Lockwood D N, Reid A J
Hospital for Tropical Diseases, Mortimer Market, Capper Street, London WC1E 6AU, UK.
QJM. 2001 Apr;94(4):207-12. doi: 10.1093/qjmed/94.4.207.
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.
麻风病诊断延迟会给患者带来严重的神经后果。我们通过对1995年至1998年间转诊至热带病医院的28例患者进行回顾性病例记录审查，研究了麻风病患者的临床表现，重点关注诊断延迟情况。症状出现时和诊断时的中位年龄分别为25.1岁（范围9 - 77.7岁）和30.1岁（范围9 - 78.3岁）。从症状出现到诊断的中位时间为1.8年（0.2 - 15.2年）。在转诊给麻风病专家之前，患者看过皮肤科医生（20例）、神经科医生（9例）、骨科医生（5例）和风湿病科医生（2例）。82%的病例存在诊断延迟。误诊为皮肤病和神经疾病是延迟的重要原因，68%的患者出现神经损伤导致残疾。在非流行地区，麻风病可能难以诊断。全科医生和医院专科医生提高认识将有助于更快诊断，从而将损害和残疾降至最低。
