## Clinical Diagnosis and MDT Initiation **Key Point:** A single hypopigmented macule with sensory loss and negative bacteriology is consistent with **Indeterminate or Tuberculoid Leprosy (TT)**. This is classified as **Paucibacillary (PB) leprosy** and requires immediate MDT-PB initiation without awaiting lepromin test results. ### Why Immediate MDT-PB? **High-Yield:** WHO classification of leprosy is based on **clinical features and bacillary load**, NOT lepromin test results. The lepromin test is: - A prognostic indicator (positive in TT/BT, negative in LL/BL) - NOT used for diagnosis or treatment decisions - Takes 3–4 weeks for results - Delaying treatment while awaiting results increases transmission risk and nerve damage ### MDT-PB Regimen | Component | Duration | Frequency | |-----------|----------|----------| | Rifampicin | 6 months | Monthly supervised | | Dapsone | 6 months | Daily unsupervised | | Clofazimine | 6 months | Daily unsupervised | **Clinical Pearl:** Patients become non-infectious within **2 weeks** of starting MDT-PB, even though clinical resolution takes months. ### Indications for PB vs MB Regimen ```mermaid flowchart TD A[Leprosy Patient]:::outcome --> B{Number of Skin Lesions?}:::decision B -->|≤5 lesions + ≤1 nerve| C[Paucibacillary]:::outcome B -->|>5 lesions OR >1 nerve| D[Multibacillary]:::outcome C --> E[MDT-PB: 6 months]:::action D --> F[MDT-MB: 12 months]:::action E --> G[Rifampicin + Dapsone + Clofazimine]:::action F --> H[Rifampicin + Dapsone + Clofazimine + Ofloxacin]:::action ``` **Mnemonic:** **RDC = Rifampicin, Dapsone, Clofazimine** (PB regimen backbone). 
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