Preliminary evaluation of a neurological clinical pathway for the early detection of leprosy in low-endemic settings: A single-center exploratory study

The early diagnosis of leprosy remains challenging in low-endemic regions. However, the implementation of clinical pathways (CPs) to improve diagnostic accuracy and understand patterns of misdiagnosis and delayed diagnosis may help reduce disability burdens. We conducted neurologist training programs focused on leprosy-related disabilities in Beijing, China, and evaluated the effectiveness of an exploratory neurological CP. Diagnostic delays and misdiagnosis patterns were analyzed. Following CP implementation (2018-2023), the number of confirmed leprosy referrals from neurology departments increased to 13 cases (vs. 4 cases during 1990-2017). The cases included various subtypes (LL, BL, BB, BT, TT, PNL). The diagnostic intervals ranged from 1.5 months (PNL) to 25 years (LL from low-endemic regions). All confirmed cases required multidisciplinary consultations (neurology: 27 visits; dermatology: 6 visits). Common misdiagnoses included peripheral neuropathy (29 instances) and skin lesions (13 instances). The neurological CP implemented in this study has potential utility for early leprosy detection in low-endemic settings. However, the single-center design and small sample size necessitate multicenter validation. These findings underscore the need for integrated diagnostic approaches.