Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.

<h4>Background</h4>Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis.<h...

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Autores principales:	Xiaohua Chen, Shun Zha, Tie-Jun Shui
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/fe1364bfbdf24ffc984bd2eb11601e73
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spelling	oai:doaj.org-article:fe1364bfbdf24ffc984bd2eb11601e732021-12-02T20:24:14ZPresenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.1935-27271935-273510.1371/journal.pntd.0009913https://doaj.org/article/fe1364bfbdf24ffc984bd2eb11601e732021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pntd.0009913https://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<h4>Background</h4>Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis.<h4>Methodology/principal findings</h4>In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010-2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms.<h4>Conclusions</h4>Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.Xiaohua ChenShun ZhaTie-Jun ShuiPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 15, Iss 11, p e0009913 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Xiaohua Chen Shun Zha Tie-Jun Shui Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.
description	<h4>Background</h4>Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis.<h4>Methodology/principal findings</h4>In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010-2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms.<h4>Conclusions</h4>Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early.
format	article
author	Xiaohua Chen Shun Zha Tie-Jun Shui
author_facet	Xiaohua Chen Shun Zha Tie-Jun Shui
author_sort	Xiaohua Chen
title	Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.
title_short	Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.
title_full	Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.
title_fullStr	Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.
title_full_unstemmed	Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.
title_sort	presenting symptoms of leprosy at diagnosis: clinical evidence from a cross-sectional, population-based study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/fe1364bfbdf24ffc984bd2eb11601e73
work_keys_str_mv	AT xiaohuachen presentingsymptomsofleprosyatdiagnosisclinicalevidencefromacrosssectionalpopulationbasedstudy AT shunzha presentingsymptomsofleprosyatdiagnosisclinicalevidencefromacrosssectionalpopulationbasedstudy AT tiejunshui presentingsymptomsofleprosyatdiagnosisclinicalevidencefromacrosssectionalpopulationbasedstudy
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Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study.

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