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Indeterminate leprosy — DTM&H MCQ

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HardDermatological Tropical ConditionsIndeterminate leprosyDTM&H

A patient has three hypopigmented anaesthetic plaques and weakness in muscles supplied by a thickened ulnar nerve. Slit-skin smears are negative. How should WHO classify the disease for treatment?

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Correct answer: C — Multibacillary leprosy because clinically evident nerve involvement is present

The best answer is “Multibacillary leprosy because clinically evident nerve involvement is present”. WHO classifies any case with nerve involvement as multibacillary, even with five or fewer lesions and negative smears. Lesion count alone would classify uncomplicated smear-negative disease as paucibacillary, but it cannot override neuritis. “Indeterminate” is not the operational alternative created by a negative smear, bacilli are not required when cardinal clinical signs exist, and nerve thickening with functional loss is highly relevant.

Reference: WHO, Leprosy fact sheet: https://www.who.int/en/news-room/fact-sheets/detail/leprosy