Phimosis and scrotal lesions in leprosy: two case reports.

We report two cases of borderline leprosy patients, one with scrotal lesions, the other presenting with leprosy on the prepuce with phimosis.

Assessment of subclinical leprosy infection through the measurement of PGL-1 antibody levels in residents of a former leprosy colony in Thailand.

OBJECTIVES: To investigate the hypothesis that there is continuing subclinical M. leprae infection, contributing to ongoing transmission of leprosy in Phra-Pradaeng Colony. DESIGN: A sero-epidemiological survey was carried out in Phra-Pradaeng Colony, Thailand between May and August 2005. The clinical and serological examinations were conducted in 398 people, aged 3-84 years (average 50 years), comprising 196 males and 202 females. RESULTS: Measurement of serum anti PGL-I antibodies in eligible contacts and ex-patients showed that 18 people (4.5%) were seropositive, six people (1.5%) were strongly positive and 374 people (94.0%) were seronegative. All six people who were strongly seropositive were ex-patients; five of them had no evidence of active leprosy but the sixth person had relapsed BL leprosy with a reversal reaction. CONCLUSIONS: This study failed to confirm the hypothesis that there was ongoing subclinical M. leprae infection. More appropriate diagnostic methods and a total survey of the colony should be considered to further clarify this problem.

Squamous cell carcinoma arising in chronic ulcers in leprosy.

Squamous cell carcinoma (SCC) arising in chronic ulcers of leprosy patients is uncommon. A retrospective analytical study of 416 biopsy specimens of chronic ulcers during 1976 - 2000 occuring on the extremity of leprosy patients was performed. Pathologic examination showed that 217 specimens (52.2%) were reported as pseudoepitheliomatous hyperplasia (PH). A total of 102 (24.5%) specimens reported as SCC, involving 100 individual patients (69 males, 31 females). SCC was localized on the lower extremity in 87 specimens (85.3%). No significant difference was observed between left and right foot using Chi-square test. The sole was the commonest site of involvement, and then the heel. SCC on the upper extremity which was much less common, presented in 15 specimens (14.7%). The tumor was localized on the palm in 10 specimens (right: 9, left: 1). SCC in chronic ulcers of leprosy patients were much more common on the lower extremity than on the upper extremity. Most of the tumors on the upper extremity were localized on the right palm. This emphasizes the need for an active policy of prevention of disability in leprosy control programs.

Assessment of the quality of leprosy services from the clients' perspective in Thailand.

To assess the quality of the leprosy service in health facilities from the clients' perspective, qualitative data collection methods, i.e. semi-structured interviews, focus group discussions (FGDs) and priority cards, were conducted in six health facilities located in all regions of Thailand. A total of 29 patients were interviewed and three focus group discussions involving 20 patients were carried out. In addition, six health staff and six community members were interviewed. The results show that patients delayed months to years before they went to a public health facility. This is due to the poor knowledge about leprosy. Most of the interviewed patients tried to get rid of the skin symptoms at home, using topical medicated cream or herbs. Distance was not regarded as a problem, because most patients go to nearby district hospitals. In district hospitals misdiagnosis is still common. More than half of leprosy patients said they did not receive any information about leprosy before they were diagnosed. Travel costs seem to cause problems for a few poor and aged patients who needed someone to accompany them. Patients at district and provincial hospitals complained that the waiting times to consult staff were too long. In most health facilities, privacy during examinations was not adequate. Patients placed a priority on health staff being friendly and respectful to them. When patients were asked to list their priorities of the quality of services, they considered the attitude of health staff, low costs to go to the leprosy services, adequate attention to POD and adequate information to leprosy patients on their disease, as their top four items. Important recommendations resulting from the study were: (1) health education to the public has to be strengthened; (2) training of health staff to minimize doctors' delay; (3) good attitude of health staff towards leprosy patients should be sustained; and (4) leprosy services in district and provincial hospitals should be improved as a one-stop service for leprosy patients.