title: Relapses vs. reactions in multibacillary leprosy: proposal of new relapse criteria.
abstract: OBJECTIVE
  To compare a new scoring system for multibacillary (MB) leprosy relapses, which combines time factor, risk factors and clinical presentation at relapse, to WHO criteria.
  
  
  METHODS
  Data were collected on all relapses diagnosed between 1998 and 2004 at the Marie-Adelaide-Centre in Karachi, Pakistan, including case histories, clinical manifestations, follow-up, bacterial indices, treatment and contacts. For the diagnosis of MB relapses a simple scoring system was developed and validated on a data-set of mouse foot pads (MFP)-confirmed relapses (Leprosy Reviews, 76, 2005, 241). Its sensitivity was further evaluated in the Karachi relapse cohort. The P-value was calculated with McNemar's test with continuity correction.
  
  
  RESULTS
  The new scoring system that combines time factor, risk factors and clinical presentation at relapse had a higher sensitivity in MFP-confirmed relapses than the WHO-criteria (95%vs. 65%, P < 0.01). The sensitivity of the scoring system was also significantly higher than the WHO criteria in the 57 cases of MB-relapses diagnosed in Karachi (72%vs. 54%, P < 0.05).
  
  
  CONCLUSIONS
  This new simple scoring system for diagnosing MB-relapses in leprosy should be further validated in a prospective study to confirm its superior sensitivity and to evaluate the specificity of these criteria by using MFP-confirmation for patients presenting with signs of activity after treatment.
authors.affiliation: Centre for Infectious Diseases and Travel Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Linder
authors.forename: Mutaher
authors.initials: M
authors.lastname: Zia
authors.forename: Winfried V
authors.initials: WV
authors.lastname: Kern
authors.forename: Ruth K M
authors.initials: RK
authors.lastname: Pfau
authors.forename: Dirk
authors.initials: D
authors.lastname: Wagner
mesh_terms: D000818:Animals; D006801:Humans; D007918:Leprosy / Q000175:diagnosis* / Q000382:microbiology; D051379:Mice; D010154:Pakistan; D012008:Recurrence; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D014944:World Health Organization