@phdthesis{21665,
  keywords = {Thesis, Relapse, leprosy, Global, Full text online, diagnosis},
  author = {Lindner K},
  title = {Rückfalldiagnostik bei multibazillären Leprafällen: Entwicklung eines Diagnose-Scores},
  abstract = {This thesis presents a simple and sensitive score for an advanced diagnosis of relapses in MB-leprosy. It is difficult to distinguish a relapse from an isolated late leprosy reaction because of a lack of practicable methods for the confirmation of bacterial growth.

Criteria for the diagnosis of relapses were identified through a wide review of recent literature, integrated in a scoring system and tested in two different relapse cohorts. The data-set of 43 mouse-foot-pad confirmed relapses from Shetty et al. served as goldstandard for the validation. In addition the score was applied to 57 cases that had been diagnosed as relapses in Karachi, Pakistan from 1998 – 2004 because of reappearing symptoms. The data had been collected during a research stay in Karachi.

The observation that relapses appear later than isolated late reactions could be objectified through the comparison of the time of onset of mouse foot pad confirmed relapses and late reactions and was included as an important criterion in the differential diagnosis. A high initial bacterial index of >/= 3+ was identified as an important risk factor for relapse and thus represented in the score. As additional criteria for a relapse available diagnostic methods were used: an increase in the bacterial index and the clinical presentation of the case.

The new scoring system had a higher sensitivity in mouse foot pad -confirmed relapses than the WHO-criteria (95% versus 65%, p<0,01). Its sensitivity was also significantly higher than the WHO criteria in the 57 cases of MB-relapses diagnosed in Karachi (72% versus 54%, p<0,05).

A final evaluation of the relapses that had been diagnosed in Karachi showed an overdiagnosis of relapses within the early years after the end of treatment because of an overvaluation of high results in the bacterial index.},
  year = {2010},
  pages = {170 p.},
  publisher = {Universität Freiburg },
  address = {Breisgau},
  url = {http://www.freidok.uni-freiburg.de/volltexte/7732/pdf/K.Linder.doc.pdf.pdf},
  language = {ger},
}