02270nas a2200313   4500000000100000008004100001260001300042653001200055653001100067653001200078653000900090653001300099653001500112653001700127653003200144653001700176653003000193100001300223700001000236700001200246700001400258700001300272245008800285856007600373300001200449490000700461520147400468022001401942       2008                            d  c2008 Mar10aAnimals10aHumans10aleprosy10aMice10aPakistan10aRecurrence10aRisk Factors10aSensitivity and Specificity10aTime Factors10aWorld Health Organization1 aLinder K1 aZia M1 aKern WV1 aPfau RK M1 aWagner D00aRelapses vs. reactions in multibacillary leprosy: proposal of new relapse criteria.  uhttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-3156.2008.02003.x/pdf  a295-3090 v133 a<p><b>OBJECTIVES: </b>To compare a new scoring system for multibacillary (MB) leprosy relapses, which combines time factor, risk factors and clinical presentation at relapse, to WHO criteria.</p><p><b>METHODS: </b>Data were collected on all relapses diagnosed between 1998 and 2004 at the Marie-Adelaide-Centre in Karachi, Pakistan, including case histories, clinical manifestations, follow-up, bacterial indices, treatment and contacts. For the diagnosis of MB relapses a simple scoring system was developed and validated on a data-set of mouse foot pads (MFP)-confirmed relapses (Leprosy Reviews, 76, 2005, 241). Its sensitivity was further evaluated in the Karachi relapse cohort. The P-value was calculated with McNemar's test with continuity correction.</p><p><b>RESULTS: </b>The new scoring system that combines time factor, risk factors and clinical presentation at relapse had a higher sensitivity in MFP-confirmed relapses than the WHO-criteria (95%vs. 65%, P < 0.01). The sensitivity of the scoring system was also significantly higher than the WHO criteria in the 57 cases of MB-relapses diagnosed in Karachi (72%vs. 54%, P < 0.05).</p><p><b>CONCLUSIONS: </b>This new simple scoring system for diagnosing MB-relapses in leprosy should be further validated in a prospective study to confirm its superior sensitivity and to evaluate the specificity of these criteria by using MFP-confirmation for patients presenting with signs of activity after treatment.</p>  a1365-3156