The diagnosis of leprosy is delayed in the United Kingdom

TLDR

Diagnostic delay in leprosy can cause serious neurological consequences and is especially difficult to recognize outside endemic areas. The study aims to raise awareness among general practitioners and specialists to accelerate diagnosis and reduce damage and disability. The authors conducted a retrospective case‑note review of 28 leprosy patients referred to The Hospital for Tropical Diseases between 1995 and 1998 to assess diagnostic delays. Among the 28 patients, the median time from symptom onset to diagnosis was 1.8 years, 82 % experienced diagnostic delay, 68 % had nerve damage, and misdiagnoses as dermatological or neurological conditions were common.

Abstract

Diagnostic delay in leprosy can have serious neurological consequences for the patient. We studied the presentation of leprosy patients, focusing on delays in diagnosis, in a retrospective case-note review of 28 patients referred to The Hospital for Tropical Diseases during 1995-1998. The median ages at onset of symptoms and at diagnosis were 25.1 years (range 9-77.7) and 30.1 years (range 9-78.3), respectively. The median time from symptom onset to diagnosis was 1.8 years (0.2-15.2). Prior to referral to a leprologist, patients had seen a dermatologist (20), neurologist (9), orthopaedic surgeon (5) and rheumatologist (2). Delay in diagnosis occurred in 82% of cases. Misdiagnoses as dermatological and neurological conditions were important causes of delay, and 68% of patients had nerve damage resulting in disability. Leprosy can be difficult to diagnose outside endemic areas. Increased awareness amongst general practitioners and hospital specialists would lead to more rapid diagnosis, thus minimizing damage and disability.