1. 1 Diagnosis of leprosy – Part II 1 LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign Salvatore Noto, Pieter A M Schreuder and Bernard Naafs Leprosy mailing list, October 2011 The 3 rd Cardinal sign

2. 2 The 3 rd cardinal sign of leprosy “Positive slit-skin smear” 2 LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

3. 3 The slit and scrape method Technique of smear-taking from the ear lobe Courtesy of B. Naafs Warning: the use of gloves is advised LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

4. 4 The slit and scrape method Technique of smear-taking from the ear lobe Courtesy of E Nunzi and A Clapasson 4 LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

5. 5 The slit and scrape method blade is then turned through 90 degrees Courtesy of B. Naafs Warning: the use of gloves is advised LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

6. 6 Technique of smear-taking Courtesy of E Nunzi and A Clapasson 6 LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

7. 7 1. Smear 2. Dry 3. Fix 4. Stain (Ziehl-Neelsen) 7 LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign Courtesy of E Nunzi and A Clapasson

8. 8 Courtesy of A Clapasson Solid (S) Morphology Granular (G) LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

9. 9 Courtesy of A Clapasson Granular (G) Fragmented (F) LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign

10. 10 Leprosy (LL) Bacteriological index (BI) = 4.83 + Morphological index (MI) = 6.1 % LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign Courtesy of S. Noto left right

11. 11 Leprosy (LL) Bacteriological index (BI) = 4.7 + Morphological index (MI) = 26.4 % LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign Courtesy of S. Noto

12. LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign 12 San Martino Hospital Genoa, Italy Smear examination report Patient's surname and name Date of smear taking Age Sex Sites of skin smearBIMISFGGlobi 1 2 3 4 5 6 Averages %% Date and averages of previous skin smear %% Skin smear comments Nasal smear Courtesy of A. Clapasson

13. LML October 2011 - The Diagnosis of Leprosy - Part II. The 3rd cardinal sign 13 Bacteriological examination is an essential procedure for all patients in whom the diagnosis of leprosy is suggestive after a detailed clinical examination. It assists in: - 1.The diagnosis of leprosy; 2.The classification of leprosy; 3.Monitoring the response to treatment in skin smear positive patients; and 4.Excluding the diagnosis of leprosy.