Leprosy mailing list – July 31st,
2006
Ref.: Diagnosis of leprosy
From: Jianping Shen, Nanjing, Jiangsu, China
Dear Dr Noto,
Thank you for your email and for comment from
Dr Latif Ahmad (LML July 18th,
2006).
Although the question we discussed was "Can leprosy skin lesions
heal and disappear, under treatment, in 3-6 months?", Dr Latif
Ahmad put forward an issue of declaring leprosy. I think it is a good
topic for discussion.
I agree with Dr Latif Ahmad that in a single
leprosy lesion the clinician has to be
very careful in declaring someone as leprosy patient. It is a common sense that
diagnosis of leprosy including indeterminate leprosy must be cautious
in China.
Now the slit skin smear is still a routine
procedure at diagnosis of disease, and the biopsy is also one of
diagnostic procedures if necessary.
When diagnosing the indeterminate patient, usually the
continuous histopathological sections with acid-fast staining are
needed to look for AFB.
It is the right for the patient to know the
truth when doctor diagnoses the patient suffering from leprosy. It is also important that
doctor should teach the patient how to deal with the disease,
including regular treatment, drug allergy, side- effect of drugs, POD,
early dealing with leprosy reaction if happening, and if necessary
keeping secrete treatment of the disease without telling anybody else.
Registration of leprosy, I think, is also a
regulation stipulated by the health bureau of the government in every
country from a point of disease control.
So doctor should confirm whether or not somebody suffered from
leprosy by every possible means. Therapeutic
trial to the doubtful patient is also dangerous sometimes when
developed drug allergy or severe side-effect of the drugs among
patients with hypersensitive characteristic or impaired function of
the kidney and the liver. It
must be explained in detail to the patient. Following up the suspicious
patient for a period of time without any treatment, I consider, is
advisable.
With best regards!
Dr Shen Jianping
