Active case detection and treatment of malaria in pregnancy using LAMP technology (LAMPREG): a pragmatic randomised diagnostic outcomes trial-study protocol.

INTRODUCTION: Malaria is one of the major public health problems in sub-Saharan Africa. It contributes significantly to maternal and fetal morbidity and mortality in affected countries. This study aims to evaluate the impact of enhanced case detection using molecular testing called loop-mediated isothermal amplification (LAMP) on birth outcomes in a prospective study design. METHODS AND ANALYSIS: A pragmatic randomised diagnostic outcomes trial will be conducted in several health institutes in different Ethiopian regions. Women (n=2583) in their first and second trimesters of pregnancy will be included in the study and individually randomised to the standard of care or enhanced case detection arms, and followed until delivery. Enrolment will encompass the malaria peak transmission seasons. In the standard of care arm, a venous blood sample will be collected for malaria diagnosis only in symptomatic patients. In contrast, in the intervention arm, mothers will be tested by a commercially available Conformité Européene (CE)-approved LAMP malaria test, microscopy and rapid diagnostic test for malaria regardless of their symptoms at each antenatal care visit. The primary outcome of the study is to measure birth weight. ETHICS AND DISSEMINATION: The study was approved by the following ethical research boards: Armauer Hansen Research Institute/ALERT Ethics Review Committee (FORM AF-10-015.1, Protocol number PO/05/20), the Ethiopia Ministry of Science and Higher Education National Research Ethics Review Committee (approval SRA/11.7/7115/20), the Ethiopia Food and Drug Administration (approval 02/25/33/I), UCalgary Conjoint Health Research Ethics Board (REB21-0234). The study results will be shared with the institutions and stakeholders such as the Ethiopia Ministry of Health, the Foundation for Innovative Diagnostics, WHO's Multilateral initiative on Malaria - Tropical Diseases Research (TDR-MIM), Roll Back Malaria and the Malaria in Pregnancy Consortium. The study results will also be published in peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER: NCT03754322.

The long-term impact of the Leprosy Post-Exposure Prophylaxis (LPEP) program on leprosy incidence: A modelling study.

BACKGROUND: The Leprosy Post-Exposure Prophylaxis (LPEP) program explored the feasibility and impact of contact tracing and the provision of single dose rifampicin (SDR) to eligible contacts of newly diagnosed leprosy patients in Brazil, India, Indonesia, Myanmar, Nepal, Sri Lanka and Tanzania. As the impact of the programme is difficult to establish in the short term, we apply mathematical modelling to predict its long-term impact on the leprosy incidence. METHODOLOGY: The individual-based model SIMCOLEP was calibrated and validated to the historic leprosy incidence data in the study areas. For each area, we assessed two scenarios: 1) continuation of existing routine activities as in 2014; and 2) routine activities combined with LPEP starting in 2015. The number of contacts per index patient screened varied from 1 to 36 between areas. Projections were made until 2040. PRINCIPAL FINDINGS: In all areas, the LPEP program increased the number of detected cases in the first year(s) of the programme as compared to the routine programme, followed by a faster reduction afterwards with increasing benefit over time. LPEP could accelerate the reduction of the leprosy incidence by up to six years as compared to the routine programme. The impact of LPEP varied by area due to differences in the number of contacts per index patient included and differences in leprosy epidemiology and routine control programme. CONCLUSIONS: The LPEP program contributes significantly to the reduction of the leprosy incidence and could potentially accelerate the interruption of transmission. It would be advisable to include contact tracing/screening and SDR in routine leprosy programmes.

Integrated approach in the control and management of skin neglected tropical diseases in three health districts of Côte d'Ivoire.

BACKGROUND: Neglected tropical diseases (NTDs) comprise 20 communicable diseases that are prevalent in rural poor and remote communities with less access to the health system. For effective and efficient control, the WHO recommends that affected countries implement integrated control interventions that take into account the different co-endemic NTDs in the same community. However, implementing these integrated interventions involving several diseases with different etiologies, requiring different control approaches and driven by different vertical programs, remains a challenge. We report here the results and lessons learned from a pilot test of this integrated approach based on integrated screening of skin diseases in three co-endemic health districts of Côte d'Ivoire, a West African country endemic for Buruli ulcer, leprosy and yaw. METHOD: This cross-sectional study took place from April 2016 to March 2017 in 3 districts of Côte d'Ivoire co-endemic for BU, leprosy and yaws. The study was carried out in 6 stages: identification of potentially co-endemic communities; stakeholder training; social mobilization; mobile medical consultations; case detection and management; and a review meeting. RESULTS: We included in the study all patients with skin signs and symptoms at the screening stage who voluntarily accepted screening. In total, 2310 persons screened had skin lesions at the screening stage. Among them, 07 cases were diagnosed with Buruli ulcer. There were 30 leprosy cases and 15 yaws detected. Other types of ulcerations and skin conditions have been identified and represent the majority of cases detected. We learned from this pilot experience that integration can be successfully implemented in co-endemic communities in Côte d'Ivoire. Health workers are motivated and available to implement integrated interventions instead of interventions focused on a single disease. However, it is essential to provide capacity building, a minimum of drugs and consumables for the care of the patients identified, as well as follow-up of identified patients, including those with other skin conditions. CONCLUSIONS: The results of this study show that the integration of activities can be successfully implemented in co-endemic communities under the condition of staff capacity building and minimal care of identified patients.

Association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale in hand functional evaluation of patients with leprosy diagnosis.

PURPOSE: To evaluate the association of results from the Rosén and Lundborg Score and the screening activity limitation and Safety Awareness scale for the assessment of hand in patients diagnosed with leprosy. METHOD: An association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale for hand was evaluated in a cross-section study with 25 people of a mean age of 51 years old (SD 14), undergoing drug treatment for leprosy. RESULTS: The mean quantitative score in the Screening Activity Limitation and Safety Awareness scale was 27.9 (SD 10.5). Rosén and Lundborg Score for the median nerve were 2.43 (SD 0.38) on the right hand and 2.41 (SD 0.54) on the left hand whilst for the ulnar nerve, the scores observed were 2.33 (SD 0.42) for the right hand and 2.31 (SD 0.61) for the left hand. Significant correlations between the two instruments in assessment of the median and ulnar nerves on both hands were found. CONCLUSIONS: Due to the association found between the scales, the Rosén and Lundborg Score may be used in assessment of the hand in patients diagnosed with leprosy, as a tool to assist the result evaluation after the drug treatment, surgical treatment, rehabilitation and follow-up in the hand dysfunction in leprosy. Implications for Rehabilitation The leprosy inflammatory neuropathy may cause limitations and disabilities related to hand functions of patients. Instruments with quantitative scores provide a reliable basis for therapeutic intervention prognosis. New evaluation methods promote a better monitoring of treatment and hand function evolution of people with leprosy.

Spatial epidemiology and serologic cohorts increase the early detection of leprosy.

BACKGROUND: Leprosy remains an important public health problem in some specific high-burden pockets areas, including the Brazilian Amazon region, where it is hyperendemic among children. METHODS: We selected two elementary public schools located in areas most at risk (cluster of leprosy or hyperendemic census tract) to clinically evaluate their students. We also followed anti-PGL-I seropositive and seronegative individuals and households for 2 years to compare the incidence of leprosy in both groups. RESULTS: Leprosy was detected in 11 (8.2 %) of 134 school children in high risk areas. The difference in the prevalence was statistically significant (p < .05) compared to our previous findings in randomly selected schools (63/1592; 3.9 %). The 2-year follow-up results showed that 22.3 and 9.4 % of seropositive and seronegative individuals, respectively, developed leprosy (p = .027). The odds of developing overt disease in seropositive people were 2.7 times that of negative people (p < .01), indicating that a follow-up of 10 seropositives has a >90 % probability to detect at least one new case in 2 years. The odds of clinical leprosy were also higher in "positive houses" compared to "negative houses" (p < .05), indicating that a follow-up of ten people living in households with at least one seropositive dweller have a 85 % probability to detect at least one new case in 2 years. CONCLUSIONS: Targeted screening involving school-based surveillance planned using results obtained by spatial analysis and targeted household and individual continuous surveillance based on serologic data should be applied to increase the early detection of new leprosy cases.

Validation of qPCR Methods for the Detection of Mycobacterium in New World Animal Reservoirs.

Zoonotic pathogens that cause leprosy (Mycobacterium leprae) and tuberculosis (Mycobacterium tuberculosis complex, MTBC) continue to impact modern human populations. Therefore, methods able to survey mycobacterial infection in potential animal hosts are necessary for proper evaluation of human exposure threats. Here we tested for mycobacterial-specific single- and multi-copy loci using qPCR. In a trial study in which armadillos were artificially infected with M. leprae, these techniques were specific and sensitive to pathogen detection, while more traditional ELISAs were only specific. These assays were then employed in a case study to detect M. leprae as well as MTBC in wild marmosets. All marmosets were negative for M. leprae DNA, but 14 were positive for the mycobacterial rpoB gene assay. Targeted capture and sequencing of rpoB and other MTBC genes validated the presence of mycobacterial DNA in these samples and revealed that qPCR is useful for identifying mycobacterial-infected animal hosts.

Selecting a Test for Leprous Neuropathy Screening.

BACKGROUND: Worldwide, leprosy represents a significant cause of disability due to progressive neurological impairment. Screening for leprous neuropathy is performed with Semmes-Weinstein monofilament (SWM) or ballpoint pen testing (BPT), which results in underreporting of its prevalence. The Pressure-specified sensory device (PSSD; Sensory Management Services, LLC, Baltimore, MD) is a sensitive, noninvasive, portable, neurosensory instrument, which has not been field-tested for leprosy screening. Early identification of leprous neuropathy would permit early antibiotic treatment to prevent contagion and early microsurgical neurolysis. METHODS: A prospective, clinical diagnostic, cross-sectional study screened a consecutive sample of patients for leprous neuropathy in the leprosy-endemic province of Los Ríos, Ecuador. Patients meeting the World Health Organization criteria for leprosy and complaining of neuropathy symptoms were classified as leprous neuropathy patients. Patients without any signs of leprosy were used as normal controls. Bilateral ulnar nerve screening with the PSSD, SWM (0.07, 0.4, 2, 4, 10, and 300 g), and BPT was performed in all patients. Sensitivity and specificity were calculated and compared across tests. A total of 71 patients (142 nerves) were evaluated. RESULTS: Compared with the 10 g SWM and the BPT, the PSSD was found to have significantly higher sensitivity (78.3 vs. 0% with p < 0.001, for both) with comparable specificity (97.8 vs. 100% with p > 0.999, for both). Compared with the 0.07 g SWM (lightest filament in our series), the PSSD showed better sensitivity (78.3 vs. 65.2%, p = 0.514) and significantly higher specificity (97.8 vs. 51.1%, p < 0.001). CONCLUSIONS: The PSSD provides superior diagnostic accuracy for detecting leprous neuropathy as compared with SWM and BPT.

Screening for depressive disorders in outpatients with mild to moderate psoriasis: a study from North India.

BACKGROUND: Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis. AIMS: The aim of this study was to test the feasibility of using a modification of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders. MATERIALS AND METHODS: One hundred and four out-patients with psoriasis were recruited in the study. In the first stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modified questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confirmed using the Mini International Neuropsychiatric Interview. RESULTS: The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confidence interval = 0.72-0.89). LIMITATIONS: The sample size is small and more studies are needed with the screening questions in different languages to validate the findings of the study. CONCLUSION: The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.

Detección de mutaciones en los genes folp1, rpoB y gyrA de M. Leprae por secuenciación directa PCR-una técnica rápida para el cribaje de resistencias farmacológicas en la lepra / No disponible

Introducción: La técnica convencional para evaluar la susceptibilidad antimicrobiana de la multiterapia (MDT) recomendado por la OMS frente al Mycobacterium leprae en la almohadilla plantar del ratón (MFP) es laboriosa y larga (aproximadamente entre 6 y 12 meses). Actualmente se han definido dianas moleculares para distintos medicamentos para tratar la lepra. Se han estandarizado diversas técnicas moleculares para la rápida detección de estas resistencias. Este estudio ha comparado dichos métodos moleculares con la técnica MFP para determinar la susceptibilidad del M. leprae frente a los anti-microbianos. Métodos: Participaron en este estudio 40 pacientes con índice bacteriológico (IB) positivo, de entre ellos había 25 con característica clara de recaída, 11 nuevos casos y 4 incumplidores del tratamiento. Se obtuvo una biopsia cutánea de todos los casos que fue procesado para MFP y métodos moleculares. Se diseña primero PCR para amplificar fragmentos DNA de 388 bp del gen folP1 para la resistencia a la dapsona, de 305 bp del gen rpoB para la resistencia a la rifampicina y de 342 bp del gen gyrA para la resistencia a ofloxacino, seguida por la secuenciación DNA. Resultados: Solamente se obtuvo un crecimiento significativo con la técnica MPF en 28 de las 40 biopsias procesadas (70%). De entre ellas, 10 muestras resultaron ser dapsona resistentes, una muestra presentó resitencia frente a la dapsona, rifampicina y clofazimina. Se obtuvo amplificación de genes en 40 (100%) de las muestras. De entre los amplificados folP1 secuenciados, 6 cepas presentan mutaciones en posición 53 o 55 de los aminoácidos. Las cepas que resultaron muy resistentes con crecimiento dos log con la técnica MFP y/o crecimiento mediante pasaje presentaban mutaciones en el gen folP1. No se detectaron mutaciones en los amplificados rpoB y gyrA. No e detectaron pues resistencia frente a la rifampicina en el DNA aislado de las biopsias. Conclusión: Se puede aplicar la técnica PCR-secuenciación directa por su sensibilidad y rapidez para sustituir a la más laboriosa MFP para la detección de resistencia frente a dapsona, rifampicina y ofloxacino (AU)

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Modalidades del proceso centinela en lepra (I) / No disponible

Se desarrollaron dos modalidades del proceso centinela de lepra en cinco municipios de ciudad de La Habana y Camagüey. La modalidad I, abarcó la capacitación al personal de la atención primaria de salud, entrevistas a familiares y pacientes, y charlas educativas a la atención primaria de salud, entrevistas a familiares y pacientes, y charlas educativas a la población que acudía a los de policlínicos; la modalidad II, consistió en la capacitación de los profesionales y en la detección de niveles de anticuerpos contra el M. leprae en dos comunidades. Para la capacitación se emplearon dos metodologías docentes: la de conferencias y la de clases interactivas. Luego de la capacitación, los participantes dominaron el diagnóstico, manejo y búsqueda de pacientes, y disponían de materiales de consulta. En las entrevistas a los convivientes, se constató que todos conocían la enfermedad, peor no sus signos precoces, así mismo los pacientes refirieron no haber hablado de ella a sus nuevos contactos. Terminada la investigación se intensificó la búsqueda activa por los profesionales de atención primaria y se diagnosticaron nuevos casos en el municipio Regla, donde en varios años no se reportaban nuevos pacientes. En dos municipios camagüeyanos de alta y baja prevalencia, se efectuaron 1.290 pruebas serológicas, a los casos seropositivos (> 0,300) y lepromino positivos, se les suministro tratamiento profiláctico por 6 meses, al final todos seronegativizaron y ninguno resultó paciente. El resto que no recibieron tratamiento y su serología bajó espontáneamente. La infección por el Mycobacterium leprae se hizo evidente con baja positividad en las dos áreas de salud camagüeyanas y se ratificó el estudio seroepidemiológico como una herramienta más para la búsqueda de personas en riesgo (AU)

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Clinico-epidemiological study of leprosy in an urban area of West Bengal.

A cross-sectional study was carried out at Naihati municipal area in West Bengal to study the prevalence and some epidemiological factors in transmission of leprosy. Side by side, the validity of WHO operational classification was also tested by using slit skin smear examination as gold standard. A group of trained paramedical workers, supervised by epidemiologist conducted house to house survey work. Experienced dermatologist and neurologist examined suspected cases. Overall prevalence of leprosy were 9.9 per 10000, of which 53% were new cases. Epidemiologically manual workers, living in slums and unhygienic surroundings had significantly higher risk of developing leprosy. Sensitivity and specificity of WHO operational classification (> 5 skin lesion= MB) was found to be quite high (sensitivity 85.9% and specificity 83.3%) in this study. However addition of > 2 nerve lesions to this criteria increase sensitivity to 90.1% without much affecting the specificity (79.8%).

Prevalencia de la sífilis en embarazadas de seis ciudades Brasileñas / No disponible

Objetivos: Estimar la prevalencia de sífilis en gestantes de seis ciudades de Brasil y su asociación con variables socioeconómicas, demográficas y de comportamiento. Métodos: Estudio multicéntrico, transversal, que incluyó gestantes atendidas en consultorios prenatales de la atención primaria de salud entre los años 2004 y 2005. Se realizó examen de tamizaje para sífilis usando RPR y examen confirmatorio (ELISA) en la s que resultaron positivas. Se aplicó un cuestionario para colectar informaciones sociodemográficas, clínica-obstétricas, y de la actividad sexual de las voluntarias. Para le análisis estadístico y evaluar los factores de riesgo asociados a la sífilis se realizó análisis bivariado y multivariado por regresión logística múltiple y las pruebas “t” de Studen, Chi2 y test exacto de Fischer. Resultados: Fueron enroladas 3.303 gestantes, cuya edad media fue 23,8 años (± 6,9). La prevalencia de sífilis fue 2,6%. Más de 90% de las gestantes con sífilis presentaban infección latente. El riesgo de tener sífilis fue ocho veces mayor para las gestantes que refirieron haber tenido más de una pareja sexual en el último año. Otros predictores de la infección treponémica fueron: edad mayor de 40 años, nivel de escolaridad baja, tener antecedentes de úlceras genitales, y haber tenido pareja sexual con úlcera genital. Conclusiones: Se observó, en las gestantes brasileras una prevalencia de sífilis elevada. El principal factor de riesgo para esta infección fue tener más de una pareja sexual en los últimos 12 meses (AU)

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Test-retest reliability of the Screening Activity Limitation and Safety Awareness (SALSA) scale in North-West Nigeria.

INTRODUCTION: The present study examines the inter-tester and intra-tester reliability of the recently developed scale for Screening of Activity Limitation and Safety Awareness (SALSA) in North-West Nigeria. The scale was developed through collaborative research in five countries around the world. METHODOLOGY: One hundred and three people affected by leprosy from three states in North-West Nigeria participated in the study. A Hausa translation of the 20-item SALSA questionnaire was used by four trained health staff to interview the participants. Seventy-five paired interviews were conducted where the second interview was administered by a different interviewer from the first at intervals of 4-76 days (median 52). Twenty-eight paired interviews were conducted, both by the same interviewer, at intervals of 52-71 days (median 63). RESULTS: Inter-tester reliability: All 20 items had Kappa's ranging from 0.45-0.8; 15 items had Kappa's > 0.6; 8 items had Kappa's > 0.7. Intra-tester reliability: All 20 items had Kappa's ranging from 0.51-1; 15 items had Kappa's > 0.6; 12 items had Kappa's > 0.7. For inter-tester reliability, the first interview had a mean SALSA score of 36.5 (95% CI = 34.96-38.05). The second interview had a mean of 35.02 (95% CI = 35.01-37.99). For intra-tester reliability, the mean SALSA scores of first and second interviews were 27.36 (95% CI = 24.36-30.36) and 26.68 (95% CI = 23.93-29.43), respectively. CONCLUSIONS: The Hausa translation of SALSA has an acceptable reliability in Nigeria provided the interviewers are well trained.

[Delayed home screening of leprosy; experience of the screening team in Mayotte]. / Dépistage actif intra-domiciliaire différé de la lèpre : expérience de l'equipe de dépistage sur l'île de mayotte.

Mayotte, a French territory island located in the Indian Ocean near Madagascar, remains a leprosy endemic area. In 2006, leprosy was still a problem of public health with a prevalence of 3.94 per 10,000 inhabitants. There is practically no formal consensus about active screening (AS) on an index case. According to teams and their related staffs, the AS concerns intradomicilary contact individuals (IDC) restrictively or extended to extra-domicilary social and professional contacts. Date, number and frequency of these investigations depend on each team. Between 1997 and 2003, there was no AS planned in Mayotte, but all index case individuals have been encouraged to propose a screening to their relatives through specific campaign information and education. This procedure allowed to identify 10 new cases of leprosy infection among the IDC. Concurrently 12 IDC cases have been diagnosed by health workers. In 2003, we performed a postponed AS within IDC of every Mahorais case registered by passive detection between 1997 and 2003. 325 IDC have been examined and 15 new cases have been detected. All these new cases showed early leprosy features: 14 were paucibacillary forms, among which 9 cases with an isolated cutaneous lesion (7 had an infracentimetric lesion). One patient had multibacillary disease although he presented with an isolated skin lesion which developed within the 6 previous months. None presented with disability. Our results suggest that passive detection even reinforced by repeated individual information and education about leprosy is neither appropriate nor effective. The postponed AS seems to favour an increased self-esteem and a better involvement of the index patient in sanitary education together with the screening of his relatives. In the Mayotte background, the postponed AS has not been associated with a significant delay for diagnosis. Although WHO recommandations are to abandon immediate AS of IDC and to promote self-screening for leprosy our study suggests an intermediate position, namely delayed active screening for an enhanced effective detection.

[Active search for leprosy and other skin diseases in school children from Agua de Dios, Colombia]. / Búsqueda Activa de Lepra y de Otras Enfermedades de la Piel en Escolares de Agua de Dios, Colombia.

OBJECTIVE: Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. METHODS: A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. RESULTS: 86 % of the 2 844 school children were examined; 833 had skin diseases and 16 % of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. CONCLUSIONS: The incidence of leprosy found (16/10,000) was 123 times higher than the rest of the country's incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.

Búsqueda Activa de Lepra y de Otras Enfermedades de la Piel en Escolares de Agua de Dios, Colombia / Active search for leprosy and other skin diseases in school children from Agua de Dios, Colombia

Objetivo: Buscar lepra, otras enfermedades de la piel y la cicatriz BCG, en escolares de Agua de Dios, municipio con la más alta prevalencia de lepra en Colombia: 23-39/10 000; educar y difundir los resultados en la comunidad. Métodos: Se hizo examen clínico de los niños por enfermeras, médicos internos y generales y por expertos en lepra. Cuando la clínica lo indicaba, se practicaron baciloscopias y biopsias de piel. En pocos casos se buscaron anticuerpos en sangre contra el glicolípido fenólico 1, del bacilo de Hansen. Resultados: Se examinaron 86 por ciento de los 2 844 escolares de las 17 instituciones del municipio; 833 tuvieron patologías cutáneas, de los cuales 16 por ciento requirieron el examen por expertos. Se demostraron cuatro casos nuevos de lepra paucibacilar, dos indeterminados y dos polineuríticos primarios. Las entidades más frecuentes fueron: pediculosis, pitiriasis alba, pitiriasis versicolor, nevus hipocrómicos, picaduras de insectos y miliaria. Cuatro niños tuvieron maltrato infantil y una niña de 11 años, micosis fungoides hipocromiante. La vacunación BCG se aplicó en 387 niños que no la habían recibido. Se trataron las condiciones encontradas. Se informó a la comunidad sobre las enfermedades detectadas, las funciones de la piel y sus cuidados generales, enfatizando la importancia del diagnóstico temprano de la lepra. Conclusiones: La incidencia de lepra encontrada (16/10 000), es la más alta en Colombia, 123 veces mayor que la global del país. Su búsqueda activa demostró enfermedad paucibacilar, sin discapacidades y otras enfermedades cutáneas importantes. Es recomendable persistir con este examen clínico y con la investigación de los factores predisponentes para adquirir la enfermedad.

Objetive: Actively searching for leprosy, other skin diseases and BCG vaccination scars amongst school children from Agua de Dios, the municipality having the highest prevalence of leprosy in Colombia. Methods: A clinical examination of the children was carried out by nurses, interns, general practitioners and experts on leprosy. Skin smear tests and skin biopsies were performed when the clinical findings suggested leprosy. Anti-phenolic glycolipid antibodies in blood were determined in special cases. Results: 86 percent of the 2 844 school children were examined; 833 had skin diseases and 16 percent of these required evaluation by specialists. Four new cases of paucibacillary leprosy, two indeterminate and two primary polyneuritic cases were found. Pediculosis capitis, pityriasis alba, tinea versicolor, hypopigmented nevus, insect bites and miliaria were frequently detected. BCG vaccination scars were absent in 387 children; following several logistical problems, they were vaccinated. Four children had signs of childhood abuse. An 11-year-old girl presented hypopigmented mycosis fungoides. All diseases and conditions found were treated. The community received information regarding the results, emphasising the importance of an early diagnosis of leprosy. Conclusions: The incidence of leprosy found (16/10 000) was 123 times higher than the rest of the country's incidence. It is advisable to continue clinical examinations in Agua de Dios and research into risk factors for acquiring leprosy.