Diagnostic Evaluation of Leprosy in Children and Adolescents: A Pediatric Evidence Synthesis on Clinical, Microscopic, Molecular, and Serological Testing

Abstract

Leprosy remains a significant infectious disease that can cause permanent disability, particularly when diagnosis is delayed. Pediatric leprosy presents unique diagnostic challenges due to nonspecific clinical manifestations, difficulties in neurological examination, and variations in the performance of available diagnostic methods. Accurate interpretation of clinical, microscopic, molecular, and serological tests is essential to support early detection and appropriate management. This study aims to synthesize current evidence regarding diagnostic approaches for leprosy in children and adolescents and to evaluate the roles, advantages, and limitations of available diagnostic methods. This study employed an evidence synthesis approach based on diagnostic accuracy concepts and reviewed relevant studies evaluating clinical examination, slit-skin smear, bacilloscopy, histopathology, molecular assays, and serological tests in pediatric leprosy. The evaluation considered participant characteristics, specimen types, reference standards, and methodological quality of diagnostic studies. The findings indicate that clinical examination remains the primary diagnostic approach, while laboratory methods provide complementary evidence depending on clinical conditions. Microscopic methods are more useful in patients with higher bacillary loads, whereas molecular techniques may assist diagnosis in uncertain cases but require careful interpretation based on specimen and assay characteristics. Serological tests are valuable for assessing exposure or risk but cannot independently confirm active disease. However, substantial heterogeneity in study designs and reference standards prevents reliable pooled diagnostic performance estimation. Pediatric leprosy diagnosis requires an integrated and context-based approach. Future research should establish standardized diagnostic pathways using representative pediatric populations, independent reference standards, and comprehensive reporting methods to improve diagnostic accuracy and clinical outcomes.