7. Pauci-bacillary

reconciliation, since evidence previously interpreted as supporting the diagnosis of "leprosy" should be carefully considered. In contrast, typical skeletal mutilation in the form of severe leprosy leaves a distinctive footprint of disease that may be identified in historic relics with high

More advanced leprosy presentations have been reported and classified as tuberculoid leprosy and lepromatous leprosy. Many other clinical presentations, known as intermediate or borderline leprosy, have been identified and classified among the two types. The Ridley and Jopling System (RJ) defines five clinical presentations of leprosy: polar tuberculoid leprosy (TT), borderline tuberculoid leprosy (BT), borderline-borderline leprosy (BB), borderline leproma-

But according WHO classification, leprosy is divided into two major groups: pauci-bacillary subtype and multi-bacillary subtype. The WHO system is based on the quantity of skin lesions and the number of bacilli on skin smear. Skin smears are made by squeezing a fold of skin and making a shallow slit in the skin with a scalpel [23]. The two main categories of the WHO classification system are: (1) pauci-bacillary (PB) leprosy: ≤5 skin lesion with no bacilli on skin smear and (2) multi-bacillary (MB) leprosy: ≥6 skin lesion and may have bacilli

The Ridley-Jopling classification system is based on the histopathology of skin lesions and essentially represents a spectrum of disease. The spectrum of leprosy classification is not static. For example, in some cases, untreated TT can progress into LL, given a long enough time and the proper immunologic environment. There are the two classification systems that are mutually exclusive. Indeterminate and tuberculoid leprosy (TT) are commonly referred to as PB leprosy, while BB and LL are commonly referred to as MB leprosy [23, 24]. This was confirmed by the WHO Expert Committee on Leprosy at the seventh meeting in 1997, which defined a case of leprosy as follows: A case of leprosy is someone who has one or more of the following features and who still needs to complete a complete treatment: skin lesions hypopigmentation or redness with a definite loss of sensation, peripheral nerve involvement, as shown by neural thickening accompanied by loss of sensation, as well as positive skin-smears for acid-fast

a. Approximately 70% of leprosy patients can be diagnosed using a single mark of anesthetic

b. 30% of all patients, including many MB patients, do not show with this sign, and health

c. The referral of a suspect who has no anesthetic symptoms is given to a person with a higher experience who has been taught peripheral nerves should be straightforward. Palpation of only two nerves (ulnar and common peroneal) may allow diagnosis of as

d. Classification should be based on the number of skin lesions: PB < 5 patches; MB > 5

The following recommendations are based on the evidence just described:

many as 90% of patients with neural enlargement.

skin patch, and this leprosy sign should be taught as widely as possible.

care workers should be taught to suspect and refer other possible cases.

tous leprosy (BL), and polar lepromatous leprosy (LL) [22].

12 Current Topics in Tropical Emerging Diseases and Travel Medicine

levels of certainty [21].

on skin smears.

bacilli [24].

patches.

Pauci-bacillary leprosy is found in people with good CMI. The disease remains localized to produce single or little skin lesions with or without peripheral nerve involvement. The skin lesion may be macular (flat) or papule (slightly raised) and plaque. People with strong immune responses are capable of destroying large amounts of normal organisms and skin normally most of them exhibit negative skin examinations.
