Prediction of 'highly skin smear positive' cases among MB leprosy patientsusing clinical parameters

Although 'highly skin smear positive' MB leprosy cases are known to be at h igh risk of relapse after release from treatment, and have been recommended to receive 'prolonged duration' MDT, government field-based control progra mmes without skin smear facilities have no simple alternative method to det ect such cases. This study reports a significant prevalence of 'highly smea r positive' cases amongst 2374 new multibacillary cases recently surveyed b y skin smears in Nepal, and retrospectively analyses 555 newly detected, pr eviously untreated BL and LL cases to identify clinical and laboratory para meters that may be associated with a 'highly positive skin smear'. While so me parameters showed high sensitivity in predicting 'highly positive smear' status, none showed both high sensitivity and high specificity simultaneou sly.