Clinical and epidemiological trends in childhood leprosy: A 20-year retrospective analysis from a tertiary care hospital in Jammu, North India.

Background Slightly more than half the total number of childhood leprosy cases worldwide are from India. Aim To analyze the clinical and epidemiological trends of childhood leprosy over 20 years in a tertiary care hospital. Methods We retrieved the medical records of all children less than 15 years of age registered in the leprosy clinic between April 1998 and March 2018. We tabulated and analyzed data pertaining to demographic details along with clinical findings such as cutaneous lesions, nerves involved, sensory loss, deformities, reactions, smear status, histopathology and treatment. Results Out of total 1548 leprosy cases registered during the study period, 55 (3.55%) cases of childhood leprosy were diagnosed. Thirty five (63.6%) children were in the age group of 11-15 years and 83.7% were migrants from other states. Thirteen (23.6%) children reported contact with a diagnosed case of leprosy, mainly in close contacts. Fifty three (96.4%) children presented with cutaneous lesions while 2 (3.6%) had pure neural involvement. Borderline tuberculoid leprosy was the most common clinical presentation in 27 (49.1%) followed by borderline lepromatous leprosy in 11 (18%). Thickened peripheral nerve trunks were detected in 42 (76.4%), most commonly the ulnar nerve. Reactional episodes occurred in 12 (21.8%) cases (Type 1 reaction, 10 (18.2%); Type 2 reaction, 2 (3.6%)). Grade 2 disability was detected in 4 (7.3%). Multidrug therapy was started in all patients, multibacillary (MB) regimen in 42 (76.3%) patients and paucibacillary (PB) regimen in 13 (23.7%). Twenty five (45.4%) children defaulted from the treatment. On comparing the data of 2008-18 with that of the previous decade (1998-2007), there was a higher proportion of migrant cases as compared to local cases (3:1-11:1) and MB cases as compared to PB cases (2:1-6:1). The proportion of treatment defaulters declined from 60% to 36%. Limitations Relapse rate could not be calculated due to inadequate follow-up period. As it is a hospital-based retrospective study with no active surveys, these findings may not reflect trends in the community. Conclusion Childhood leprosy continues to be a significant problem. There is a clear need to strengthen early detection, treatment and regular follow-up of these cases in both high and low endemic settings.

Profile of Defaulters and Pattern of Treatment Default among Leprosy Patients at a Tertiary Care Hospital: A 10-Year Analysis.

BACKGROUND: The focus of leprosy control programs worldwide today is the WHO multidrug therapy which adequately cures the disease. Incomplete treatment puts not only the patient but the entire community at risk which may further jeopardize the leprosy control program. OBJECTIVE: To study the magnitude of treatment default among leprosy patients, its trend in the last 10 years, and association with clinicodemographic variables. MATERIALS AND METHODS: This was a retrospective study conducted at the urban leprosy center (ULC) attached to the dermatology department of a tertiary care centre. Data were obtained from the standard leprosy cards maintained at ULC from 2005-14. The following data were collected from the preformatted cards: age, gender, residence, occupation, type of leprosy, treatment, time of default, and so on and analyzed to see the association of defaulter status with sociodemographic and disease-related variables. RESULTS: In a total of 743 cases, the rate of treatment default was 39.3%. The default status was found to have decreased significantly over the years from 2005-14 (P = 0.03). Majority of the treatment defaulters were migrants (47.9%) as compared with natives (29.7%) (P < 0.001). Regardless of the residential status, treatment default was more in pure neuritic (58.5%) and tuberculoid type (40.7%) as compared with others (P < 0.001). Smear negative cases (40.0%) were more likely to default than smear-positive cases (31.4%) (P < 0.001). Rate of defaulting was more among patients in the district where ULC was located than in the districts away from ULC (P = 0.017). CONCLUSION: Though the study period witnessed an overall decreasing trend over the 10-year period, treatment default remains a major concern in leprosy. Adherence to treatment is central to the success of leprosy control programs and therefore the factors associated with defaulting from treatment need to be addressed.

Trends and patterns of leprosy over a decade in a tertiary care hospital in Northern India: A retrospective analysis.

BACKGROUND: Leprosy was declared to be eliminated from India in 2006, but recent reports point to an increase in newly detected cases despite the overall fall in prevalence. AIM: This study aimed to analyze the patterns and trends of epidemiological and operational indicators of leprosy at a tertiary care center in northern India over a decade. METHODS: This is a 10-year retrospective study from 2005 to 2014 conducted at the urban leprosy centre (ULC) of the Department of Dermatology, Venereology, and Leprology, Government Medical College, Jammu (J and K), India. Data were obtained from the preformatted standard leprosy cards of the urban leprosy centre. Details of demographic data, clinical features, smear results and treatment received were collected from individual cards and analyzed to observe various epidemiological trends. RESULTS: A total of 743 cases were analyzed for the period 2005-2014, of which 8.6% were childhood cases, 52.5% patients were immigrants, and 56.4% were farmers and laborers. Lepromatous cases showed a significantly increasing trend when compared with tuberculoid cases (P < 0.05). Smear positivity was seen in 29.6% of cases and showed an increasing trend (P < 0.05). An important observation was the increase in multibacillary cases. World Health Organization (WHO) grade 2 disability also showed an increasing trend over the past decade pointing to delayed diagnosis. LIMITATION: The study is limited by its retrospective design. CONCLUSION: The increasing trend of lepromatous and multibacillary cases and cases with grade 2 disability is a poor sign as it indicates delays in diagnosis. Further, smear-positive cases contribute to continued transmission of disease in the community. Leprosy has been declared to be eliminated, but recent reports including the present study suggest a rise in newly detected cases and hence in disease burden.

A new focus of cutaneous leishmaniasis in Jammu division of Jammu and Kashmir State, India.

BACKGROUND: Cutaneous leishmaniasis in India is mainly confined to the deserts of Rajasthan; some cases have been reported from the dry north-western half of the Indo-Gangetic plain, including Punjab, Himachal Pradesh, Delhi and Varanasi. AIMS: To highlight a new focus of cutaneous leishmaniasis in the Jammu division of Jammu and Kashmir State, previously a non-endemic area. This report presents the clinico-epidemiological and investigative results of 120 new cases of cutaneous leishmaniasis detected between November 2012 and October 2013. METHODS: The clinical diagnosis of cutaneous leishmaniasis was made using criteria proposed by Bari and Rahman. It was further confirmed by the demonstration of Leishman-Donovan bodies in Leishman stained slit skin smears and skin biopsy specimens, and/or by a satisfactory response to intra-lesional sodium stibogluconate given weekly for 4 weeks. Serial clinical photographs were taken before giving injections and at the end of the 6 th week. RESULTS: There were 67 females and 53 males with an age range of 8 months to 80 years. The most frequently affected site was the face. Lesions were most commonly of the nodulo-ulcerative type. The number of lesions ranged from 1 to 4. Farmers (28.1%), homemakers (27.2%) and students (27.2%) were significantly over-represented among the occupations (P < 0.001). Skin smears and biopsies were positive for Leishman-Donovan bodies in 50.8% and 44.2% cases, respectively. CONCLUSIONS: There is a new focus of cutaneous leishmaniasis in Jammu division which deserves urgent attention from the public health angle. Further epidemiological studies are warranted to establish the identity of the vector and the strain of Leishmania involved.