Implementation of Active Case Detection of Visceral Leishmaniasis along with Leprosy through Female Community Health Volunteers in Sarlahi District, Nepal.

Background Visceral leishmaniasis (VL) and leprosy are important public health problem in Nepal. Female Community Health Volunteers (FCHVs) play pivotal role to promote community based health services. Therefore, we designed an implementation research to assess the effectiveness of active case detection (ACD) and information education and communication (IEC) campaign of Visceral leishmaniasis cases along with leprosy cases through Female Community Health Volunteers in Visceral leishmaniasis endemic 10 Village Development Committees of both Visceral leishmaniasis and leprosy prevalent Sarlahi district of Nepal. Objective To determine the effectiveness of active case search strategy of visceral leishmaniasis along with leprosy through Female Community Health Volunteers in Sarlahi district. Method One hundred fifty one Female Community Health Volunteers of twelve Village Development Committees were oriented on detection, identification and referral of Visceral leishmaniasis and leprosy patients. They were oriented on referring the patients to district hospital for confirmatory diagnosis and treatment. The intervention was continued up to ten months after training of Female Community Health Volunteers. Data on number of Visceral leishmaniasis and leprosy patients detected and referred by Female Community Health Volunteers and detected through passively at district hospital were collected and indicators was calculated. Result Altogether 151 Female Community Health Volunteers were trained from 12 (Village Development Committees) VDCs of Sarlahi district. Their knowledge on leprosy and Visceral leishmaniasis related information subsequently increased after training. None of the Visceral leishmaniasis or leprosy cases were detected actively through Female Community Health Volunteers. However, two leprosy cases were detected through household screening. Conclusion Female Community Health Volunteers should be provided sufficient knowledge to use them in community based active case detection of Visceral leishmaniasis and leprosy.

Absence of nucleotide-binding oligomerization domain-containing protein 2 variants in patients with leprosy and tuberculosis.

Crohn's disease-associated NOD 2 variants (Arg702Trp and 3020insC) were found to be monomorphic (wild), and 7 subjects were heterozygous for Gly908Arg SNP in 263 patients with tuberculosis, 260 patients with leprosy and 270 healthy controls residing in northern Indian states. This is the first report to suggest the minimal role of these variants in susceptibility/resistance to TB and leprosy in this population.

A study of peripheral T-Lymphocytes in alopecia areata.

Estimation of peripheral T-lymphocytes (active and total) was carried out in 100 cases of alopecia areata as per method described by Boyam (1977) and West et al (1978). Clinically patients were divided in two groups, alopecia areata circumscribed (group I) and severe alopecia areata (group II). Thirty healthy subjects served as controls. Decrease in percentage of both active and total E-RFC was observed in 70% cases. The decrease was more significant in group II.

A study of immunoglobulins and complements (C3 & C4) in alopecia areata.

Estimation of serum Immunoglobulins (IgG, IgM and IgA) and complements (C3 and C4) was carried out in 100 cases of alopecia areata as per method described by Mancini (1965).[1] Clinically patients were divided in two groups, alopecia areata circumscribed (group I) and severe alopecia areata (group II). Significant decrease in levels of one or more Immunoglobulins were observed in most of the patients. However, Serum complements (C3 and C4) were within range of normal control values.

Serum iron and total iron binding capacity in leprosy patients.

Serum Iron and total Iron binding capacity was estimated by Ramsay's Method in 40 leprosy patients having different types of leprosy and 20 normal subjects serving as controls. Significantly low serum Iron and total Iron binding capacity were observed in lepromatous leprosy patients.

Study of serum zinc level in leprosy.

Serum Zinc level was estimated in different types of leprosy by 'Dithiazone extraction' method in 75 leprosy patients comprising 15 each of Tuberculoid-Tuberculoid (TT); Borderline Tuberculoid (BT); Borderline Borderline (BB); Borderline Lepromatous (BL) and Lepromatous Lepromatous (LL). These findings were evaluated in comparison to 15 normal subjects serving as controls. Serum zinc level was observed to be significantly low in all types of leprosy except tuberculoid leprosy (TT). No significant difference was observed in serum zinc levels before and after 90 days of dapsone Therapy. The findings of our study are of considerable importance as zinc deficiency can be one of the factors involved in non-specific suppression of cell mediated Immunity (CMI) in lepromatous leprosy.

Adenosine deaminase activity in leprosy (a preliminary study).

Adenosine deaminase (ADA) activity was studied in 25 patients having different types of leprosy and 25 healthy volunteer as control. There was definite rise of ADA activity in BL (72.9 +/- 6.85), LL (56.7 +/- 3.35) and BT (39.1 +/- 8.28) which was statistically significant when compared to ADA activity in healthy control (9.7 +/- 0.53).

Histoid Leprosy in Varanasi.

Seventeen cases of histoid leprosy were found in skin out patients department of Institute of Medical Sciences in one year out of a total of 1394 cases of leprosy registered. The histoid leprosy rate is thus 1.2 %. The total lepromitous leprosy cases were 194 with which lepromatous index works out to be 13.9% About half of the histoid leprosy cases had no antileprosy treatment. Bacteriological index was high (4 to 6 + ) and morphological index renged from 20 to 70%. In this study there does not appear to be any correlation between histoid leprosy and DDS resistant strains of mycobacterium leprae.