Leprosy Mailing List – March 28th, 2010
Ref.: Indeterminate (I) leprosy
From: Grace Warren,
Dear Salvatore,
Indeterminate leprosy is the very earliest form of leprosy in which the first signs of inflammation are evident but, the disease is only just becoming established. By the time the first indefinite vague edged lesions can be seen there is still only mild inflammation in the tissues and many good pathologists are even hesitant to make a diagnosis on the pathology. Which from the name is still INDETERMINED as to which type of disease is developing. In fact a number of senior pathologists will only make a positive diagnosis if they detect some acid fast bacilli (AFB) in the biopsy.
A slit skin smear examination rarely shows the bacilli which are relatively rare. If bacilli are easily found in a slit skin smear it is already determined.
In Indeterminate leprosy the earliest lesions are merely dyschromic. They can be pinkish is a true light skin or light in colour on a pigmented skin. They do not hurt and there is no detectable sensory abnormality or pain or itch. There may be one only or many lesions.
Diagnosis is often a result of suspicion and every dyschromic lesion in an endemic area should be looked at carefully. The whole body must be examined and all nerves palpated; though if any nerve is enlarged it would probably cancel indeterminate.
A biopsy may show some inflammation but, as said before, if AFB cannot be found a positive diagnosis of leprosy cannot be made.
Grace
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