Ref.: The
diagnosis of leprosy is not always easy
From: B Naafs,
Munnekeburen, The Netherlands
Dear
Salvatore,
I refer to
last week messages about early diagnosis of lepromatous leprosy. Kindly,
find in attachment the paper of J A da Costa Nery et al. “Hansen’s disease
in a general hospital: uncommon presentations and delay in diagnosis” J Eur Acad
Dermatol Venereol 2009 Feb;23 (2):150-6. Epub 2008 Sep
10. I would be very grateful if you forward it to the leprosy mailing
list.
The diagnosis
of leprosy is not always easy, as it is generally stated and thought. To be
aware that a condition or complaint could be leprosy is a start. As
leprosy is suspected it has to be proven. The cardinal signs of leprosy
have to be investigated. They are loss of sensation in a skin lesion, enlarged
peripheral nerves and positive slit-skin smear examination (*). When two
of these three signs are positive, leprosy is diagnosed.
Ninety nine
per cent of all leprosy patients can be diagnosed in the above mentioned
way. Herewith I will say a few words about one exception (indeterminate
leprosy) and, two particular conditions namely: early lepromatous leprosy and
diffuse lepromatous leprosy (also called Lapati’s leprosy or “Lepra bonita”).
Indeterminate
leprosy
The diagnosis
of indeterminate leprosy depends on awareness. Loss of sensation is often
hardly present or is absent, nerves are not enlarged and skin smear is
negative. Even biopsy may be hardly helpful. It is “the time
that makes the diagnosis” and thus careful follow-up of the patient is
needed for a few months.
Early
lepromatous (LL) leprosy
In an early
state LL leprosy is often not diagnosed, though these patients can be extremely
infective. Awareness and skin smear may be of help. When people do
not think of leprosy it can be easily missed.
Diffuse
lepromatous leprosy (Lapati’s leprosy)
In early and
late diffuse lepromatous leprosy mostly nothing is to be seen or found, only
the patient may complain of some aches and pain or having the feeling of
dropping things or of sleeping skin. In late diffuse leprosy the patient
looks younger and has a smooth skin due to infiltration [lepra bonita].
Skin smears in both groups of patients are positive.
Nery’s
paper addresses these problems. Herewith I report part of the
conclusions:-
<< Multibacillary
(MB) leprosy, especially close to the lepromatous end of the spectrum, may
mimic other diseases, and the patient cannot be diagnosed without a biopsy or a
slit skin smear examination. Leprosy should be considered in all patients
with skin lesions not responding to treatment, especially when they have
neurological deficits, and live or have lived in a leprosy endemic area.
>>
Ben
Naafs
(*)
The Diagnosis of Leprosy
S Noto, P A M Schreuder and B Naafs
Leprosy mailing list - October 2011
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