In contrast with tuberculoid cases, lepromatous patients show very low or no resistance at all and therefore have very large numbers of M. Leprae in the skin, peripheral nerves and various organs.
Skin lesions |
innumerable macule, papules, nodules, infiltration; sometimes “histoid nodules” shiny firm nodules usually found in relapse; slight or no hypopigmentation; no loss of sensation. |
Nerves |
nerve trunk damage occurs late, usually years after the onset of the disease and is extensive |
Eyes |
eye involvement as a result of the presence of M. leprae in the eye: nodules may grow on the conjunctiva, in the sclera and cornea; sensory fibres in the cornea may be damaged leading to further damages of the insensitive cornea, resulting in opacities (scar tissue); the iris may be involved, causing an acute or chronic iridocyclitis. |
Skin smears |
are always highly positive for AFB |
Other organs |
nose, mouth, throat and in women breasts and testes in mencan also be affected. |
The classification of leprosy and the distinction between multi bacillary and paucibacillary are important because there are differences in infectiousness, treatment duration and in the problems of reactions and complications.
For the choice of MDT regimen, patients should be allocated either to the PB or to the MB group. If there is doubt about the classification, the patient should be classified as MB and treated accordingly. This in particular applies to patients who have been treated with dapsone before MDT, and for whom the available records or clinical findings give insufficient evidence for the original classification.
PB patients: are patients who are clinically TT or BT and who have negative skin smears. All clinically PB. patients who have a positive skin smear result (B1 = 1 or more) should be allocated to the MB regimen.
MB patients: are patients who are clinically BL or LL and all PB cases with a positive skin smear result (B1 = 1 or more).
If clinical classification cannot be confirmed by bacteriology, then all patients who are clinically MB and have negative skin smear results should be allocated to the MB regimen
In case of doubt, for reasons of unreliable or inconsistent results of the skin smear, any leprosy patient with more then 10 lesions should be allocated to the MB regimen.
In this way as few MB leprosy patients as possible will be wrongly allocated to the PB category.
