Leprosy in children in Cuba: Epidemiological and clinical description of 50 cases from 2012-2019.

INTRODUCTION: In 1993, Cuba achieved leprosy elimination according to the World Health Organization's (WHO) indicator of less than one case per 10,000 population. Despite this achievement, detection of new cases occurs every year among all age groups including children. Detection of new cases in children reveals persistent transmission of the infection. OBJECTIVE: To describe the clinical and epidemiological features of leprosy in individuals younger than 15 years (childhood leprosy) reported to the Cuban National Leprosy Control Program (NLCP) between 2012 and 2019. METHODS: We conducted a retrospective descriptive study between 2012 and 2019 to assess the clinical and epidemiologic features of individuals under the age of 15 years with a confirmed diagnosis of leprosy reported to the NLCP. We reviewed the NLCP database and collected data to better define the total number of cases of leprosy in adults, children (younger than 15 years). We assessed socio-demographic variables (age, gender, and province of residence) as well as variables of clinical interest including operational classification and staging at diagnosis, bacillary index, grade of disability by WHO staging. Additionally, we evaluated epidemiological variables including passive versus active surveillance of cases, contact investigation focusing specifically in household transmission, and the degree of kinship as well as standing of the child within the focus of transmission when there were additional cases. RESULTS: We identified fifty children during the study period corresponding to 3% of the overall cases of leprosy comprising all age groups in Cuba. In the age group younger than 15 years, the majorities of cases was from the Granma province and most were between the ages of 10 and 14 years. Clinically, multibacillary/lepromatous forms were the most common type identified with positive bacillary index. The majority of children diagnosed with leprosy during our study period had a history of a relative with a confirmed diagnosis of leprosy. CONCLUSIONS: Detection of cases of leprosy in individuals younger than 15 years of age in Cuba demonstrates ongoing transmission of M. leprae in specific geographic hotspots. Its frequency in the early adolescence, the predominant clinical forms, and the mode of detection associated with sources of suspected familiar infection demonstrated that there is a need for further efforts by the NLCP to conduct active surveillance activities among affected communities to identify cases of leprosy earlier with the goal of preventing further household and community transmission.

Diagnóstico de lepra en niños mediante seguimiento serológico de anticuerpos contra el glicolípido fenólico I / Leprosy diagnosis in children by antibodies serologic follow up against the phenolic glycolipid I

Introducción: Los niños contactos de pacientes con lepra se consideran las personas con mayores posibilidades de desarrollar la enfermedad. Objetivo: Valorar la utilidad del seguimiento serológico de anticuerpos contra el glicolípido fenólico I para el diagnóstico de lepra en niños. Métodos: Investigación prospectiva. Se incluyeron todos los niños contactos de pacientes diagnosticados con lepra en las provincias de La Habana, Santiago de Cuba y Guantánamo entre enero 2013-junio 2015. Los menores se evaluaron clínicamente mediante examen dermatoneurológico y se determinó la presencia de anticuerpos contra el glicolípido fenólico I de Mycobacterium leprae para el estudio serológico. Los niños con serología positiva se siguieron, con estos dos métodos, cada seis meses durante dos años. La confirmación de un caso nuevo de lepra se realizó mediante baciloscopía y biología molecular. Resultados: Se estudiaron 151 niños, de ellos 44 (29,13 por ciento) resultaron positivos al glicolípido fenólico I. Se diagnosticaron durante el período 12 casos, de los cuales 11 tuvieron serología positiva. Presentaron sospecha clínica 10 niños de los estudiados, solo se confirmó un caso nuevo, el cual tuvo serología negativa. En ocho de los niños diagnosticados se detectó presencia de bacilos ácido alcohol resistente en la lámina de baciloscopía. En los restantes cuatro niños el diagnóstico se confirmó por la reacción en cadena de la polimerasa. Conclusiones: Los resultados de esta investigación denotan la utilidad del seguimiento serológico de anticuerpos contra el glicolípido fenólico I en el diagnóstico de lepra en niños, en apoyo a la vigilancia clínica(AU)

Introduction: Children having contact with leprosy patients are considered the contacts with greater possibilities of developing the disease. Objective: To assess the usefulness of antibodies´ serologic follow up against the phenolic glycolipid I (PGL-1) for the diagnosis of leprosy in children. Methods: Prospective study in which were included all children contacts of patients diagnosed with leprosy in Havana, Santiago de Cuba and Guantanamo provinces between January 2013 and June 2015. They were evaluated clinically by the dermato-neurological examination and the presence of antibodies against the PGL-1 of M. leprae was determined. Children with positive serology were followed up using these same two methods every six months for two years. The confirmation of a new case of leprosy was made by smear microscopy and molecular biology / PCR-Rlep. Results: A total of 151 children were studied. Of these, 44 children (29.13 percent) were positive for phenolic glycolipid I. A total of 12 children were diagnosed during this period, of which 11 had positive serology. Only 10 children of the studied ones presented clinical suspicion and of these only one new case was confirmed, which had negative serology. In eight of the diagnosed children, the presence of acid-fast bacilli was detected in the smear microscopy. In the remaining four children, the diagnosis was confirmed by the PCR result. Conclusion: The results of this investigation show the usefulness of the antibodies´ serologic follow up against the phenolic glycolipid I in the diagnosis of leprosy in children as a support to clinical surveillance(AU)

Diagnóstico de lepra en niños mediante seguimiento serológico de anticuerpos contra el glicolípido fenólico I / Leprosy diagnosis in children by antibodies serologic follow up against the phenolic glycolipid I

Introducción: Los niños contactos de pacientes con lepra se consideran las personas con mayores posibilidades de desarrollar la enfermedad. Objetivo: Valorar la utilidad del seguimiento serológico de anticuerpos contra el glicolípido fenólico I para el diagnóstico de lepra en niños. Métodos: Investigación prospectiva. Se incluyeron todos los niños contactos de pacientes diagnosticados con lepra en las provincias de La Habana, Santiago de Cuba y Guantánamo entre enero 2013-junio 2015. Los menores se evaluaron clínicamente mediante examen dermatoneurológico y se determinó la presencia de anticuerpos contra el glicolípido fenólico I de Mycobacterium leprae para el estudio serológico. Los niños con serología positiva se siguieron, con estos dos métodos, cada seis meses durante dos años. La confirmación de un caso nuevo de lepra se realizó mediante baciloscopía y biología molecular. Resultados: Se estudiaron 151 niños, de ellos 44 (29,13 por ciento) resultaron positivos al glicolípido fenólico I. Se diagnosticaron durante el período 12 casos, de los cuales 11 tuvieron serología positiva. Presentaron sospecha clínica 10 niños de los estudiados, solo se confirmó un caso nuevo, el cual tuvo serología negativa. En ocho de los niños diagnosticados se detectó presencia de bacilos ácido alcohol resistente en la lámina de baciloscopía. En los restantes cuatro niños el diagnóstico se confirmó por la reacción en cadena de la polimerasa. Conclusiones: Los resultados de esta investigación denotan la utilidad del seguimiento serológico de anticuerpos contra el glicolípido fenólico I en el diagnóstico de lepra en niños, en apoyo a la vigilancia clínica(AU)

Introduction: Children having contact with leprosy patients are considered the contacts with greater possibilities of developing the disease. Objective: To assess the usefulness of antibodies´ serologic follow up against the phenolic glycolipid I (PGL-1) for the diagnosis of leprosy in children. Methods: Prospective study in which were included all children contacts of patients diagnosed with leprosy in Havana, Santiago de Cuba and Guantanamo provinces between January 2013 and June 2015. They were evaluated clinically by the dermato-neurological examination and the presence of antibodies against the PGL-1 of M. leprae was determined. Children with positive serology were followed up using these same two methods every six months for two years. The confirmation of a new case of leprosy was made by smear microscopy and molecular biology / PCR-Rlep. Results: A total of 151 children were studied. Of these, 44 children (29.13 percent) were positive for phenolic glycolipid I. A total of 12 children were diagnosed during this period, of which 11 had positive serology. Only 10 children of the studied ones presented clinical suspicion and of these only one new case was confirmed, which had negative serology. In eight of the diagnosed children, the presence of acid-fast bacilli was detected in the smear microscopy. In the remaining four children, the diagnosis was confirmed by the PCR result. Conclusion: The results of this investigation show the usefulness of the antibodies´ serologic follow up against the phenolic glycolipid I in the diagnosis of leprosy in children as a support to clinical surveillance(AU)

Caracterización de los casos de Lepra Infantil atendidos en el Hospital Pediátrico Universitario Juan Manuel Márquez / Characterization of cases of leprosy treated at the Children's Pediatric Hospital Universitario Juan Manuel Marquez

La lepra es una enfermedad crónica transmisible tan antigua como el hombre mismo. En Cuba se ha desarrollado un programa nacional orientado a prevenir, diagnosticar oportunamente y tratar de forma adecuada esta enfermedad. En este trabajo nos propusimos mostrar su comportamiento en los niños entre 0 años y 17 años, 11 meses y 29 días. Se realizó un estudio descriptivo, retrospectivo y transversal de los casos de lepra atendidos en la consulta de Dermatología del Hospital Pediátrico Universitario Juan Manuel Márquez de Ciudad Habana desde su inauguración (Noviembre 1989) hasta el año 2006. Como hallazgo significativo se encontro que predominan las formas clínicas con mayor posibilidad de transmitir la enfermedad, y que juega un rol fundamental como fuente de transmisión la familia inmediata. Todos los casos diagnóticados eran mayores de 10 años(AU)