Leprosy Mailing List – March 9, 2016
Ref.: (LML) 19th International Leprosy Congress Beijing 2016
From: Rajeev B Dudhalkar, Mumbai, India
Dear Pieter,
I would like get clarification looking at the present field situation on some of the following issues to MB/PB grouping of cases.
1. Counting of lesions
a. Skin lesions (patches) and nerve lesions (trunk nerves) though nerve palpation remains an issue.
b. Skin lesion: patch with the satellite lesion/s (including feeding cutaneous nerve involvement) to be counted as one lesion.
c. Irrespective size of the patch, even though it may big/ very large in size counted as one lesion.
- Morphology of the skin lesion: margin (well defined/ill-defined), satellite lesion/s, distribution(symmetrical/asymmetrical), number, consistency, texture indicates or gives clue for the immunological status of the case on Ridley&Jopling classification so the MB and PB grouping on the basis of number of lesions.
- Patches with sensory loss can be easily diagnosed and counted to be grouped as PB.
- But cases with many or innumerable patches and patches seen with characteristics suggestive of BB and BL which may be diagnosed with bacteriological examination only and difficult to diagnose in field condition confirmation of sensory loss by testing a sensation. These cases may not be diagnosed and grouped into MB in the absence of skin smear facility though they confirm bacteriologically positive. These bacteriologically positive case means infectious cases which may give setback to the whole purpose of early case detection to curtail the source of infection in the community.
2. Bacteriological examination (skin smear)
a. Availability of skin smear facility within the programme.
b. Detection of the cases without skin patches (Lepromatous cases) that is cases with change in skin texture namely smooth, oily, shiny and thickened skin, suspects with nodules, suspects with patches without sensory loss (BB & BL) and macular lepromatous. As these cases are considered to be source of infection being bacteriologically positive and cases of consequences.
All these in mind I have shared a chart ‘A simple guide to diagnose leprosy’ published by ALERT-INDIA, where the basis for MB and PB grouping is attempted to explained based on the clinical and bacteriological features with the help of Ridley&Jopling classification. Which I would like share again.
With best regards,
Rajeev B. Dudhalkar
Mumbai, India
LML - S Deepak, B Naafs, S Noto and P Schreuder
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