The allocation of leprosy patients into paucibacillary and multibacillary groups for multidrug therapy, taking into account the number of body areas affected by skin, or skin and nerve lesions

Abstract

In Nepal, the setting up and maintaining of reliable services for slit skin smears has proven difficult. A clinical classification system for leprosy has therefore been developed to assist in the allocation of patients to either paucibacillary or multibacillary groups for the purposes ofmulhple drug therapy (MDT), using 9 body areas: head (I), arms (2), legs (2), trunk (4). Patients with more than two areas of the body affected are grouped as multibilcillary (MB) and those with only one or two areas affected are paucibacillary (PB). Using a computer simulation model and the data of 53 patients registered at Green Pastures Hospital (GPH) in Pokhara and 703 field patients from the Western Region, different clinical classification systems were evaluated with regard to their sensitivity, specificity, and predictive value for MB or PB classification, as compared with the histological classification for the GPH cases and the bacteriological classification for the field patients. The sensitivity and specificity of the body area system in present use were 93% and 39%, respectively. The low specificity is due to MB overclassification. The sensitivity of the WHO classifica tion system without skin smear facilities is 73% (the difference with the body area system is significant: p < 0•05, McNemar's test). Our histology findings confirm previous publications indicating that, while some borderline-tuberculoid (BT) patients may outwardly have a 'PB appearance' and be skin-smear negative, their nerve biopsy and sometimes skin biopsy may show a 'MB' picture. This is the first publication discussing a 'body area system' for the purpose described, including diagrams of the areas used. In Nepal it has proved easy to use and teach and its use may be justified in other control programmes which implement MDT, particu larly if slit-skin smear services are unreliable or nonexistant.

A Study of Proportion of Disability and Its Dete Rminants Among Leprosy Patients

“…[6] , study in Nepal by van Brakel showed nearly 8.7%. [7] and Sarkar et all showed 9.4% but in our study compared to all other studies slightly higher 13% of pure neuritic leprosy going for deformity. Males suffered more than their female counterparts, which may be due to their more exposure to outdoor activities making them more vulnerable to different injuries.…”

Disability among new leprosy patients, an issue of concern: An institution based study in an endemic district for leprosy in the state of West Bengal, India

“…A study in South India by Mahajan and others had found lower proportion of neuritic leprosy (4.6%) compared to this study [14] but the study in Nepal by van Brakel showed nearly similar proportion (8.7%) of neuritic leprosy patients. [15] Kumar et al, [16] also found (2004) paralytic deformity was highest (26%) among neuritic leprosy patients.…”

Methods for the Classification of Leprosy for Treatment Purposes

“…Oskam [8] reviewed previous studies [9][10][11][12][13][14], mostly prior to 1993, that compared the number of skin lesions (although not always with 15 as the cutoff) and body zones involved with skin smears or biopsies with a BI value 10-1 (table 4). The first 3 studies resulted in a low specificity (39%-42%) for a clinical diagnosis of MB leprosy in locations where MB leprosy is more common [9][10][11] but not in areas where it is less common (81%-88%) [12,13]. Misclassifying patients with PB leprosy as having MB leprosy may result in overtreatment, whereas misclassifying patients with MB leprosy as having PB leprosy may result in undertreatment.…”