Facial burning in women with leprosy, physiological or pathological?

INTRODUCTION: Eight peri-menopausal women, five with borderline lepromatous leprosy and three with borderline tuberculoid leprosy, self-referred complaining of 'burning of the face. Four were seen in 1993, three having been treated as 'menopausal'without betterment and four were seen in 1997. METHODS: Eight peri-menopausal women who self-referred because of facial burning', and seven women who self-referred for other problems had a careful review of clinical records and were assessed fully for leprosy including graded sensory skin testing of the face, and standard nerve function tests. RESULTS: On examination three in each group of four complaining of facial burning were found to have major loss of facial sensation and one had generalised neuritis without significant facial involvement. Treatment with antileprotics and steroids resulted in recovery of facial sensation, although one later became blind. Of the seven who self-referred without facial burning, five had no facial sensory loss and two had slight loss of facial sensation.

Growth and development of children of mothers with leprosy and healthy controls.

INTRODUCTION: In the pre-sulphone and early sulphone years children of leprous parents had been followed in a few prospective studies to observe the development of leprosy. No studies were made of the growth and development of these children. METHODS: A prospective, open-ended, cohort study began in 1975 with follow-up of both mothers and their children until 2003. 156 pregnancies were studied consisting of 36 non-leprous (NL), 25 tuberculoid and borderline tuberculoid leprosy (TT&BT) (released-from-treatment), 18 with TT&BT (active), 42 borderline lepromatous leprosy (BL) and 35 lepromatous leprosy (LL). RESULTS: Babies of mothers with leprosy had lower birth weight, smaller placentae, grew more slowly, had more infections and higher infant mortality than those of non-leprous mothers. The findings were most marked in babies of LL mothers. Growth in childhood was uneventful, infants of LL mothers catching up by age 3.6 years. Childhood infections were common in all groups but more serious for children of lepromatous mothers. The puberty skeletal growth spurt, and, for the girls, menarche was delayed for children studied compared with a new healthy control group, with catch-up by late teens. These findings were most marked in children of lepromatous, especially LL, mothers. CONCLUSION: Impaired growth in utero and infancy is probably due to immunological factors but we could find no explanation for the delayed growth in adolescent children of LL mothers.

Health profile of highland Ethiopians in a small town in the south-western part of the country.

BACKGROUND: In conjunction with an investigation of nerve function tests of highland Ethiopians in an area of low endemicity of leprosy for 25-30 years, a comprehensive health survey was performed. METHODS: We assessed 236 subjects, 118 females and 118 males, 177 students and 59 adults (Others) aged 10-75 years from Chencha woreda. We used a detailed medical, personal and social history, anthropomorphic measurements and complete physical examination. RESULTS: We identified six areas of medical concern: Intestinal parasite and diarrhoeal diseases affected 62%, despite treatment of all students and symptomatic adults the recurrence rate was high; skin diseases/conditions affected 88%; eye injections affected 26%; dental decay affected 33%; 20% had hypertension 14% requiring treatment; 11% gave a personal and/or family history of tuberculosis, 44% gave a history of BCG immunisation, while 34% had BCG scars, the lowest percentage (11%) being in students from Daramallo woreda. RECOMMENDATIONS: Supplies of clean water, effective disposal of human excreta and control of flies would greatly reduce intestinal, skin and eye infections. Regular tooth cleaning and possibly fluoridation of drinking water should improve dental health, with diet and exercise for young hypertensives. BCG immunisation in Chencha and Daramallo woredas (inaccessible areas) needs urgent attention.

Thermal threshold tester, a useful tool for detection of very early nerve damage--determination of normal values in a healthy population unexposed to Mycobacterium leprae and its application in the A9 study.

INTRODUCTION: In Ethiopia, a large percentage of leprosy patients present with established nerve damage. Present techniques for measuring nerve function impairment show no abnormality until 30% of nerve axons are destroyed. Nerve damage in leprosy occurs first in small diameter unmyelinated fibres, then in small myelinated fibres, and much later in large myelinated fibres. The Thermal Threshold Tester (TTT) was used to measure function in nerves carrying heat sensation (unmyelinated C fibres) and cold sensation (thinly myelinated Adelta fibres). PATIENTS: A school and community health survey, assessed 234 students and adults aged 10-75 years from Chencha Woreda, an area with low endemicity of leprosy. A group of students in Addis Ababa, exposed to leprosy, were also studied. RESULTS: The upper limits of normal were: wrist hot threshold (HT): 0.17 degrees C, wrist cold threshold (CT): 0.19 degrees C, foot HT: 0.17 degrees C and foot CT: 0.20 degrees C. Both the leprosy group and also controls in Addis Ababa showed significantly increased TTT values. CONCLUSION: The TTT detects nerve damage before clinical neuritis occurs and is a valuable tool for early diagnosis of leprosy or detecting clinical relapse of treated patients and for sequential and quantitative monitoring of small diameter nerve function in other neuropathies.

Peripheral nerves and nerve function in highland Ethiopians.

INTRODUCTION: In Ethiopia, where leprosy has been one of the commonest causes of peripheral nerve enlargement and dysfunction, nerve functions are assessed by a battery of "physical" tests. Voluntary Muscle Test (VMT) and Graded Sensory Skin Test (STG) are standard tests used for persons with leprosy. Normal values for nerve function tests (NFT) in Highland Ethiopians have not previously been determined, but have been taken from standard textbooks. In this study, normal values for NFT were determined by VMT, STG, 2-Point Discrimination Tests both static and moving, and Thermal Threshold Test. Physiological enlargement of right ulnar and radial-cutaneous nerves has been recognised by some leprologists, but we were unable to find written records in the available medical literature. MATERIALS: We assessed 236 students and adults aged 10-75 years from Chencha Woreda, an area with low endemicity of leprosy for 25-30 years. Two affected by leprosy were excluded from the analysis. RESULTS: NFT thresholds were affected variously by age, exercise and skin factors, domicile and exposure to organo-phosphates. Nerve size was affected by age, gender, exercise, skin fold thickness, body mass index. Exercise related physiological nerve enlargement has been documented. CONCLUSION: These data provide a usefull baseline for investigation of peripheral nerve function in highland Ethiopians.