WS 291-2018 in English
VALIDDiagnosis for leprosy
- Issued on:2018-03-06
- Implemented on:2018-08-01
- File Format:PDF
- Delivery:Via email within 1~3 business days
$621.00
本标准规定了麻风病的诊断依据、诊断原则、诊断和鉴别诊断。
本标准适用于全国各级各类医疗卫生机构及其医务人员对麻风病的诊断。
Introduction
Core changes in the standard revision
| Items | WS 291—2008 | WS 291—2018 |
|---|---|---|
| Diagnostic basis | Includes histological examination of lesion biopsy | Changed to histological examination of skin lesions |
| New content | Leprosy reaction criteria are not clarified | New leprosy reaction diagnostic criteria (Section 5.2) |
| Technical methods | Mouse footpad inoculation method is not included | New Appendix G Method for inoculating live bacteria in mouse foot pads |
Key diagnostic technical specifications
Skin smear examination for bacteria (Ziehl-Neelsen method)
The standard requires that the edge of active skin lesions be selected for sampling, with an incision depth of 2-3mm and a smear diameter of 5-7mm. The bacterial density was graded using the Ridley logarithmic method:
- 1+: 1-10 bacteria in 100 fields of view
- 4+: 10-100 bacteria per field of view
- 6+: >1000 bacterial clusters per field of view
Key points of histopathological diagnosis
Features of tuberculoid type (TT): epithelioid cell granulomas with Langhans giant cells in the dermis, and destroyed nerve branches can be seen by S-100 staining; characteristics of neoplastic type (LL): "no infiltration zone" under the epidermis, and a large number of acid-fast bacilli (4+ or more) are seen in the foamy cell granulomas.
Comparison of leprosy reaction types
| Type | Mechanism | Typical manifestations |
|---|---|---|
| Type I (reverse) | Enhanced cellular immunity | Redness, swelling and pain of original skin lesions, swelling of nerve trunks |
| Type II (ENL) | Immune complex reaction | Erythema nodosum with fever and iritis |
Clinical implementation recommendations
- Both skin smears and Biopsy pathological examination
- Patients with leprosy reactions need glucocorticoid shock treatment
- MB patients need annual bacterial examination after completing the course of treatment until clinical cure
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