Attending to the historic and social impact of leprosy in the population, a careful assessment of the clinical status of the patient should be made, before advancing the definitive diagnosis of leprosy. Even when suspected in the differential diagnosis, a reasonable degree of certainty is required, before communicating to the patient.
For the diagnosis of leprosy, at leads one of the following signs should be present:
# Confirmed loss of sensation of a hypo pigmented or erythematous skin patch.
# 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.
Definite loss of sensation in a skin lesion may be detected by touching the skin lightly (use something like a piece of cotton wool). The person’s skin is touched in different places. The person is then asked to point to each place that is touched. If the person cannot feel the points of contact within the skin patch but does point to other places where the skin is normal, diagnosis of leprosy is confirmed.
Examination of the nerves is an important part in the examination of a person affected with leprosy. But this requires experience and should be done only by staff specifically trained to do it.
Skin smear examination requires a suitably equipped laboratory with staff trained to perform this test. Leprosy skin smear services could be made available in selected units (such as those already doing sputum smears for the diagnosis of TB). In most patients, a skin smear is not essential in the diagnosis of leprosy, but in some cases of early MB leprosy it may be the only conclusive sign of the disease. The majority of people with leprosy have a negative smear.
Revision as of 19:39, 5 July 2014
In Progress
Leprosy, a chronic infectious disease, usually affects the skin and peripheral nerves but has a wide range of possible clinical manifestations. Patients may be classified as having paucibacillary or multibacillary Hansen's disease. Paucibacillary Hansen's disease is milder and characterized by one or more hypopigmented skin macules. 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.
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