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Allocation of patients to paucibacillary or multibacillary drug regimens for the treatment of leprosy--a comparison of methods based mainly on skin smears as opposed to clinical methods--alternative clinical methods for classification of patients.
Int J Lepr Other Mycobact Dis. 1991 Jun; 59(2):292-303.IJ

Abstract

This paper reports on the experience with classification of patients at the All-Africa Leprosy and Rehabilitation Training Centre (ALERT) in the Shoa Province in Ethiopia. Classification on clinical grounds is compared with classification which is primarily based on the result of skin-smear examinations. In addition, possible alternative clinical methods for the allocation of patients to the multidrug therapy (MDT) regimens are discussed. The analysis includes 1525 new patients. In 730 patients classified clinically as paucibacillary (PB), this classification was not confirmed by skin-smear results in only 1.5%; whereas in 795 patients classified clinically as multibacillary (MB), the classification was not confirmed in 21.1%. Possible reasons, notably for the latter discrepancy, are discussed. Based on an assessment of the correctness of the diagnosis and the most probable classification, it was found that if classification had been based on the skin-smear results, 9.3% of the 795 patients classified as MB would have been classified incorrectly as PB. Classification based on clinical signs resulted in incorrect classification, MB instead of PB, of 8.7% of the 795 patients. Over-classification of MB patients, which was found to be supervisor related, is open to improvement by a strict application of clinical criteria for classification. The experience in the ALERT leprosy control program shows that classification which is based on clinical signs may, in particular, result in some PB patients being classified as MB, while classification based on the results of skin-smear examinations is more likely to result in some MB patients being classified as PB. It was concluded that, provided a number of requirements aimed at limiting the number of misclassified patients are introduced, patients can be classified based on clinical signs and, hence, in the absence of skin-smear services for routine classification purposes.

Authors+Show Affiliations

Leprosy Control Division, All Africa Leprosy and Rehabilitation Centre (ALERT), Addis Ababa, Ethiopia.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

2071986

Citation

Becx-Bleumink, M. "Allocation of Patients to Paucibacillary or Multibacillary Drug Regimens for the Treatment of Leprosy--a Comparison of Methods Based Mainly On Skin Smears as Opposed to Clinical Methods--alternative Clinical Methods for Classification of Patients." International Journal of Leprosy and Other Mycobacterial Diseases : Official Organ of the International Leprosy Association, vol. 59, no. 2, 1991, pp. 292-303.
Becx-Bleumink M. Allocation of patients to paucibacillary or multibacillary drug regimens for the treatment of leprosy--a comparison of methods based mainly on skin smears as opposed to clinical methods--alternative clinical methods for classification of patients. Int J Lepr Other Mycobact Dis. 1991;59(2):292-303.
Becx-Bleumink, M. (1991). Allocation of patients to paucibacillary or multibacillary drug regimens for the treatment of leprosy--a comparison of methods based mainly on skin smears as opposed to clinical methods--alternative clinical methods for classification of patients. International Journal of Leprosy and Other Mycobacterial Diseases : Official Organ of the International Leprosy Association, 59(2), 292-303.
Becx-Bleumink M. Allocation of Patients to Paucibacillary or Multibacillary Drug Regimens for the Treatment of Leprosy--a Comparison of Methods Based Mainly On Skin Smears as Opposed to Clinical Methods--alternative Clinical Methods for Classification of Patients. Int J Lepr Other Mycobact Dis. 1991;59(2):292-303. PubMed PMID: 2071986.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Allocation of patients to paucibacillary or multibacillary drug regimens for the treatment of leprosy--a comparison of methods based mainly on skin smears as opposed to clinical methods--alternative clinical methods for classification of patients. A1 - Becx-Bleumink,M, PY - 1991/6/1/pubmed PY - 1991/6/1/medline PY - 1991/6/1/entrez SP - 292 EP - 303 JF - International journal of leprosy and other mycobacterial diseases : official organ of the International Leprosy Association JO - Int J Lepr Other Mycobact Dis VL - 59 IS - 2 N2 - This paper reports on the experience with classification of patients at the All-Africa Leprosy and Rehabilitation Training Centre (ALERT) in the Shoa Province in Ethiopia. Classification on clinical grounds is compared with classification which is primarily based on the result of skin-smear examinations. In addition, possible alternative clinical methods for the allocation of patients to the multidrug therapy (MDT) regimens are discussed. The analysis includes 1525 new patients. In 730 patients classified clinically as paucibacillary (PB), this classification was not confirmed by skin-smear results in only 1.5%; whereas in 795 patients classified clinically as multibacillary (MB), the classification was not confirmed in 21.1%. Possible reasons, notably for the latter discrepancy, are discussed. Based on an assessment of the correctness of the diagnosis and the most probable classification, it was found that if classification had been based on the skin-smear results, 9.3% of the 795 patients classified as MB would have been classified incorrectly as PB. Classification based on clinical signs resulted in incorrect classification, MB instead of PB, of 8.7% of the 795 patients. Over-classification of MB patients, which was found to be supervisor related, is open to improvement by a strict application of clinical criteria for classification. The experience in the ALERT leprosy control program shows that classification which is based on clinical signs may, in particular, result in some PB patients being classified as MB, while classification based on the results of skin-smear examinations is more likely to result in some MB patients being classified as PB. It was concluded that, provided a number of requirements aimed at limiting the number of misclassified patients are introduced, patients can be classified based on clinical signs and, hence, in the absence of skin-smear services for routine classification purposes. SN - 0148-916X UR - https://www.unboundmedicine.com/medline/citation/2071986/Allocation_of_patients_to_paucibacillary_or_multibacillary_drug_regimens_for_the_treatment_of_leprosy__a_comparison_of_methods_based_mainly_on_skin_smears_as_opposed_to_clinical_methods__alternative_clinical_methods_for_classification_of_patients_ L2 - https://medlineplus.gov/mycobacterialinfections.html DB - PRIME DP - Unbound Medicine ER -