Leprosy classification: Difference between revisions

Jump to navigation Jump to search
Line 4: Line 4:


==Overview==
==Overview==
Leprosy may be divided according to different systems of classification, from which two of them, the ''Ridley Jopling classification'' and the ''WHO classification'' are the most broadly used. These classifications are based on [[clinical]], [[bacteriological]] and [[histopathological]] features presented by the patient and help to identify the class of leprosy, thereby determining the [[prognosis]] and the [[Therapy|treatment]] regimen to give to that particular patient.<ref name="WalkerLockwood2007">{{cite journal|last1=Walker|first1=Stephen L.|last2=Lockwood|first2=Dina N.J.|title=Leprosy|journal=Clinics in Dermatology|volume=25|issue=2|year=2007|pages=165–172|issn=0738081X|doi=10.1016/j.clindermatol.2006.05.012}}</ref><ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref><ref name="BhatPrakash2012">{{cite journal|last1=Bhat|first1=Ramesh Marne|last2=Prakash|first2=Chaitra|title=Leprosy: An Overview of Pathophysiology|journal=Interdisciplinary Perspectives on Infectious Diseases|volume=2012|year=2012|pages=1–6|issn=1687-708X|doi=10.1155/2012/181089}}</ref>
The ''Ridley Jopling classification'' and the ''WHO classification'' are the two most widely used systems to classify Leprosy. These classification systems are based on [[clinical]], [[bacteriologic]] and [[histopathological]] features, and are used to determine the patient's [[prognosis]] and the [[Therapy|treatment]] regimen.<ref name="WalkerLockwood2007">{{cite journal|last1=Walker|first1=Stephen L.|last2=Lockwood|first2=Dina N.J.|title=Leprosy|journal=Clinics in Dermatology|volume=25|issue=2|year=2007|pages=165–172|issn=0738081X|doi=10.1016/j.clindermatol.2006.05.012}}</ref><ref name="EichelmannGonzález González2013">{{cite journal|last1=Eichelmann|first1=K.|last2=González González|first2=S.E.|last3=Salas-Alanis|first3=J.C.|last4=Ocampo-Candiani|first4=J.|title=Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatment|journal=Actas Dermo-Sifiliográficas (English Edition)|volume=104|issue=7|year=2013|pages=554–563|issn=15782190|doi=10.1016/j.adengl.2012.03.028}}</ref><ref name="BhatPrakash2012">{{cite journal|last1=Bhat|first1=Ramesh Marne|last2=Prakash|first2=Chaitra|title=Leprosy: An Overview of Pathophysiology|journal=Interdisciplinary Perspectives on Infectious Diseases|volume=2012|year=2012|pages=1–6|issn=1687-708X|doi=10.1155/2012/181089}}</ref>


==Classification==
==Classification==

Revision as of 12:53, 4 July 2014

Leprosy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Leprosy from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Tertiary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Leprosy classification On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Leprosy classification

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Leprosy classification

CDC on Leprosy classification

Leprosy classification in the news

Blogs on Leprosy classification

Directions to Hospitals Treating Leprosy

Risk calculators and risk factors for Leprosy classification

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 Ridley Jopling classification and the WHO classification are the two most widely used systems to classify Leprosy. These classification systems are based on clinical, bacteriologic and histopathological features, and are used to determine the patient's prognosis and the treatment regimen.[1][2][3]

Classification

Leprosy may present among different patients, or even in one single patient throughout the course of the disease, with a multitude of clinical, histopathological and bacterial states. By attributing a class to a certain manifestation of the disease in one patient, it is possible to determine his prognosis, infectivity rate and the type of treatment to administrate in that patient. [1]

There are several different approaches for classifying leprosy however, some similarities do exist:

  • The World Health Organization system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria[4]
  • The SHAY scale provides five gradations.[5][6]
  • The ICD-10, though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry.[7]
  • 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 (Th2)

However, the two most common classifications include:

Ridley Jopling classification

This classification provides an optimal organization of the different presentations of the disease, being able to include clinic, histopathology and bacterial index in each category, thereby providing an insight of the patient's immune response to the disease. [1] The status of disease will range from the tuberculoid or pauci-bacillary pole, in which is present 1 to 3 well-defined lesions with a central hipopigmented area, with hipoesthesia, a well-developed immune response from the patient, with evidence of an adequate granulomatous inflammation and presence of very few acid-fast bacilli; to the lepromatous or multi-bacillary pole, in which patients presents with numerous undefined nodular lesions throughout the body, with a weak immune response towards the bacteria, histological evidence of foamy macrophages in dermis filled with a great number of mycobacteria. On this last pole, it is important to notice that even though the immune system is not capable of mounting an immune response towards the [bacilli]], patients are still immunocompetent for other diseases. For this classification contribute the following elements:[8]

Between these two poles, there is also the intermediate, dimorphous or borderline state. This last category is subdivided into 3 subcategories, depending on the pole each subcategory has more similarities with, which include:

  • Borderline Tuberculoid, or BT
  • Mid-Borderline, Borderline-Borderline, or BB
  • Borderline Lepromatous, or BL

This intermediate category is considered to be the one where the disease usually begins. It will then progress to one of the poles: [1]

Some patients show evidence of early unspecific lesions and nerve infiltrates, lacking the required criteria for being classified as above mentioned. These patients are included in a specific category called indeterminate. This category should only be used when there is diagnostic proof of leprosy, from a biopsy sample showing evidence of mycobacteria leprae and perineural infiltrates, but the disease is not advanced enough to show the clear patient position in the leprosy classification.

WHO classification

The WHO organization defined a more simple and straightforward classification, according to the number of skin lesions present. This classification is due to be used there is lack of laboratory support of clinical expertise, in which case, the disease will be classified as paucibacillary leprosy, when five or less skin lesions are present but no bacilli is present on skin smears; or multibacillary leprosy, when more than six skin lesions are present, with a possibly positive skin smear. However, despite useful in certain occasions, this method may lead to misclassification of some patients, resulting in undertreatment of some cases.[8]

Cutaneous leprosy lesions on a patient's thigh.


References

  1. 1.0 1.1 1.2 1.3 Walker, Stephen L.; Lockwood, Dina N.J. (2007). "Leprosy". Clinics in Dermatology. 25 (2): 165–172. doi:10.1016/j.clindermatol.2006.05.012. ISSN 0738-081X.
  2. 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.
  3. Bhat, Ramesh Marne; Prakash, Chaitra (2012). "Leprosy: An Overview of Pathophysiology". Interdisciplinary Perspectives on Infectious Diseases. 2012: 1–6. doi:10.1155/2012/181089. ISSN 1687-708X.
  4. Smith DS (2008-08-19). "Leprosy: Overview". eMedicine Infectious Diseases. Retrieved 2010-02-01.
  5. 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)
  6. 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.
  7. "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>.
  8. 8.0 8.1 Pardillo FE, Fajardo TT, Abalos RM, Scollard D, Gelber RH (2007). "Methods for the classification of leprosy for treatment purposes". Clin Infect Dis. 44 (8): 1096–9. doi:10.1086/512809. PMID 17366457.


Template:WikiDoc Sources