In a study done in Thailand, 72% of multibacillary (MB) and 67% of
paucibacillary (PB) patients had a delay in detection of 2 years.
MB-MDT (Multibacillary-multidrug therapy) was given for 2 children and
paucibacillary treatment for the other.
However, anti PGL-l antibodies are not universally positive and sensitivity is low, especially in
paucibacillary cases.
By using our approach, 23 new cases were found after we investigated households that had a person positive for anti-PGL-I (15 multibacillary, 8
paucibacillary); we found only 7 new cases in households where residents were negative for anti-PGL-I (4 multibacillary, 3
paucibacillary) (Table).
Due to the
paucibacillary characteristic of this condition, the sensitivity of these tests is low [3,4].
The complementary observation that children have
paucibacillary disease may support a hypothesis that immune control of TB in this age group is optimal.
Treatment was started according to the multibacillary or
paucibacillary status and the patients were periodically followed up for their compliance.
Six participants (22.2%) had the
paucibacillary classification of leprosy and 21 (77.8%) had multibacillary leprosy.
Considering the limitations of PGL-1 in patients with low BI (less than 3) and
paucibacillary cases, attempts were made to find another method of serodiagnosis.
According to the microbiological classification, 14 patients had a multibacillary form (positive smear) and 1 patient had a
paucibacillary form (negative smear).
Because lupus vulgaris is a
paucibacillary form of tuberculous infection, culture is often negative and the diagnosis is mainly based on the Mantoux test, the histopathological appearance, and the response to chemotherapy [8].
Diagnostic confirmation may be difficult because of many factors including nonspecific clinical signs, coexisting malnutrition, variable interpretation of chest radiographs,
paucibacillary disease, difficulty in obtaining specimens for culture and relatively low rates of bacteriological confirmation.