New Case Detection

 

Leprosy Mailing List – May 22,  2013 

Ref.:    (LML) New Case Detection

From:  Maria Leide W. de Oliveira, Rio de Janeiro, Brazil 

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Dear  colleagues,

 

Regarding the subjects under discussion by  doctors  Jaison and Kawuma (LML May 20, 2013):

 

In fact the child rate of leprosy is considered very important by national and state programs in Brazil. Recently, the  Ministry of Health did an educational campaign in elementary state  schools of selected most endemic municipalities, involving leprosy in addition to with other Neglected Diseases . 

 

Since 2008 all new leprosy cases less than 15 years old must present a specific record with diagnosis criteria description (to avoid overdiagnosis). Also a household contacts investigation is recommended. Of course it is not always easy to diagnosis indeterminate leprosy in children, and it is necessary to maintain  up to date  training  for health professionals in most endemic areas.

 

My experience in diagnosis of sensory impairment in children is successful as I use to do it in a playful manner.  All regular materials could be utilized and  I normally start with dry and wet a cotton ball  with ethyl- butyl- ether or alcohol to make  the simple thermo-sensibility test.  

 

In children the Histamine is also very useful. The solution of histamine is cheap to be formulated (1/1000) and the test easy to be performed (less than 10 minutes). So I advocate to have this in spot screening in the field and in referral units. See below for 2 clinical cases to demonstrate it:

 

Fig. 1: The child was seen in a campaign, brought by a family team doctor. He correctly suspect of leprosy considering the symptoms of tingling and, hair loss but the he was insecure regarding the sensitive skin test. Also the child ´s mother did not accept promptly the diagnosis.

 

As it can be observed there are visible differences between the 2 areas tested. So that the histamine test not only corroborate the other signs presented but was useful  to demonstrate to the mother the disease evidence of nervous system damage and the importance in starting  treatment immediately .

  

Testimony area: complete reaction. Local redness ; then secondary redness due to axonal stimulus and third phase: papule.

Suspect area: incomplete reaction local redness ; then secondary redness due to axonal stimulus is absent and third phase  present.

 

 

 

 

Fig. 2: the child, 04 years old presented also Atopic Dermatitis   and it was my first diagnosis for this pale spot. But as it was a training practice I decided to use histamine test and as you can see the secondary redness halo was absent, comparing to the testimony area. We call immediately all family to the health family unit and discovered that her brother, 11 years old  boy presented many patches of borderline leprosy not noticed yet by his mother. Later on we were informed that he lived with his grandfather in the countryside who was diagnosed as having leprosy at that time.

 

Complete histamine test (three phased reaction) and incomplete reaction : secondary halo redness is absent due to autonomous nervous system involvement.

 

 

One observation: this test is based on redness so that it could be observed only in normal skin color of white  and  brown people or in pale macules in different ethnics skin. It is also not indicated in redness patches. 

 

 

Maria Leide W. de Oliveira,  Md. Phd.

Federal University of Rio de Janeiro-Brazil

 

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