2) Where Do We Go From Here in Early Case Detection
Dr. H. J. Kawuma
1 . INTRODUCTION：
While my first impression was that "Case - detection" was a very narrow field, further thought shows clearly that it is too wide a field to be handled in such a short time and that it is unreasonable to expect a single presenter to handle its various aspects.
I, not only, do not have the answers to the issues raised but also feel un-worthy to give an authoritative view of current issues relating to case detection. I will only attempt to stimulate discussion on the subject since I am convinced that it is what the Chairman wanted me to do.
2. DEFINITION OF EARLY CASE - DETECTION：
2.1 Detection：
This could mean one or more of the following：
- Notice leprosy which is partly hidden or not clear.
- Discover or recognise that leprosy is present
- "Solving a crime" as done by the Police!
- the "process of being detected" from the point of view of the person affected (which could be unpleasant for one who is fearing to be found out.)
Is detection then, the same as diagnosis or case-finding?? (a systematic search for cases)
Can we define detection as the product of suspecting leprosy and diagnosis???
2.2 Early：
This could mean：
- near the beginning of the disease or even before the usual expected time.
- near the beginning of a particular period.
- or a meaning like the one implied in the statement "at your earliest convenience" (the convenience of the person affected by leprosy, the health provider or the community????)
2.3 Single lesion leprosy and Indeterminate leprosy：
There is some evidence to suggest that single skin lesion leprosy is a clinical entity defined as： only one hypopigmented or reddish skin lesion, with definite loss of sensation but without nerve trunk involvement. The specificity of this diagnosis in some settings is uncertain. A single lesion can progress and even develop nerve damage. Although almost all single lesion cases may be classified as paucibacillary leprosy, a few could be multibacillary.
(1) Are single lesions then early or even too early? Are there early single lesions and late single lesions?
Indeterminate leprosy is widely accepted as the earliest manifestation of leprosy which clinically presents as a single hypopigmented or erythematous macule with minimal or no impairment of sensation.
