A 28-year-old man presents with hypopigmented anaesthetic patches and thickened peripheral nerves. Slit-skin smear from the ear lobe shows an BI (bacteriological index) of 4+ on the logarithmic scale. Which Ridley-Jopling classification and which therapeutic regimen is most appropriate?

• A Tuberculoid (TT); WHO PB MDT for 6 months
• B Borderline tuberculoid (BT); WHO PB MDT for 6 months
• C Mid-borderline (BB); dapsone monotherapy for 2 years
• D Lepromatous (LL); WHO MB MDT (rifampicin + clofazimine + dapsone) for 12 months ✓

Explanation

A bacteriological index of 4+ (on Ridley's log scale) indicates a very high bacterial load, placing this patient at the lepromatous (LL) end of the spectrum. WHO multibacillary MDT (rifampicin 600 mg monthly supervised + clofazimine 300 mg monthly supervised and 50 mg daily + dapsone 100 mg daily) for 12 months is the standard treatment. Paucibacillary (TT, BT) patients have BI of 0 and receive 2-drug PB MDT for 6 months. Dapsone monotherapy is obsolete due to resistance.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.