Leprosy classification: Difference between revisions

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There are different classification schemes for the [[diagnosis]] of [[Leprosy]]:
There are different classification schemes for the [[diagnosis]] of [[Leprosy]]:
* The [[World Health Organization]] system  
* The [[World Health Organization]] system
* The SHAY - scale provides five subclassifications<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 SHAY system - coding <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]] - although 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>
* The [[ICD-10]] system - although 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]], there are three subclasses.
* In [[Medical Subject Headings|MeSH]] system - there are three subclasses.
However, the two most common classifications include the ''[[WHO]]'' and the ''Ridley-Jopling'' classifications.
However, the two most common classifications include the ''[[WHO]]'' and the ''Ridley-Jopling'' classifications.



Revision as of 14:57, 8 July 2014

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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, microbiologic and histopathological features, and are used to determine the patient's prognosis and the treatment regimen.[1][2][3]

Classification

Leprosy may present with a variety of clinical, histopathological and bacterial manifestations. Different classes of Leprosy type determine prognosis, infectivity rate and the appropriate treatment.[1]

There are different classification schemes for the diagnosis of Leprosy:

  • The World Health Organization system
  • The SHAY system - coding [4][5]
  • The ICD-10 system - although developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry.[6]
  • In MeSH system - there are three subclasses.

However, the two most common classifications include the WHO and the Ridley-Jopling classifications.

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)

Ridley Jopling classification

There are 5 classes in the Ridley Jopling classification scheme.

Tuberculoid or Pauci-bacillary Pole

This is the least severe form of the disease. In this form of the disease the following are present:

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 has defined a more simple and straightforward classification, according to the number of skin lesions present. This classification is due to be used when there is lack of laboratory support or clinical expertise, in which case, the disease will be classified as paucibacillary leprosy or multibacillary leprosy. However, despite useful in certain occasions, this method may lead to misclassification of some patients, resulting in undertreatment of some cases.[7]

This classification allows, however, for a rapid diagnosis, selection and initiation of treatment, according to the class of leprosy:[8]

Paucibacillary or PB

Multibacillary or MB

If a skin smear is done and shows a positive result, then that patient will immediately be classified as a multibacillary patient, irrespective of the number of skin lesions identified on physical examination.

References

  1. 1.0 1.1 1.2 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. 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)
  5. 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.
  6. "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>.
  7. 7.0 7.1 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.
  8. "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).


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