02668nas a2200301   4500000000100000008004100001260001300042653002600055653002300081653001500104653001100119653003100130653001100161653002300172653002200195653001200217653003100229653002500260653001400285653003000299100001600329700001500345245007200360300001100432490000800443520190100451022001402352       2008                            d  c2008 Jul10aAnti-Infective Agents10aAntibody Formation10aBiomarkers10aBrazil10aDrug Resistance, Bacterial10aHumans10aImmunity, Cellular10aImmunologic Tests10aleprosy10aMolecular Probe Techniques10aMycobacterium leprae10aPrognosis10aSeverity of Illness Index1 aGoulart IMB1 aGoulart LR00aLeprosy: diagnostic and control challenges for a worldwide disease.  a269-900 v3003 a<p>Leprosy is a curable disease with well-defined etiology, but lacks better diagnostic tools, preventive and therapeutic strategies. The continued application of the Ridley-Jopling clinical classification that recognizes the natural diversity of the immune response has provided the basis for understanding leprosy, and this review proposes its implementation in all Reference Centers in order to standardize the diagnostic resources, aiming at the improvement of the disease control. Due to the broad bioepidemiological aspects of infection its eradication is difficult, and proper diagnosis of the disease and the correct clinical classification are required to ensure proper treatment. Tools and markers for diagnosis and prognosis, and the novel use of nanotechnology, as well as strategies for disease control and monitoring populations at higher risk are still continuous challenges, which will be specifically reviewed with additional insights. The use of the current diagnostic tools, such as ELISA and PCR has a very limited approach for leprosy that has been considered as a marginal disease; therefore, the current diagnostic tools must be applied extensively in the routine to accumulate clinical experience in order to improve their precise application, like what has been done in many other infectious diseases. Since a vaccine for leprosy presents an unpredictable future, the proposed chemoprophylaxis of contacts (healthy carriers and/or with subclinical infection) must also be employed in referral centers of endemic countries not only to evaluate its efficacy, but also because of the favorable cost-benefit ratio, given that there is no other available approach, besides the multi-drug therapy of patients. This strategy should readily be applied as a public health policy, and may lead to a substantial breakage of the transmission chain aiming a world without leprosy.</p>  a1432-069X