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Leprosy skin lesion — DTM&H MCQ

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HardDermatological tropical conditionsLeprosy skin lesionDTM&H

A man has three anaesthetic hypopigmented patches, a negative slit-skin smear and definite weakness in the distribution of a thickened ulnar nerve. Under the current WHO operational classification used to select treatment, how is this case classified?

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Correct answer: A — Multibacillary under the peripheral-nerve involvement criterion

The best answer is “Multibacillary under the peripheral-nerve involvement criterion”. Current WHO operational criteria classify a case as multibacillary when there are more than five lesions, a positive smear, or peripheral-nerve involvement, including neuritis with any number of skin lesions. The simplified paucibacillary lesion-count rule misses motor nerve disease, an indeterminate label ignores cardinal clinical signs, pure neural leprosy is incompatible with visible anaesthetic lesions, and a negative smear does not exclude clinically diagnosed leprosy. This classification determines 12 rather than 6 months of multidrug therapy.

Reference: WHO: Leprosy (Hansen disease): https://www.who.int/health-topics/leprosy