Leprosy in children: association between clinical and pathological aspects

Leprosy among children is a public health problem reflecting the disease's transmission in the community and the efficiency of control programmes. To evaluate some clinical, epidemiological and histopathological criteria, as well as the level of agreement between clinical and histopathological diagnoses, 207 biopsies were studied from patients less than 15 years old who were clinically diagnosed with leprosy between March 1994 and September 2000. Leprosy was confirmed by histopathology in 119 cases (57.5 per cent). Forty-seven per cent of children were 10 years old or more; 28.5 per cent shared their dwellings with leprosy patients; 35 per cent had only one lesion, and 43 per cent were multibacillary cases. Agreement between clinical and histopathological classification was 36 per cent; hypochromic chronic eczema and post-inflammatory incontinence of melanin pigment were the clinical lesions most frequently mistaken with leprosy. Leprosy among children represents 7 per cent of new leprosy cases in Colombia and the high percentage of multibacillary cases suggests that diagnosis is being made late. The disease must be investigated in all children living with leprosy patients and skin biopsy is recommended to avoid false-positive diagnoses.