Leprosy classification: Difference between revisions
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* Patients are [[immunocompetent]], despite not being able to fight [[mycobacterium leprae]] | * Patients are [[immunocompetent]], despite not being able to fight [[mycobacterium leprae]] | ||
===Intermediate, Dimorphous or Borderline State=== | |||
This last category is subdivided into 3 subcategories: | |||
====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: <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> | This intermediate category is considered to be the one where the [[disease]] usually begins. It will then progress to one of the poles: <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> | ||
* In case of progression towards the ''tuberculoid pole'', it means the patient's [[Cell-mediated immunity|cell-mediated immunity]] is increasing, thereby being associated with [[inflammation]] of the [[nerves]] and [[skin]]. | * In case of progression towards the ''tuberculoid pole'', it means the patient's [[Cell-mediated immunity|cell-mediated immunity]] is increasing, thereby being associated with [[inflammation]] of the [[nerves]] and [[skin]]. |
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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 systems for classifying leprosy. However, the two more common include the WHO and the Ridley-Jopling.
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
- Least severe form
- 1 to 3 well-defined lesions with central hypopigmented area and hypoesthesia
- Well-developed immune response
- Granulomatous inflammation
- Rare acid-fast bacilli
Lepromatous or Multi-Bacillary Pole
- Multiple undefined nodular lesions throughout the body
- Weak immune response
- Evidence of foamy macrophages in dermis filled with mycobacteria
- Patients are immunocompetent, despite not being able to fight mycobacterium leprae
Intermediate, Dimorphous or Borderline State
This last category is subdivided into 3 subcategories:
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]
- In case of progression towards the tuberculoid pole, it means the patient's cell-mediated immunity is increasing, thereby being associated with inflammation of the nerves and skin.
- In case of progression towards the lepromatous pole, usually occurring before treatment is initiated and is compatible with loss of cell-mediated immunity.
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.
For this classification contribute the following elements:[4]
- Cutaneous
- Neurological
- Biopsy findings
- Immunological status
- Sum of acid-fast bacilli in the dermis.
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.[4]
This classification allows, however, for a rapid diagnosis, selection and initiation of treatment, according to the class of leprosy:[5]
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
- ↑ 1.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).