II. Presentation on Current Issues and Workshop Reports
Disease and Disease Control
A. THEME： DISEASE AND DISEASE CONTROL
Moderator： Prof. W.C.S. Smith
A) PRESENTATION ON CURRENT ISSUES
1) Defining the Disease and Antibacterial Therapy
Dr. R. Jacobson
My brief introductory talk for this Workshop will, first of all, focus on defining the disease and secondly on antibacterial therapy.
Defining the Disease：
I think it is helpful to begin by looking at the World Health Organization's definition of the disease as a starting point since this definition is the one generally used throughout the world. WHO defines a case of leprosy as a person having one or more of the following findings, who has yet to complete a full course of treatment.
1. Hypopigmented or reddish skin lesion (s) with definite loss of sensation.
2. Damage to the peripheral nerves, as demonstrated by loss of sensation and/or weakness of the muscles of the hands, feet or face.
3. Positive skin smears.
Cases are then further classified by WHO as： single lesion paucibacillary leprosy (SLBP), paucibacillary leprosy (PB) and multibacillary leprosy (MB). Utilizing their definition, single lesion PB cases have only 1 lesion and no nerve trunk involvement though there will be sensory loss within the lesion itself. Paucibacillary leprosy cases have 2-5 lesions which are generally asymmetrically distributed which have definite loss of sensation and no more than I nerve trunk involved. Finally, multibacillary cases have more than 5 lesions with a more or less symmetrical distribution, loss of sensation in various areas and may have many nerve trunks involved.
Using these definitions, a patient who has completed treatment for whatever type of leprosy he or she had is no longer considered "a case of leprosy." Thus, WHO does not recommend post-treatment follow-up, nor does it recommend follow-up of household contacts after an initial evaluation unless signs of the disease appear. Patients who have completed treatment are merely advised to return at once if they develop any complications of the disease which would include reactions, neuritis, iritis and signs of relapse such as new skin lesions appearing. Many of these problems may continue after therapy is completed, however, or may appear for the first time after completion of therapy. This is particularly true of neuritis and silent neuropathy. Furthermore, patients may continue to have problems due to sensory loss and deformities for which they may need special shoes, gloves, or other protective measures. In addition, they may have socioeconomic problems due to disability and/or the stigma often associated with this disease. Thus, the current definition may be generally correct for leprosy, the bacterial infection and certainly simplifies reporting as far as the bacterial infection is concerned, but it would appear that in defining the disease some account should be taken of the problems the patients may continue to have or, in fact, develop for the first time after treatment has been completed.
