected deterioration of the tissues, the lack of pain not triggering an immediate response as in a fully functioning body.  Recently, leprosy has also emerged as a problem in [[HIV]] patients on [[antiretroviral drugs]].<ref name=McNeil_2006>{{cite news | author = McNeil Jr DG|title = Worrisome New Link: AIDS Drugs and Leprosy |url = http://www.nytimes.com/2006/10/24/health/24lepr.html | work = New York Times |date = 2006-10-24 |accessdate=2007-05-07 }}</ref>
Contrary to popular belief, Hansen's bacillus does not cause rotting of the flesh; rather, a long investigation by [[Paul Wilson Brand|Paul Brand]] yielded that insensitivity in the limbs extremities was the reason why unfelt wounds or lesions, however minute, lead to undetected deterioration of the tissues, the lack of pain not triggering an immediate response as in a fully functioning body.  Recently, leprosy has also emerged as a problem in [[HIV]] patients on [[antiretroviral drugs]].<ref name=McNeil_2006>{{cite news | author = McNeil Jr DG|title = Worrisome New Link: AIDS Drugs and Leprosy |url = http://www.nytimes.com/2006/10/24/health/24lepr.html | work = New York Times |date = 2006-10-24 |accessdate=2007-05-07 }}</ref>
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[[Image:Leprosy_thigh_demarcated_cutaneous_lesions.jpg|left|thumb|Cutaneous leprosy lesions on a patient's thigh.]]
[[Image:Leprosy_thigh_demarcated_cutaneous_lesions.jpg|left|thumb|Cutaneous leprosy lesions on a patient's thigh.]]
<br clear="left"/>
<br clear="left"/>
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 16:54, 2 January 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The clinical manifestations of leprosy vary but primarily affect the skin, nerves, and mucous membranes.[1] Patients with this chronic infectious disease are classified as having paucibacillary (tuberculoid leprosy), multibacillary Hansen's disease (lepromatous leprosy), or borderline leprosy.

Classification

  • Borderline leprosy (also termed multibacillary), of intermediate severity, is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become more like lepromatous leprosy or may undergo a reversal reaction, becoming more like the tuberculoid form.
  • Paucibacillary Hansen's disease is characterized by one or more hypopigmented skin macules and anaesthetic patches, i.e., damaged peripheral nerves that have been attacked by the human host's immune cells.
  • Multibacillary Hansen's disease is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis (nose bleeds) but typically detectable nerve damage is late.

There are several different approaches for classifying leprosy; however, parallels exist.

  • The World Health Organization system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria[2] ("pauci-" refers to a low quantity.)
  • The SHAY scale provides five gradations.[3][4]
  • The ICD-10, though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry.[5]
  • In MeSH, three groupings are used.
WHO Ridley-Jopling ICD-10 MeSH Description Lepromin test Immune target
Paucibacillary tuberculoid ("TT"), borderline tuberculoid ("BT") A30.1, A30.2 Tuberculoid It is characterized by one or more hypopigmented skin macules and anaesthetic patches, where skin sensations are lost because of damaged peripheral nerves that have been attacked by the human host's immune cells. Positive bacillus (Th1)
Multibacillary midborderline or borderline ("BB") A30.3 Borderline Borderline leprosy is of intermediate severity and is the most common form. Skin lesions resemble tuberculoid leprosy but are more numerous and irregular; large patches may affect a whole limb, and peripheral nerve involvement with weakness and loss of sensation is common. This type is unstable and may become more like lepromatous leprosy or may undergo a reversal reaction, becoming more like the tuberculoid form.
Multibacillary borderline lepromatous ("BL"), and lepromatous ("LL") A30.4, A30.5 Lepromatous It is associated with symmetric skin lesions, nodules, plaques, thickened dermis, and frequent involvement of the nasal mucosa resulting in nasal congestion and epistaxis (nose bleeds), but, typically, detectable nerve damage is late. Negative plasmid inside bacillus[citation needed] (Th2)

Hansen's disease may also be divided into the following types:[6]:344-346

Contrary to popular belief, Hansen's bacillus does not cause rotting of the flesh; rather, a long investigation by Paul Brand yielded that insensitivity in the limbs extremities was the reason why unfelt wounds or lesions, however minute, lead to undetected deterioration of the tissues, the lack of pain not triggering an immediate response as in a fully functioning body. Recently, leprosy has also emerged as a problem in HIV patients on antiretroviral drugs.[7]

Cutaneous leprosy lesions on a patient's thigh.


References

  1. ↑ Naafs B, Silva E, Vilani-Moreno F, Marcos E, Nogueira M, Opromolla D (2001). "Factors influencing the development of leprosy: an overview". Int J Lepr Other Mycobact Dis. 69 (1): 26–33. PMID 11480313.
  2. ↑ Smith DS (2008-08-19). "Leprosy: Overview". eMedicine Infectious Diseases. Retrieved 2010-02-01.
  3. ↑ Singh N, Manucha V, Bhattacharya SN, Arora VK, Bhatia A (2004). "Pitfalls in the cytological classification of borderline leprosy in the Ridley-Jopling scale". Diagn. Cytopathol. 30 (6): 386–8. doi:10.1002/dc.20012. PMID 15176024. Unknown parameter |month= ignored (help)
  4. ↑ Ridley DS, Jopling WH (1966). "Classification of leprosy according to immunity. A five-group system". Int. J. Lepr. Other Mycobact. Dis. 34 (3): 255–73. PMID 5950347.
  5. ↑ "What Is Leprosy?" THE MEDICAL NEWS | from News-Medical.Net - Latest Medical News and Research from Around the World. Web. 20 Nov. 2010. <http://www.news-medical.net/health/What-is-Leprosy.aspx>.
  6. ↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
  7. ↑ McNeil Jr DG (2006-10-24). "Worrisome New Link: AIDS Drugs and Leprosy". New York Times. Retrieved 2007-05-07.


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