WS 291-2008Diagnosis for leprosy (English PDF)

Foreword

Chapter 5 of this standard is mandatory and the rest are recommended.

This standard was drafted in accordance with the rules given in GB/T 1.1-2009.

This standard replaces WS 291-2008 "Diagnostic Standards for Leprosy".

Compared with WS 291-2008, the main technical changes of this standard are as follows.

- Revised the Diagnostic Basis section (see Chapter 3, Chapter 3 of the 2008 edition);

- Removed the original damage biopsy histological examination clause (see 3.1.3.2 of the 2008 edition);

- increased the histological examination of skin damage (see 3.2.2);

- Added diagnostic criteria for leprosy response (see 5.2);

- Deleted the MDT program and treatment (see Table D.2 of the 2008 edition);

- Revised the clinical cure (clinical inactivity) standard section (see F.2);

- Increased the method of inoculation of M. vaginalis by mouse footpad (see Appendix G).

This standard was drafted. China Center for Disease Control and Prevention, Leprosy Control Center, Guangdong Provincial Center for Dermatology and Venereology, Jiangsu Province Prevention and Control Center, Shanghai Dermatology Hospital.

1 Scope

This standard specifies the diagnostic basis, diagnostic principles, diagnosis and differential diagnosis of leprosy.

This standard applies to the diagnosis of leprosy in various types of medical and health institutions and their medical staff at all levels.

2 Terms and definitions

The following terms and definitions apply to this document.

Mycobacterium leprosy mycobacterium leprae; ML Leprosy Intracellular parasites, positive for acid-fast staining, arranged in bundles or clustered, have special properties for Schwann cells and reticuloendothelial cells Affinity.

Acid-fast bacillus anti-fast bacillus; AFB when dyeing by Ziehl-Neelsen method, the bacteria can be red-dyed red by carbolic acid, and can not be acidized under the specified conditions after coloring.

Decolorized bacilli. Acid-fast bacilli include M. leprae, Mycobacterium tuberculosis and some other mycobacteria.

Bacterial morphology index the sum of the complete bacteria of each part (coating film) divided by the sum of the whole bacteria and non-intact bacteria of each part (coating film), generally as a percentage table Show.

Bacterial density index when the skin tissue fluid smear is examined, the sum of the density of the leprosy bacteria of each of the bacteria-detecting parts (coating film) and the spot of the investigation (coating film) the ratio of the totals (the result is one digit after the decimal point).

Leprosy endemic area in the county (district), there are areas where there are new leprosy patients in the local resident population within 3 years.

Leprosy nodular erythema nodosum leprosum; ENL an acute or subacute hypersensitivity reaction of the body to ML antigen in patients with leprosy during chronic disease is the main cause of leprosy type II response to be expressed, belongs to the antigen-antibody complex type hypersensitivity reaction with complement involvement.

Leproy reaction

In patients with leprosy, the original skin lesions suddenly appear red, swollen or new skin lesions, or severe peripheral nerve swelling Pain, new disability, called type I (reverse) reaction; or leprosy nodular erythema, iritis, lymphadenitis, orchitis or hair the case where some or all of the heat is expressed is called a type II reaction.

Early case patient at early stage Newly diagnosed cases with short duration (generally within 1 year) and no disability or irreversible nerve damage.

Advanced patient at advanced stage Newly diagnosed cases with long-term (more than 2 years) lesions with extensive or severe disability and/or nerve damage.

2.10

Relapsed patient

Complete the prescribed course of treatment, show normal efficacy, and clinical, bacterial or histopathology after clinical cure (clinical inactivity) Patients with evidence of disease reactivation.

3 Diagnosis basis

4 Diagnostic principles

According to epidemiological history, clinical manifestations, combined with laboratory tests (skin smear examination of AFB and tissue biopsy for leprosy-specific pathology) Make a comprehensive analysis to make a timely and accurate diagnosis.

5 Diagnosis

6 Differential diagnosis

Clinically, there are many diseases that need to be identified with leprosy. Therefore, we should fully understand the clinical features of leprosy, master its diagnostic points and diagnosis.

Broken skills, combined with epidemiological history, laboratory findings and the need to identify the clinical features of the disease, through careful and comprehensive analysis can make a diagnosis of this disease. Skin diseases, neurological diseases, other diseases, and skin that need to be differentiated from leprosy can also be found in acid-fast bacilli See Appendix H for the disease.

Appendix A

(normative appendix) Clinical examination method A.1 Medical history inquiry and clinical damage examination Talk to the patient and their family to get a real history of leprosy. Mainly understand the exact name, age, address, Occupation, work unit and place of birth, whether it has been in the leprosy epidemic area, whether there is family history or contact history. Try to review the initial symptoms and their development During the birth time, the skin lesions have no itching, ant walking, acupuncture, burning and pain. With or without skin damage, eye, hand, foot feels diminished or mourned Loss, hand and foot weakness, paralysis and other movement disorders. Inquire about its duration and evolution, and master the whole process of seeking medical treatment, and outcome.

Skin damage examination should be carried out under bright natural light and suitable temperature conditions. The focus of the examination is on the skin, mucous membranes and surrounding areas.

nerve. The inspection method and requirements are explained to the subject in advance to obtain the cooperation. Should be from head to toe, from front to back, at different angles and distances Separately, a detailed examination of the whole body is performed in order to clearly identify any lesion on the skin and include concealed parts as much as possible. Peripheral nerve examination Under the bilateral contrast, the thickness, shape, texture, uniformity, tenderness and radiation pain of the surrounding superficial nerves were examined. Pay attention to the presence or absence of neuroma, Nerve abscess or fibrosis.

A.2 Physical examination A.2.1 Examination of skin damage A.2.1.1 Type and form of skin damage such as macules, papules, plaques, nodules and infiltration, with or without "immune zone" or "satellite" damage.

A.2.1.2 Edge

Whether it is clear or not, whether it is infiltrated or raised. If it is ring-shaped, it is necessary to separately describe whether the inner and outer edges are clear. Pay special attention to large maps, the center is located near the edge of the normal skin color immune area lesion.

A.2.1.3 Number and size those with less skin lesions can count directly, and many can write mostly or hard to count. The size can be described in kind (such as miliary, soy or silver dollar size), it is also possible to measure the longitudinal and transverse diameters in units of cm.

A.2.1.4 Color and luster such as light, light red, tan or rose, etc.; whether the skin lesions are infiltrated, shiny, atrophic or dull.

A.2.1.5 rash surface High, flat or sunken, dry or juicy, smooth or rough, with or without scales, hair loss and "immune zone".

A.2.1.6 Distribution Clustering or not, limited or extensive, symmetrical or asymmetrical.

A.2.1.7 Hardness and activity Hard or soft, active or inactive.

A.2.1.8 Shallow sensation, investigation and pathological changes Skin damage is associated with shallow sensory disturbance, positive or negative detection, and specific pathological changes in leprosy.

A.2.2 Inspection of nerve damage A.2.2.1 Neuromorphological examination A.2.2.1.1 supraorbital nerve. the upper incision and the eyebrow arch are perpendicular to the forehead. Use both hands to hold the subject's ankle while checking, both thumbs Touch from the inside to the outside of the eyebrow to check for abnormal nerves and abnormal hardness.

A.2.2.1.2 Auricular nerve. 1/3 out of the posterior edge of the sternocleidomastoid muscle, subcutaneously obliquely inward and upward, and the muscle crosses behind the ear. an examination when the subject's head is later tilted and turned to the opposite side, it can be touched to check for nerve enlargement and abnormal hardness.

A.2.2.1.3 ulnar nerve. the proximal end of the carpal tunnel through the iliac crest, the proximal end of the elbow and the ulnar side of the transverse ligament of the wrist. The examinee will be closed at the time of examination.

The section is slightly flexed and abducted. The examiner holds the forearm in one hand and touches the ulnar nerve groove upwards in one hand. Or the left hand grasps the subject's hand in the transverse ligament of the wrist.

The proximal side of the ulnar carpal tunnel was touched to check for abnormal nerves and abnormal hardness.

A.2.2.1.4 Median nerve. During the examination, touch the wrist between the wrist and the palmar tendon muscle, pay attention to whether there is tenderness and observe whether the part is present or not.

swelling.

A.2.2.1.5 phrenic nerve. During the examination, touch the phrenic nerve between the sacral sulcus and the superficial temporal nerve at the lateral head of the humerus in the middle of the upper arm.

Check for abnormal nerves and abnormalities in hardness.

A.2.2.1.6 Common peroneal nerve. the inner edge of the biceps femoris muscle outside the axilla, and the posterior humeral head. During the examination, the knee of the subject is slightly flexed, since Touch the outside of the armpit to check for abnormal nerves and abnormal hardness.

A.2.2.1.7 sacral nerve. The upper end of the fistula (inward iliac and upper 1/3 of the heel) after the medial malleolus is examined for neurological coarseness and abnormal hardness.

A.2.2.1.8 cutaneous nerve. examination of skin lesions and cutaneous nerves in or near the numb area, with or without nerve enlargement and hardness.

A.2.2.2 Peripheral nerve function test A.2.2.2.1 Sensory function check A.2.2.2.1.1 Skin pain, touch temperature perception test. The sensory test has high specificity and low sensitivity, often subjective components, and needs to be obtained.

The cooperation of examiners can reflect objective results. Before the examination, explain the purpose, method and requirements of the examination to the examinee patiently and meticulously. First in normal Test on the skin, so that the patient can understand the method of examination, and then point it to the closed eyes or cover the eyes with the object, indicating the feeling of the tested part.

what. The skin lesions were compared with the corresponding normal skin, and their expressions and responses were observed to determine the credibility of the test results. When the subject If the thought is not concentrated or the inspection result is uncertain, it should be retested. It should be noted that not all leprosy lesions must have sensory impairments.

In the early LL end patients, the erythema of the trunk and the diffuse infiltration of the face were not obvious.

A.2.2.2.1.1.1 Pain. Take two pins or needles, and use the tip or blunt tip to stimulate the normal skin and the corresponding lesions alternately.

Let the subject answer whether it is "spike" or "blunt", or "pain" and "no pain." Normal people can answer clearly and observe their expression and presence or absence.

Avoid stimulating movements; those with hypoalgesia are unclear or slow to respond to "tip" and "blunt"; those with pain loss are indistinct, blunt, or no pain, only feeling touched.

A.2.2.2.1.1.2 Tactile. Lightly touch the normal skin and the corresponding skin lesions with cotton wool or soft feather at the end of the cotton swab.

The person feels that the object touches in time, indicating the number of times the site is touched or the order in which the answer is reached. Those with normal touch, pointing to the test site or reporting no False; those who are declining, most of them are pointing, the report is not allowed or the response is slow; those who are lost cannot be pointed or reported. Hand and foot protective sensation should be used with beads Tip check.

A.2.2.2.1.1.3 Temperature sense (cold and heat sensation). use two test tubes, one for cold water (about 10 °C), one for hot water (about 50 °C), with two the lower end of the test tube is alternately tested for normal skin and corresponding lesions to understand its sensitivity to cold and heat. Most of the losers answered incorrectly or late Slow; the loser can not distinguish between cold and hot test tubes.

A.2.2.2.2 Motion function check A.2.2.2.2.1 Contrast examination, record the muscle strength of the muscles affected by the affected nerve, determine the resistance of each innervating muscle, with or without 瘫痪 or shrinking.

A.2.2.2.2.1.1 Face. Observe facial nerve dysfunction by squatting, frowning, closing eyes, whistling and tooth decay. Order the examiner closes his eyes to see if the upper and lower eyelids can be closed and whether there is any valgus; if it cannot be closed, the distance (mm) of the cleavage should be measured and recorded.

A.2.2.2.2.1.2 Hand. Determine the presence or absence of dysfunction of the upper limb nerves (ulnar nerve, median nerve, and radial nerve). Observe the finger abduction, inside Receiving, the situation and strength of the thumb palm side abduction, palm, fist, wrist dorsiflexion.

A.2.2.2.2.1.3 Foot. Observe the dorsiflexion, varus, valgus of the subject's foot, as well as the condition and strength of the flexion and toe, and examine the lower limbs.

There are no dysfunctions in the sacral nerve and the posterior tibial nerve.

A.2.2.2.3 Autonomic nerve function test Check for signs of sweating at the lesion, and whether the tripartite reaction in the histamine test is complete.

A.2.2.2.4 Judgment of disability in the event of a disability, it should be recorded using the WHO Level 0 to 2 disability classification method (see Exhibit E.3).

A.2.3 Examination of eye diseases all types of leprosy patients are often accompanied by primary or secondary eye disease, and attention should be paid to eye examination. Mainly pay attention to whether the eyebrows and eyelashes are off Fall; presence or absence of trichiasis, blinking and closed eyes. Whether the cornea feels normal, whether the eyes have pain, photophobia or foreign body sensation. Check for cornea White spot, ulcer or turbidity, sclera congestion. Is there a leprosy, whether the iris texture is clear, whether the pupil is regular, and the response to light is Whether it is sensitive, whether the intraocular pressure is increased, etc.

A.2.4 Other inspections Especially in the case of advanced and advanced patients (MB), ear, nose, pharynx, larynx, lymph nodes and internal organs should be examined.

A.3 Clinical trials

Whether the peripheral nerve function is damaged, or in the skin lesions or numbness, through the histamine test, sweat test and the vertical muscle test Test. However, these tests are not specific. They can also be abnormal in peripheral nerve diseases or trauma. Some patients with early leprosy can also be normal.

Should, be noted to exclude.

Appendix B

(normative appendix) Skin smear method (Ziehl-Neelsen acid-fast staining method) B.1 Skin smear B.1.1 Selecting the smear Skin smear smear, generally take 4 to ...