Leprosy diagnostic criteria: Difference between revisions
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* Reevaluate the [[diagnosis]], considering the possibility of another [[skin disease]]. | * Reevaluate the [[diagnosis]], considering the possibility of another [[skin disease]]. | ||
* Reevaluate within 3 to 6 months. In case of leprosy, [[loss of sensation]] will then be observed and multi drug therapy would be initiated. | * Reevaluate within 3 to 6 months. In case of leprosy, [[loss of sensation]] will then be observed and multi drug therapy would be initiated. | ||
In case of absence of [[loss of sensation]] in the [[skin lesions]] and absence of enlarged [[nerves]], but with suspicious [[signs]] | In case of absence of [[loss of sensation]] in the [[skin lesions]] and absence of enlarged [[nerves]], but with suspicious [[signs]] such as [[nodules]] or swellings on the face and/or earlobes, a [[skin]] smear test should be requested. A positive [[skin]] smear will confirm the [[diagnosis]] of leprosy, while a negative result, without other cardinal [[signs]], would decrease the probability of leprosy, in which case an alternative [[diagnosis]] should then be considered.<ref name=WHO>{{cite web | title = Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015) | url = http://www.searo.who.int/entity/global_leprosy_programme/documents/enhanced_global_strategy_2011_2015_operational_guidelines.pdf }}</ref> It is important to communicate to the patient the leprosy [[diagnosis]] only there is a certain degree of certainty. Leprosy inflicts a psychological and social impact in the patient's life that should be taken into consideration. | ||
==References== | ==References== | ||
Revision as of 16:59, 7 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
For the diagnosis of leprosy at least 1 of 3 criteria should be present: loss of sensation of a hipopigmented skin patch, a thickened peripheral nerve concomitantly with weakness or loss of sensation of the area, and/or confirmation of mycobacterium leprae in the skin smear.
Diagnostic Criteria
Attending to the historic and social impact of leprosy in the population, a careful assessment of the patient should be made before the definitive diagnosis of leprosy. Even when suspected in the differential diagnosis, a reasonable degree of certainty is required, before communicating this to the patient.[1]
According to the WHO, for the diagnosis of leprosy, at least one of the following signs should be present:[1]
- Confirmed loss of sensation of a hypopigmented or erythematous skin patch. At this point is also important to count the number of skin lesions, in order to classify the type of leprosy, so that adequate therapy regimen may be started.
- 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, although most people with leprosy will have a negative smear.
In the case of presence of all 3 criteria, then the sensitivity of the diagnosis has been reported to be around 97%.[2][3] Otherwise, when the patient does not fill the above criteria for diagnosis, three options are available:[1]
- Discuss the case with colleagues specialized in leprosy and refer these cases to a healthcare center specialized in the condition.
- Reevaluate the diagnosis, considering the possibility of another skin disease.
- Reevaluate within 3 to 6 months. In case of leprosy, loss of sensation will then be observed and multi drug therapy would be initiated.
In case of absence of loss of sensation in the skin lesions and absence of enlarged nerves, but with suspicious signs such as nodules or swellings on the face and/or earlobes, a skin smear test should be requested. A positive skin smear will confirm the diagnosis of leprosy, while a negative result, without other cardinal signs, would decrease the probability of leprosy, in which case an alternative diagnosis should then be considered.[1] It is important to communicate to the patient the leprosy diagnosis only there is a certain degree of certainty. Leprosy inflicts a psychological and social impact in the patient's life that should be taken into consideration.
References
- ↑ 1.0 1.1 1.2 1.3 "Enhanced global strategy for further reducing the disease burden due to leprosy (2011-2015)" (PDF).
- ↑ 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.
- ↑ Moschella SL (2004). "An update on the diagnosis and treatment of leprosy". J Am Acad Dermatol. 51 (3): 417–26. doi:10.1016/j.jaad.2003.11.072. PMID 15337986.