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Leprosy is a very variable disease, affecting different people in different ways, according to their immune response. Those at one end of the spectrum with a high level of immunity harbour a low number of bacilli and are termed paucibacillary or PB patients. Those with many bacilli in the body are referred to as multibacillary or MB cases. MB patients need more intensive treatment than PB patients – they need three instead of two antileprosy drugs taken for a longer duration of time. Classification in routine programmes is, therefore, a practical step which categorizes leprosy patients into two treatment groups. A simple clinical rule is now used to divide patients into these two groups. The number of individual skin lesions is counted (this means that the whole body must be examined to make an accurate count): - PB cases have up to five skin lesions in total. - MB cases have six or more skin lesions. If a skin smear is done and is positive, the patient must be classified as MB irrespective of the number of skin lesions. If the smear is negative, the classification is decided by the number of skin lesions. Other factors such as nerve involvement may be considered at the referral level for classifying the disease (e.g. multiple peripheral nerve involvement irrespective of the number of skin lesions).
The risk of nerve damage is greater in MB patients. Therefore, classification is helpful in assessing future risk (Section 6.1) and in guiding patient care.
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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