It has even been suggested to be the primary lesion of leprosy. (2) Its diagnosis usually requires a combination of clinical and histopathological evidence but even these approaches are not without observer variations. (3, 4)
3. HOW EARLY IS EARLY?
The most straight forward meaning of early leprosy would be： just turned leprosy and with no consequences. Early leprosy would, all the same have to be characterised by the presence of the usual features： macular lesions, sensory disturbances, nerve thickening, positivity for Acid Fast Bacilli (AAFB) . (5) How many of these should be present for one to diagnose early leprosy?
The decision of where early should begin depends on the purpose for which the detection is required or the answer to the question：
3.1 Why should we detect leprosy early?
This looks like a very simplistic question for which (unfortunately) there may not be a single all embracing answer. The known reasons include：
a- To give treatrnent (MDT) early in the course of the disease and to cure it. By the current definition, a person who has completed a course of treatment is no longer regarded a case of leprosy. (6)
b- To prevent irreversible nerve damage since early case detection is the most important factor in preventing disability in leprosy.
c- To reduce transmission. In order to satisfy this intention it would be necessary to establish the earliest stage at which transmission of leprosy might occur. (7)
d- For epidemiological/control monitoring：
The earlier the case detection the better case detection rate would be as a proxy for incidence of leprosy.
e- Political：
This is mostly to do with the number of cases detected and may require some administrative an d managerial engineering.
Finding only a small number of early cases of leprosy could mean that they either do not exist (worthy of praise) or that not enough is being done to detect them (worthy of blame).
Old (disabled) newly detected cases might help to put up a better argument during appeals for donor funding in contrast with early cases with nothing to show!
Detecting large numbers of early cases could be the result of hard work (worthy of praise) or the result of having done nothing to control the spread of leprosy (worthy of blame) or the reflection of poor quality work (detecting and registering as leprosy all kinds of leprosy-like conditions)
What about where the number of cases detected are stable? While this might raise a good argument for job security (as there is still a job to do) (8) , it may also be seen as a good illustration of the fact that the Manager is stuck!
Every wise Leprosy Programme Manager would like to depict a case detection trend that is politically sound.
