Pitfalls in the diagnosis of leprous neuropathy: Lessons learnt from a University hospital in an endemic zone

摘要: Leprosy is the oldest disease known to mankind and has piqued humans since Before Christian Era (BCE) [1]. The causative agent, Mycobacterium leprae, was thefirst bacterium be identified as causing in humans. Effective treatment, viz, Promin, introduced only 1940s. Multi-drug therapy came into vogue 1970s [2,3] popularised by World Health Organisation (WHO) 1980s. This resulted a rapid decline new case detection rates [4]. Global efforts eliminate leprosy have met with partial success continues prevail certain endemic pockets developing countries [5–8]. In India prevalence of reduced from 58 per 10,000 population 1980 0.69 2010 [9]. Thus, been ‘eliminated’ public health problem.However, this not ensured complete interruption transmission cases continue occur, sometimes after several years because long incubation period. underscores need for active continued identify primary targets M. leprae are skin peripheral nerves [6]. diagnosis rests on demonstration one or more three cardinal signs namely anaesthetic/hypoesthetic patches, thickened impaired sensation areas innervated affected acid-fast bacilli smear [4,10]. Characteristically, superficial cooler regions body [11,12]. commonly include ulnar, radial, median, lateral popliteal, tibial, facial trigeminal [13]. Leprous neuropathy can occur absence lesions [14]. Even presence lesions, mismatch severity vis-a-vis occurs. Thus may paucibacillary skin, but multibacillary [15,16]. Untreated delayed treatment major cause disability, deformity, morbidity social isolation patients [11]. it imperative recognise establish an early institute timely therapy. Meanwhile, each considered highly sensitive specific A considerable skill experience required detecting their failing which missed [17].