Delay in leprosy diagnosis

In the post leprosy elimination era, focus is on diagnosis of early leprosy so as to prevent disabilities or worsening of disabilities. Early lesions of leprosy mimic common dermatologic conditions and neurologic deficit is also minimal. This poses diagnostic challenges. A prospective observational study was carried out at Govt. Medical College attached SSG Hospital, Vadodara (Gujarat), Western India, India over period of 8 months (January 2018 to August 2018) to study the clinical presentation and neurological deficit at the time of diagnosis. All the 40 newly diagnosed cases of Hansen’s disease were included in the study. All these cases were thoroughly examined clinically and detailed history taken, AFB smear was taken and skin biopsy was also done in doubtful cases. Out of these 40 cases, 37 presented with both skin and neurological manifestations (including 1 with facial palsy) and 3 with only neurological manifestations. 11 cases were diagnosed as LL, 14 as BL, 10 as BT, 2 as TT and 3 as Pure Neuritic leprosy. Lepra reaction was observed in 5. Trophic ulcers in 7cases were noted. AFB in slit skin smears were positive in 20 cases and this shows of importance of smears in diagnosis of leprosy. Presentation with advanced neurologic deficit specially grade II disabilities in such nearly one third of these self reporting cases indicates late diagnosis. While the need of histopathological examination due to lack of cardinal features was felt in 7/40 (17.5%), it helped in accurate classification of the disease which has therapeutic relevance. Though nearly half of the cases (18/40) consulted their family physicians, diagnosis was missed due to lack of adequate knowledge and expertise. Awareness in people seems to be an issue as 55% presented 6 months after noticing the symptoms. Access to services to migrant population also appears important. Compared with national and state figures, this appears to be local/ regional problem and needs to be addressed by studies at community level in this area.