This is the new leprosy (LL) case found in Dist. Nashik.
Diagnosis and the clinical spectrum of leprosy
Systematically searching for the 3 cardinal signs will allow the diagnosis of leprosy in most of the cases but, 3 concepts need to be explained:- firstly the cardinal signs are just part of the vast clinical picture of leprosy; secondly their relevance is in relation to the clinical spectrum of the disease and, therefore with its classification; thirdly there are a few, mostly early, leprosy cases where none of the cardinal signs is present.
The cardinal signs are just part of the vast clinical picture of leprosy.
The reader will be able to conveniently cover the vast clinical picture of leprosy after studying the following subjects: - history taking, physical examination, classification, reactions and nerve damage and, disabilities. Herewith we deal with the signs and symptoms of the disease that are relevant to the 3 cardinal signs. Other important signs and symptoms are mentioned only.
The relevance of the cardinal signs is related to the clinical spectrum of the disease and, therefore to its classification.
Knowledge of the classification of the disease has to guide the physician or the paramedical worker during the assessment of the patient. In tuberculoid (TT) leprosy the slit-skin smear examination is negative. In borderline tuberculoid (BT) leprosy slit-skin smear examination is normally negative but, sometimes it may be positive (Part I. Introduction Slide 22.). In these (TT and BT) forms of leprosy the diagnosis should be based on the presence of loss of sensation in skin lesions and/or enlarged peripheral nerves. In mid borderline (BB) leprosy the slit-skin smear examination is normally positive, sensation on skin lesions may be preserved or lost. Here the diagnosis can be based upon all of the 3 cardinal signs. In borderline lepromatous (BL) leprosy slit-skin smear examination is positive, sensation on skin lesions may be preserved or lost. Here the diagnosis can be based upon all of the 3 cardinal signs. In lepromatous (LL) leprosy slit-skin smear examination is positive but sensation on skin lesions is often preserved. Here the diagnosis is based on positive slit-skin smear examination and or enlarged peripheral nerves.
