Epidemiological and Clinical Characteristics of Children and Adolescents with Leprosy Admitted Over 16 Years at a Rural Hospital in Ethiopia: A Retrospective Analysis.

AIM: To analyse differences in children and adolescents aged ≤18 years admitted to the leprosy ward in a rural Ethiopian hospital >16 years. METHODS: We retrospectively collected data from leprosy admission registry books on patients with leprosy who were admitted to a referral hospital from September 2000 to September 2016. RESULTS: There were 2129 admissions for leprosy during the study period: 180 (8.4%) patients were s ≤ 18 years old. Of these, 98 (54.4%) were male and 82 (45.6%) were female. The proportion of new diagnoses in children and adolescents was 31.7%, significantly higher than in adults (11.7%; p < 0.001). There were also significant differences in the prevalence of lepromatous ulcers (46.9 vs. 61.7%), leprosy reaction (29.4 vs. 13.0%) and neuritis (16.9 vs.5.3%) between these age groups. CONCLUSIONS: There were more new diagnoses, leprosy reactions and neuritis, and fewer lepromatous ulcers, in children and adolescents compared with adults, with younger patients being referred more frequently to reference centres.

Epidemiology of Leprosy in Spain: The Role of the International Migration.

BACKGROUND: Although incidence of leprosy in Spain has declined steadily over the years, the fivefold increase in immigration since the turn of the century--much of it from countries where leprosy is still prevalent--has been linked to an uptick in registered cases. OBJECTIVE: To describe the epidemiologic trends of incident leprosy cases detected in Spain among Spanish- and foreign-born population groups. METHODS: Observational, retrospective study of suspected leprosy cases in Spain, as reported through the System of Compulsory Notification of Diseases from 2003 to 2013, with results disaggregated by country of birth. We collected statistical data on leprosy burden for other countries from WHO to estimate the expected number of imported cases. RESULTS: Of the 168 leprosy cases registered during the study period, 40 (24.6%) were in Spanish patients, while 128 (76.2%) were detected in legally resident immigrants. We identified a significantly higher number of imported leprosy cases during the 2008-2010 and 2011-2013 trienniums compared to the reference biennium 2003-2004 (OR 5.38, 95% CI 1.83-14.88 and OR 4.80, 95% CI 1.41-16.33, respectively). Most imported cases were diagnosed in Latin American immigrants (71.9%), especially Brazilians, but also Paraguayans, Bolivians and other nationalities from South and Central America. However, registered incidence was lower than expected for each year. For example, in 2003, the expected new cases in immigrants was 47.12, compared to only four cases that were actually detected (a 91% difference). Likewise, we expected to find 49.6 incident cases among immigrants in 2009, but only 15 new cases were reported (60% fewer than expected). CONCLUSION: Imported cases of leprosy are responsible for most leprosy incidence in Spain, and we cannot rule out some under-diagnosis. Clinicians should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic.

Dolor neuropático en pacientes afectados por la lepra / No disponible

Algunos pacientes con lepra pueden sufrir dolor crónico o dolor neuropático, tras el éxito del tratamiento. La prevalencia oscila entre un 17% y un 70% de los antiguos pacientes leprosos. El dolor neuropático se asocia con un deterioro de la calidad de vida de los pacientes y conlleva un elevado agravamiento de la morbilidad psicológica propia de los pacientes con lepra. El manejo de los pacientes con dolor neuropático puede requerir los servicios de salud durante muchos años y un elevado consumo de analgésicos

Some leprosy patients may suffer chronic pain or neuropathic pain after successful treatment. The prevalence ranges between 17% and 70 % of former leprosy patients. Neuropathic pain is associated with deterioration in the quality of life of patients and involves high worsening own psychological morbidity of patients with leprosy. The management of patients with neuropathic pain may require health services for many years and a high consumption of analgesic drugs

Prevalence and characteristics of neuropathic pain in leprosy patients treated years ago.

The aim of this study was to determine the prevalence of neuropathic pain, now recognized as another late complication of leprosy, and its characteristics among leprosy patients. A cross-sectional study was carried out of people treated for leprosy up to at least 5 years ago in a rural area of Ethiopia. Seventy-four patients were interviewed using the Neuropathic Pain Symptom Inventory (NPSI) questionnaire. In total, 78.9% of the patients were female with a mean age of 42.9. The mean time from initial diagnosis to the time of the study was 28.0 years, and 73.0% of patients were diagnosed over 20 years ago. Fifty-two (70.3%) reported having symptoms suggestive of neuropathic pain and the majority described the pain as burning (88.5%), electric (80.8%), stabbing (76.9%), cutting (76.9%), tingling (65.4%), squeezing (57.7%), and/or pressure (53.8%). The pain caused a severe or moderate impact on daily life in 75% and 57.7% of cases, respectively, and 92.3% suffered from disrupted sleep. Eighty percent of patients with pain (42/52) took some medication for pain relief. Neuropathic pain is common in patients treated for leprosy and in more than half of them, it causes disruption in their daily life and sleep, limiting their quality of life even more.

The burden of leprosy in children and adolescents in rural southern Ethiopia.

BACKGROUND: Childhood leprosy has an important bearing on the epidemiology of disease and reflects the level of control in a community. There is limited information about this disease in rural Ethiopia. SUBJECTS AND METHODS: Data were collected retrospectively from leprosy patient records and treatment cards in a rural mission hospital in southern Ethiopia from 1999 to 2011. RESULTS: Over the 13-year period, 298 patients with leprosy were registered for treatment. Of these, 22 (7.4%) were children (under 15 years) and 66 (21.1%) were adolescents (from 15 to 18 years). The male:female ratio was 2.6:1 in children and 1.7:1 in adolescents. Slit skin examination was positive in eight of 15 (36.4%) child patients and in 26 of 53 (41.3%) adolescents. Multibacillary leprosy was the most common type in both age groups, encountered in 95.5% of children and in 84.1% of adolescents. Six (27.3%) children and 18 (28.6%) adolescents had deformities of the hand, feet or eyes (WHO grade II), detected either at the time of diagnosis or during follow-up. Sixty-one per cent of children were transferred to their health institutions for treatment and follow-up; seven children (38.9%) completed the treatment and one (5.9%) defaulted while on therapy. Of 63 adolescent patients, 31 (49.2%) completed the recommended therapy, 28 (44.4%) were transferred out, and four (6.3%) defaulted on therapy. CONCLUSION: Childhood leprosy continues to be a common problem in rural southern Ethiopia. Multibacillary disease and disabilities remain common in children. Early detection and treatment of cases including the study of contacts should reduce the burden of leprosy in the community.

Lepra en población infantiles / No disponible

No disponible

Uña y Lepra / No disponible

En la lepra, las uñas pueden verse afectadas hasta en tres de cada cuatro pacientes que presentan la enfermedad. Los cambios ungueales no son específicos de la lepra, pueden ser muy variados y afectar al tamaño, el grosor, la superficie, la consistencia, el color de la relación placa-lecho y el tejido ungueal en general. Los cambios de las uñas en los pacientes con lepra son muy variados como estrías longitudinales, melanoniquia longitudinal, braquioniquia, uña en raqueta, anoniquia, onicauxis, onicogrifosis, hapaloniquia, onicorrexis, líneas de Beau, pterigium unguis dorsal, onicolisis, palidez de la uña y hematoma subungueal (AU)

In leprosy, the nails may be affected by up to three quarters of patients with the disease. Nail changes are not specific leprosy, can vary widely and affect the size, thickness, surface area, consistency, colour and relative bed plate-nail tissue in general. Nail changes in leprosy patients are varied as longitudinal striations, longitudinal melanonychia, brachionychia, nail racket, anonychia, onychauxix, onychogryphosis, hapalonychia onychorrhexis, Beau lines, dorsal pterygium unguis, onycholysis, pallor and subungual hematoma (AU)

Gender differential on characteristics and outcome of leprosy patients admitted to a long-term care rural hospital in South-Eastern Ethiopia.

INTRODUCTION: In previous studies, women are less aware of causation and symptoms of leprosy and have less access to health care coverage than men, thus contributing to their delay in seeking for treatment. We assess the gender differences in leprosy cases admitted to a rural referral hospital in Ethiopia for 7 and a half years. METHODS: Retrospective data of the leprosy patients admitted to referral hospital were collected using leprosy admission registry books from September 2002 to January 2010. Variables were entered in an Excel 97 database. RESULTS: During the period of study, 839 patients with leprosy were admitted; 541 (64.5%) were male, and 298 (35.6%) female. Fifteen per cent of female patients, and 7.3% of male patients were paucibacillary leprosy cases while 84.8% of female patients and 92.7% of males were multibacillary leprosy cases (p<0.001). Female leprosy patients were younger than male ones (median: 36 versus 44 years) (p<0.001). In the multivariate analysis, age (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.96-0.98; p<0.001), admission for cardiovascular diseases (OR: 7.6, 95% CI: 1.9-29.3; p=0.004), admission for gastroenteritis (OR: 14.0; 95% CI: 1.7-117; p=0.02), admission from out patients clinic (OR: 2.04; 95% CI: 1.1-4.01; p=0.02), and mortality as final outcome (OR: 3.1, 95% CI: 1.2-8.0; p=0.02) were independently associated with female gender. CONCLUSIONS: Female patients with leprosy admitted to hospital were younger, had a different profile of admission and a higher mortality rate than male ones.

Prevención de la lepra: estudio convencional de contactos y quimioprofilaxis / No disponible

No disponible

Disability profile in leprosy patients' diagnoses in a rural reference leprosy centre in Ethiopia during 1999-2009.

We assessed the epidemiology of disabilities in leprosy cases treated in a rural hospital over a 10-year period. This is a retrospective data collection using leprosy registers and treatment cards in a rural private mission hospital. Over the 10-year period, 210 patients with leprosy were registered for treatment. One hundred and twenty-eight (61.5%) had disabilities (26.0% grade 1 and 35.6% grade 2): 13.5% ocular disabilities, 44.5% disabilities in hands and 44.7% foot impairment. Patients >19 years had more disabilities (66.7% versus 50.7%) (P = 0.03), especially ocular disabilities (16.7% in >20 versus 6.0% in <20 years) (P = 0.03). This study detected a high prevalence of disabilities.

La experiencia del tratamiento médico de la lepra en un centro sanitario de referencia en Etiopía / No disponible

El Hospital General Rural de Gambo (HGRG) es un centro de referencia de la provincia de West-Arse (Etiopía) para el tratamiento de la lepra. El objetivo de este trabajo es comunicar nuestra experiencia del tratamiento de la lepra durante los 10 años (2000-2009). A lo largo del periodo de estudio se trataron 210 pacientes con lepra. De ellos el 68,1% eran hombres, con el 7,2% (15 pacientes) menores de 15 años. El 68,1% de los pacientes fueron casos nuevos, mientras que el 17,1% eran enfermos que estaban en tratamiento en otro centro antes de acudir al HGRG para continuar con el tratamiento. La mayoría de los casos fueron lepra multibacilar (90,5%) y sólo 20 (9,5%) fueron de lepra paucibacilar. El 23,8% tenían un grado 1 de discapacidad y el 33,8% de grado 2. Ciento dieciocho pacientes ingresaron por alguna complicación: el 21,5% por reacción reversa y el 15,3% por eritema nudoso leproso. Durante el seguimiento de los pacientes, el 36,7% de los pacientes completaron el tratamiento, y el 51,0% fueron transferidos a otras áreas de salud para seguir el tratamiento. En países en vías de desarrollo los centros sanitarios de referencia son importantes no sólo para el tratamiento de la propia enfermedad sino para el tratamiento y el cuidado de las complicaciones y discapacidades que conlleva, a el fin de aminorar las limitaciones funcionales asociadas (AU)

The Gambo General Hospital is a leprosy reference centre for West-Arsi zone. The objective of this manuscript is to show our experience of treatment of leprosy during 10 year (2000 to 2009). Over the 10 year period, 210 patients with leprosy were registered for treatment, 68,1 were male and 7,2% (15 patients) were less than 15 years old. The 68,1% of patients were a new case, 117,1% patients have started treatment in other health post. The majority of cases were multibacillary leprosy (90,5%) and only 20 (9,5%) were paucibacillary leprosy. The 23,8% had grade 1 of disability and 33.8% grade 2. One hundred and eighteen patients completed the treatment, and 51,0% were transferred to others health post for continuing of treatment. In developing countries, the referral health centre of leprosy are important for the treatment of leprosy, and also for treating and caring of complication and disabilities, to try the decrease the functional limitations associated with the diseases (AU)