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This classification will then allow a rapid diagnosis, selection and initiation of treatment, according to the class of leprosy:
- Paucibacillary or PB will show:
- Higher level of immunity.
- Lower number of bacilli
- Need less intensive treatment - will need two instead of three antileprosy drugs, for a shorter period of time.
Multibacillary or MB will show:
- Lower level of immunity.
- Higher number of 'bacilli.
- Need more intensive treatment - will need three instead of two antileprosy drugs, for a longer period of time.
Leprosy is a very variable disease, affecting different people in different ways, according to their immune response.
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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