New case detection - delay in diagnosis

 

 

Leprosy Mailing List – May 9,  2013 

Ref.:    (LML)  New case detection – delay in diagnosis

From:  Dr. J. Barreto, São Paulo, Brazil

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Dear Pieter,

 

By attached file another case of borderline leprosy, detected by Dr J.  Cabral in Mato Grosso State, Brazil. This child was previously misdiagnosed as having pityriasis alba, even with a history of  familial leprosy, i.e., mother and grandfather with MB leprosy.

Despite the typical features of BB-LLs (LL subpolair)  leprosy (white patches which go to foveolar (honeycomb-like) lesions and facial infiltration, enlargement of several nerves, the histo-pathology was "indeterminate leprosy" (probably because the specimen was not   representative). Bacilli were seen in the tissue, but the they were not counted.

Lesions appear 2 years ago. The child's mother brought the child to the health centre. Despite living in a hyperendemic area, having a family history of leprosy, showing many skin lesions,  enlarged nerve trunks and visible fibularis superficialis, leprosy was not suspected. Instead,  other  diagnoses were made, such as: worm spots (pytiriasis alba), sunburns, allergy. Lack of suspicion by health services is one of the most important causes of delayed  diagnosis.

In order to prevent advanced cases like this, our Ministry of Health is stimulating the search for early leprosy in school children. The histamine test is being widely reintroduced, together with thermal sensitivity testing.

 

Regards,

Dr. Jaison Barreto, Bauru, São Paulo, Brazil

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LML - S Deepak, B Naafs, S Noto and P Schreuder
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