Ref.: The Diagnosis of Leprosy. Two Cardinal Signs are necessary.
From: B Naafs, Munnekeburen, The Netherlands
Dear Dr Manglani,
Thank you very much for your question and comments [LML June 16th, 2012].
One single clinical sign is not enough to make a definite diagnose of leprosy. Herewith are reported some possible exceptions.
1st cardinal sign:- "loss of sensation in a skin lesion".
Thick skin for example in lichen simplex can have some loss of sensation for cotton wool wisp.
2nd cardinal sign:- "enlarged nerves".
There are neuropathies which can have it, like Charcot-Marie-Tooth-Hofmann.
3rd cardinal sign:- "positive skin smear":
Buruli ulcer, or M. africanum infection for instance, may give a positive skin smear result too.
When you have only one sign the diagnosis is very very likely, but must be proved. Your own feelings are not enough as a second "sign", though I agree, that it is only my feeling, that such "sign" may seem a strong second "sign" but, it may not be used like this.
A few more points need to be considered. In leprosy having only one single sign is rare. Being in an endemic or in non-endemic area may make some difference. In areas with high endemic leprosy one sign (only loss of sensation on skin lesions or only one enlarged nerve) usually is leprosy but you cannot be sure. In non-endemic areas you surely need a second sign. Two cardinal signs are indeed needed to make a definite diagnosis.
You may have the help of electro-neurophysiology, biopsy or of any other test. For example high levels of anti PGL I antibodies may be indicative.
With high regards.
Dr Ben Naafs
LML - S Deepak, B Naafs, S Noto, P A M Schreuder
LML Archives: http://www.aifo.it/english/resources/online/lml-archives/index.htm
Dr Salvatore Noto
Padiglione Dermatologia Sociale
Ospedale San Martino
Largo R. Benzi, 10
16132 Genoa, Italy
Tel: (+39) 010 555 27 83 - Fax: (+39) 010 555 66 41 - E-mail: salvatore.noto@hsanmartino.it
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