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Pediatric Leprosy Workup

  • Author: Benjamin Estrada, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Sep 30, 2013
 

Laboratory Studies

While in contact with patients with leprosy, healthcare workers should employ standard precautions. It has been suggested that M leprae is sensitive to ultraviolet light, and this sensitivity may be useful in sterilization and disinfection practices.[13]

M leprae cannot be cultured in vivo; however, some laboratory studies are available that can be useful in the diagnosis of leprosy. Measurement of phenolic glycolipid-1 antibodies may be helpful in epidemiologic studies and follow-up treatment.

Detection of M leprae by polymerase chain reaction (PCR) is promising; however, PCR detection is not widely available and has not been standardized. RNA gene probes have been used to assist in the diagnosis and response to treatment among patients with paucibacillary (PB) and multibacillary (MB) disease. The absence of M leprae rRNA in skin samples of previously diagnosed patients correlates with response to treatment. Probes targeting 16S rRNA and 16S rDNA have been used in the diagnosis of smear-negative MB disease.[14, 15, 16, 17]

Drug resistance can be tested in vivo by inoculation of mouse footpad. This type of test is not widely accessible, and results are not usually available until 6 months after inoculation.[18]

Lepromin testing is an intradermal skin test that contains heat-killed M leprae. Patients with PB leprosy and individuals who are asymptomatic but live in endemic areas usually present an area of induration after the antigen administration; however, patients with MB leprosy rarely react to the administration of this antigen. The use of this test has no practical diagnostic value and has recently been discouraged.

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Tissue Analysis and Histologic Findings

Skin biopsies and smears are helpful not only in establishing the diagnosis of leprosy but also in the process of establishing the difference between PB and MB disease. Skin biopsy specimens obtained from patients with leprosy should always be stained with hematoxylin and eosin (H&E) and an acid-fast stain.

In PB leprosy, giant cells in skin and nerves may accompany accumulation of epithelioid-lymphocyte granulomas. Bacilli are rare in this type of leprosy, and they are not present in nerves. In LL leprosy, bacilli are abundant; they can be observed in the areas surrounding blood vessels and are also present in nerves.

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Contributor Information and Disclosures
Author

Benjamin Estrada, MD Professor, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine, University of South Alabama Children's and Women's Hospital

Benjamin Estrada, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

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Infiltration of ear lobes in patient with lepromatous leprosy.
Man with advanced deformities caused by unmanaged leprosy: keratitis, loss of eyebrow, thickened skin, and typical hand impairments. Ho Chi Minh City, Vietnam. Image courtesy of D. Scott Smith, MD.
 
 
 
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