Clinicoepidemiological profile of 590 cases of beetle dermatitis in western Orissa.

BACKGROUND: Beetle dermatitis is a very common condition in western Orissa. It is often misdiagnosed and causes significant morbidity among the rural population. AIM: This study was conducted to determine the epidemiological and clinical profile of beetle dermatitis in western Orissa. METHODS: All clinically diagnosed cases of beetle dermatitis were included in the study. Detailed history was taken and thorough clinical examination was conducted in all the cases. One urban and three rural localities were visited regularly to detect the epidemiological trends of the disorder. RESULTS: A total of 590 cases were studied: 486 males and 104 females. The age of the patients ranged from 2 to 65 years. Forty-four percent of the patients belonged to the pediatric age group. Majority of the cases (85%) presented during the months of March to July, indicating a distinct seasonal trend. The disorder was prevalent in the localities nearer to paddy and sugarcane fields and grasslands with stagnant water. The clinical lesions included papules, erosions, crusted lesions, urticarial plaques and vesiculobullous lesions. Distribution was mainly linear, but kissing lesions were also observed. Head, neck and upper extremities were the most commonly involved sites. Lymphadenopathy and systemic features such as fever and malaise were observed in 24% and 15% of the cases, respectively. CONCLUSION: Beetle dermatitis should be included in the differential diagnosis of the acute onset of vesiculobullous lesions in the endemic areas.

Fnac study of histoid nodule: an early tool for diagnosis.

Histoid lesion, a variety of lepromatous leprosy, is due to alteration in the growth pattern of Mycobacterium leprae, possibly due to loss of immunity in localized areas. The distinction is based on cellular morphology by demonstrating pallisading arrangement of multi-layered spindle-shaped histocytes. Cytodiagnosis by fine needle aspiration cytology is therefore an early tool to recognize the histoid variety, differentiating it from a conventional LL module, as it is a simple and less traumatic procedure.

Prevalence of leprosy among household contacts of leprosy cases in western Orissa.

The prevalence rate of leprosy among household contacts is an important epidemiological indicator in the character and trend of the disease. During the period January 2001 to December 2002, families of 400 primary cases were studied to detect contact (secondary) cases. Seventy-two cases were detected from 54 families; of these 72 cases, 45 (62.5%) were in the paediatric age-group (0-14 years) and of these 45.8% belonged to 6-14 years group. Out of the 72 cases, there were more (58) of paucibacillary (PNL+I+TT+BT) cases. Secondary cases were significantly high when there was lepromatous type of leprosy in the family. The attack rate among those exposed to paucibacillary type (TT, BT) of leprosy, though much less, was still observed. The influence of duration of contact revealed that a maximum number of cases (N=43, 59.7%) acquired the disease during 0-6 years of contact. A majority of the patients belonged to low-income groups, were illiterate and lived in extended families. The father was the source case for most of the secondary cases (N=41, 57%). Conjugal leprosy was very rare. The results of the study points to the fact that PB leprosy is still a potential source of infection and cannot be ignored. It is important to evolve a hospital-based surveillance programme for contacts of leprosy patients since early detection and treatment of contacts are important measures for reducing the reservoir of infection in the community.

Silent neuropathy in leprosy.

Twelve patients of silent neuropathy attending the OPD of Skin and VD, VSS Medical College Hospital during 1996-1998 were taken for study. On clinical analysis 5 cases were present as silent neuropathy, 4 cases during MDT and 3 cases after completion of MDT Seventy percent of cases showed good response to systemic steroid.

Lupus vulgaris on keloid.

A 28-year-old man presented with multicentric lupus vulgaris on keloids over chest, axilla, neck and back for last 6 months. He had pulmonary tuberculosis. All the laboratory investigations were in favour of clinical diagnosis. The patient responded to antituberculosis therapy.

Surgical treatment of plantar ulcers in leprosy.

Plantar ulcers present a serious problem in the management of leprosy. After studying the mechanism of ulceration and the causes of their indolence, it appears that the treatment of the disease by antileprotic drugs is not sufficient. The underlying causes, such as anaesthesia, bony deformities and paralysis, should usually be treated by surgical means. Anaesthesia can be reversed by decompression of the posterior tibial nerve if this is done early. Deformities should be corrected by procedures on the soft tissues or bones, and chronic infection eradicated to prevent recurrence of the ulceration. A combination of procedures may sometimes be needed.

Surgical treatment of plantar ulcers in leprosy.

Plantar ulcers present a serious problem in the management of leprosy. After studying the mechanism of ulceration and the causes of their indolence, it appears that the treatment of the disease by antileprotic drugs is not sufficient. The underlying causes, such as anaesthesia, bony deformities and paralysis, should usually be treated by surgical means. Anaesthesia can be reversed by decompression of the posterior tibial nerve if this is done early. Deformities should be corrected by procedures on the soft tissues or bones, and chronic infection eradicated to prevent recurrence of the ulceration. A combination of procedures may sometimes be needed.

Surgical treatment of plantar ulcers in leprosy

Plantar ulcers present a serious problem in the management of leprosy. After studying the mechanism of ulceration and the causes of their indolence, it appears that the treatment of the disease by antileprotic drugs is not sufficient. The underlying causes, such as anaesthesia, bony deformities and paralysis, should usually be treated by surgical means. Anaesthesia can be reversed by decompression of the posterior tibial nerve if this is done early. Deformities should be corrected by procedures on the soft tissues or bones, and chronic infection eradicated to prevent recurrence of the ulceration. A combination of procedures may sometimes be needed.