Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study

Abstract

Background Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis. Methodology/Principal findings In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms. Conclusions Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.

Epidemiological characteristics of leprosy during the period 2005–2020: A retrospective study based on the Chinese surveillance system

“…Furthermore, in the early stages of leprosy, patients often face misdiagnosis because the various early symptoms can be non-specific, which makes early diagnosis extremely difficult. The typical clinical symptoms include discoloration, nodules, and deformities or disfigurement ( 63 ). A similar conclusion has also been obtained by Chu et al ( 57 ) in Shandong Province.…”

A Bibliometric Analysis of Leprosy during 2000–2021 from Web of Science Database

“…The hotness of the network clusters is sorted by serial number size: (#1) Public health: In this cluster, the priorities for leprosy studies include the need to create accurate methods to detect individuals who are in subclinical infection and diagnose new cases correctly (especially in the early stages of the disease). If the clinicians diagnose early and particularly treat them well, there will be no disabilities and concerns about the quality of life [ 27 ]; and to provide ongoing professional health training to improve patients’ quality of life and develop campaigns to raise awareness of the disease and reduce stigma [ 28 ]. There has been a growing body of research on “stigma” in recent years, which may raise eyebrows in the future.…”

The burden of physical disability among patients with newly detected leprosy in Yunnan, China, 1990–2020: A population-based, cross-sectional survey

“…Claw hand, plantar insensitivity and simple plantar ulceration were the most frequent disabilities in the hands and feet. In our previous studies, nerve enlargement in the peripheral upper limbs detected by ultrasound [ 14 ] and claw hand were the most frequently reported symptoms in leprosy patients [ 15 ]. Lagophthalmos, insensitivity and decreased visual ability were the most frequent disabilities of the eyes.…”