Diagnostic utility of PCR in detection of clinical cases and carriers of leprosy: A cross sectional study at a tertiary care teaching hospital in central India.

PURPOSE: Since ancient era leprosy is existing across the world. India, Indonesia and Brazil still harbour major proportion of global cases. Child leprosy and Grade II disability indicate delayed diagnosis and persistence of transmission in community. So, this study was conducted with aim to evaluate the diagnostic efficacy of PCR in comparison to SSS (Slit Skin Smear) microscopy for detection of leprosy in early stages in both cases and carriers (contacts). METHODS: A cross sectional observational study was conducted on 100 subjects including 50 clinically diagnosed new cases of leprosy and their 50 contacts. Each group was subjected to SSS (Slit Skin Smear) microscopy and PCR using RLEP gene as target. RESULTS: The overall male: female ratio was 2.44. The Slit Skin smear (SSS) microscopy positivity was 34% (n = 17/50) among cases while it was 0% (n = 0/50) among contacts. The overall positivity for PCR was 42% (n = 42/100) being 66% (n = 33/50) in cases and 18% (n = 9/50) in contacts. About 30% (n = 25/83) of all the microscopically negative subjects were found to be positive by PCR. CONCLUSIONS: PCR was found to be a better diagnostic tool both among cases and their contacts. It should be used for screening contacts for early diagnosis and treatment and thus preventing transmission in community. KEY MESSAGE: To diagnose case and contacts of leprosy in early stages even in very low bacterial density using PCR.

Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India.

BACKGROUND: Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions. AIMS: We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India. METHODS: This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017. RESULTS: Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted. LIMITATIONS: The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study. CONCLUSION: This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified.

Predisposing factors and histopathological variants of cutaneous squamous cell carcinoma: Experience from a North Indian teaching hospital.

BACKGROUND: Squamous and basal cell carcinomas together constitute the majority of non-melanoma skin cancers. These malignancies are infrequent in Indians as compared to the white skinned population. Literature on squamous cell carcinoma in dark skin is limited. AIM: To analyze the risk factors and to characterize the histopathological subtypes of cutaneous squamous cell carcinoma in Indian patients in an area, non-endemic for arsenicosis. METHODS: A retrospective analysis of data from January 2003 to August 2013 was performed to evaluate the predisposing factors and histopathological types of cutaneous squamous cell carcinoma at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Demographic and disease characteristics such as age, gender and predisposing factors, particularly premalignant dermatoses were recorded and histopathology slides were reviewed. RESULTS: Of the 13,426 skin biopsy specimens received during the 10-year period, there were 82 (0.6%) cases of squamous cell carcinoma and 170 (1.7%) of basal cell carcinoma. The mean age at diagnosis of cutaneous squamous cell carcinoma was 53.7 years and the male to female ratio was 2:1. The most common site of involvement was the lower limbs in 34 (41.5%) patients. Marjolin's ulcer was present in 36 (43.9%) cases. No predisposing factor was identified in 35 (42.7%) patients. Histopathologically, the tumors were classified most commonly as squamous cell carcinoma not otherwise specified in 33 (40.2%) cases. LIMITATIONS: This was a retrospective study and details of occupation and interval between the precursor lesions and development of tumor were not recorded. Immunohistochemistry for human papilloma virus and p53 tumor suppressor protein were not performed as these tests were not available. CONCLUSION: Cutaneous squamous cell carcinoma is uncommon in Indian patients and a high index of suspicion is necessary when a rapidly enlarging nodule, verrucous fungating plaque or an ulcer with everted margins develops in long standing scars and other predisposing dermatologic conditions. Histopathological examination is mandatory to confirm the diagnosis and identify the subtype and this has prognostic implications.

Could Mycobacterium leprae Infection Be an Occupational Disease? A Survey in Healthcare Workers From an Endemic Area in the Amazonian Region.

A serologic survey was conducted to evaluate the prevalence of Mycobacterium leprae infection among healthcare workers and associated factors. Of 280 workers, 26 (9.3%) were positive using immunoglobulin M serology for PGL-I M. leprae antigen. Exposure to leprosy patients in the workplace was significantly associated with seropositivity (P=.044).

Childhood leprosy in a tertiary-care hospital in Delhi, India: a reappraisal in the post-elimination era.

OBJECTIVE: To assess the profile and describe the clinical presentations, clinico-histopathological profile, complications and treatment compliance of childhood leprosy at a tertiary care hospital in north-east district of Delhi during 2000-2009. DESIGN: A retrospective institutional study of children less than 14 years of age diagnosed with leprosy and registered in a leprosy clinic during 2000-2009. Demographic, clinical, investigative and treatment data was extracted from a pre-designed proforma. RESULTS: A total of 1790 cases of leprosy were registered during this period, of which 172 (9.6%) were children. The majority of patients (70.3%) were more than 11 years of age with a male preponderance. History of contact was present in 25 (14.5%) patients. Borderline tuberculoid (BT) was the commonest clinical type (70.3%) followed by tuberculoid (TT) seen in 5.8%, mid-borderline (BB) in 1.2%, borderline lepromatous (BL) in 9.9%, lepromatous (LL) in 4.1%, pure neural (PNL) in 4.6% and indeterminate in 4.1% cases. More than half (52.9%) patients had a single lesion. Nerve thickening was detected in 70% cases. Slit skin smears were positive in 34 (19.8%) patients. Eighty-nine (51.7%) children were classified as multibacillary (MB) and 83 (48.3%) as paucibacillary (PB) disease by NLEP criteria. Of the available biopsy records, clinico-histological correlation was observed in 130/151 (86.1%) patients. Lepra reactions were observed in 32 patients (18.6%), Type I in 29 cases and Type II in three cases. Neuritis occurred in 11 (6.4%) and deformities in 22 (12.8%) patients. Thirty-four (19-8%) children defaulted from treatment. Two patients relapsed. CONCLUSIONS: Despite the statistical elimination of leprosy in this region, childhood leprosy cases continue to present in alarming numbers. Our study confirmed that multibacillary disease and the complications of lepra reactions and deformities remain common in children. Early detection, treatment and contact tracing may be important reducing the burden of leprosy in the community. There is a need to continue leprosy control activities with full vigour even in areas where, statistically, it has been eliminated.

Dapsone hypersensitivity syndrome in non-leprosy patients: a retrospective study of its incidence in a tertiary referral center in Taiwan.

BACKGROUND: Dapsone hypersensitivity syndrome (DHS) is a potentially life-threatening adverse drug reaction consisting of fever, hepatitis, exfoliative dermatitis, lymphadenopathy and hemolytic anemia. The incidence of DHS is estimated to be 2% in leprosy patients. Because the incidence of this drug eruption may be different in different ethnicities and diseases, we thought to investigate the incidence of DHS in non-leprosy patients. METHODS: This is a retrospective study to examine the incidence, clinical manifestations and prognosis of DHS in non-leprosy patients who were given dapsone at the National Taiwan University Hospital between June 2001 and December 2005. RESULTS: The incidence of DHS among non-leprosy patients was 1.66%. These patients ran a relatively benign course as compared with leprosy patients. CONCLUSION: The incidence of DHS among non-leprosy patients was compatible to that observed among leprosy patients. DHS in non-leprosy patients runs a favorable course with low morbidity in our study.

Prescription auditing of griseofulvin in a tertiary care teaching hospital.

BACKGROUND: Griseofulvin has been the mainstay of treatment for dermatophytosis since many years. Since it is a penicillium antibiotic and used commonly in the outpatient department, the prescription should be audited for its safety and quality. Clinical pharmacists being an important member of the healthcare system have an immense responsibility in delivering pharmaceutical care by auditing prescriptions in order to achieve rational and cost-effective medical care thereby improving patient's Quality of Life (QOL). AIMS: To study the utilization of griseofulvin by auditing prescriptions, to assess the impact of griseofulvin on the QOL of patients and to emphasize role and responsibilities of a clinical pharmacist in the treatment outcome of dermatophytosis. METHODS: 120 patients prescribed with griseofulvin in the dermatology outpatient department were included in the study. On the basis of therapeutic response, improvement was graded at the end of the treatment regimen. Adverse drug reactions (ADRs) during the treatment period were recorded. Laboratory investigations were performed at baseline and at the end of treatment. Quality of Life was measured at baseline and at the end of therapy. RESULTS: 56.7% were females and 43.3% were males. The most common diagnosis was tinea corporis (44.17%) followed by tinea cruris (14.17%) and onychomycosis (9.17%). The most common ADR due to griseofulvin was headache (5.83%). 64.20% patients had complete cure following treatment with griseofulvin. The overall QOL score improved significantly following treatment with griseofulvin (P < 0.0001). CONCLUSION: Griseofulvin can be used extensively for the treatment of dermatophytosis as it has no serious adverse effects and has higher cure rates. Treatment with griseofulvin significantly improves the QOL in patients with dermatophytosis.

Cutaneous lesions in Turkish neonates born in a teaching hospital.

BACKGROUND: The neonatal period is regarded as the first 4 weeks of extrauterine life. In the literature, there are numerous articles about the skin findings in neonates and the results of these studies show differences according to races and environmental factors. AIMS: Our objective was to evaluate the skin lesions seen in neonates delivered in our hospital and to determine their relationship to gender, gestational age and route of delivery. METHODS: Newborns delivered at the Obstetrics Clinics of our hospital between November 2007 and April 2008 were included in this study. Dermatologic examination was performed and relationship between the 10 most common skin findings and gender, gestational age and route of delivery were statistically evaluated. RESULTS: A total of 572 newborns were examined for the presence of skin lesions. Most common skin findings were Epstein pearls (58.76%), sebaceous hyperlasia (48.45%) and xerosis (31.29%). Milia and sebaceous hyperplasia in girls, desquamation and xerosis in preterms, Epstein pearls, sebaceous hyperplasia and desquamation in vaginally delivered babies were found to be more frequent and the differences were statistically significant. CONCLUSION: We found that 90.7% of the neonates had one or more cutaneous lesions. Maturity and type of delivery of the babies were important factors in their causation. In Turkey, this study is the first study performed on the skin lesions seen during the neonatal period. With this study, we want to increase the awareness about the skin findings in neonates.

Chromoblastomycosis in Nepal: a study of 13 cases.

BACKGROUND: Chromoblastomycosis is a chronic fungal infection caused by several pigmented fungi commonly seen in tropical and subtropical climates. AIM: To evaluate the epidemiologic, clinical and pathological characteristics of chromoblastomycosis in our patients. METHODS: This retrospective and prospective study was conducted at the Manipal Teaching Hospital, Pokhara, Nepal. Clinical features and histopathology of all the cases diagnosed as chromoblastomycosis during the last eight years were studied. RESULTS: A total of 13 cases of chromoblastomycosis were diagnosed during the period of 1999-2006. The disease was seen predominantly in middle-aged male farmers and those from rural areas. The lesions commonly involved the lower extremity and were single or multiple in number. They clinically presented as verrucous or nodular growths. Out of these 13 cases, three were diagnosed clinically as squamous cell carcinoma and one as psoriasis. The histopathological features included sclerotic bodies in 12 cases (92%), microabscess formation in 10 cases (76.9%), pseudoepitheliomatous hyperplasia in nine cases (69.2%) and granuloma in eight cases (61.5%). CONCLUSION: Farming is the commonest occupation in patients with chromoblastomycosis. Early histological diagnosis helps in effective management of the condition.

An analysis of the pattern of detection of leprosy patients by institutions in the general health services in Sri Lanka after the integration of leprosy services into general health services.

Integration of leprosy services into the General Health Services was initiated in 2001 in Sri Lanka, and by the end of 2003 all services related to leprosy care were fully integrated. Against this background, routinely collected data available at the Anti-Leprosy Campaign for a 3-year period from 2000-2003 were analyzed to identify the pattern of the detection of cases by hierarchical institutions in the General Health Services. The analysis showed that more than 75% of leprosy patients had been detected at base, general and teaching hospitals and this trend was increasing proportionally during the period of concern (P < 0.001). Teaching hospitals had detected more than 50% of patients and this trend was also proportionally increasing. Nearly one-third of patients detected at teaching hospitals had been detected at the Central Leprosy Clinic (CLC) at the National Hospital. The trend for case detection at the CLC was decreasing proportionally and in absolute terms during the 3-year period after integration. More than 60% of leprosy patients had been detected at institutions where consultant dermatologists were available. The analysis concluded that centralized leprosy diagnostic and treatment services have been taken over by the institutions in the General Health Services but within districts these activities are predominantly concentrated on higher level institutions with consultant dermatological services. This suggests that similar to the existing general trend of by passing of lower level institutions by patients to seek treatment at higher-level institutions, which are perceived to provide a service of better quality, leprosy patients too prefer to seek treatment at these institutions.

Directly observed short course therapy for tuberculosis--a preliminary report of a three-year experience in a teaching hospital.

SETTING: The Chest Clinic of Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, southwest Nigeria is a referral center for tuberculosis patients in the region. Directly Observed Treatment Short Course (DOTS) has been in operation in the center since 1996. OBJECTIVE: To review the outcome of patients on DOTS with the aim of determining factors that may influence compliance. METHODS: Tuberculosis patients were placed on different treatment regimens according to the recommendation of the International Union Against Tuberculosis and Lung Disease (IUATLD) and the Nigerian Tuberculosis and Leprosy Control Program (NTBLCP). The results were recorded and evaluated periodically by the clinic staff under central supervision. The outcome of treatment over a three-year period (1996-1999) was reviewed. RESULTS: Five-hundred-seventy-one patients were treated during this period. Cure/treatment completed rate was 86.1%, and compliance rate was 93.8%. Age, sex category of treatment, and distance from hospital had no significant influence on drug compliance. CONCLUSION: DOTS is an effective means of administering anti-TB drugs. Efforts should be channeled towards developing strategies for implementing DOTS in a more efficient way.

Vitiligo in the Nigerian African: a study of 351 patients in Benin City, Nigeria.

BACKGROUND: There is a paucity of reports on vitiligo in sub-Saharan Africa. AIM: To define the clinical and epidemiologic pattern of vitiligo in the Nigerian African. METHODS: We examined all new cases of vitiligo seen in the Dermatology Unit of the University of Benin Teaching Hospital (UBTH) over a 14-year period: January 1985 to December 1998. RESULTS: Three hundred and fifty-one patients with vitiligo, representing 3.2% of new dermatologic cases, were enrolled. The study group was made up of 153 males and 198 females, giving a sex ratio of 1 : 1.3. The peak incidence of vitiligo was in the second and third decades of life, and the most common form of presentation was the localized focal type (77%), followed by the segmental type (12.5%) and the generalized form (10.5%). Common sites affected were the limbs (32%), trunk (23.8%), face (18.2%), head and neck (9.1%), and the mucous membranes (7.4%). There was a positive family history of vitiligo in 18% of subjects and 3.4% had systemic diseases, such as diabetes mellitus (1.7%), anemia (0.8%), hyperthyroidism (0.6%), and leukemia (0.3%). CONCLUSIONS: Vitiligo on darkly pigmented skin is often a very striking disease. Our findings show that the pattern of vitiligo is similar to that reported from other parts of the world. The high level of social stigmatization is due to confusion with leprosy.