Clinicoepidemiologic profile of leprosy in geriatric population in post-elimination era: A retrospective, hospital-based, cross-sectional study from Eastern India.

Background and Aim: Geriatric populations are susceptible to leprosy infection with masked clinical signs due to lower immunity in them. Our aim was to analyze the clinicoepidemiologic profile of patients with geriatric leprosy and find out the reasons for delayed diagnosis and treatment. Materials and Methods: A retrospective, record-based study was conducted in a tertiary care center from May 2019 to May 2022. The clinicodemographic data of biopsy-confirmed leprosy cases aged ≥60 years were obtained from the leprosy clinic record. Various reasons for the delay in treatment were also recorded. Simple statistics was used for analysis. Results: Out of 605 leprosy cases, 50 (7.4%) cases belonged to the geriatric population. Males outnumbered females (M/F = 37/13). The mean age of the patients was 66.28 + 6.5 years. Maximum patients belonged to 60-69 years of age. The mean duration of illness was 35.22 months (range 1-240 months). Most of the patients were illiterate (33.6%), and 56% were farmers by occupation. The ulnar nerve was the most common nerve to be thickened in 90% (45/50) cases, followed by the common peroneal nerve in 54% (27/50) cases, radical cutaneous nerve in 52% (26/50) cases, and posterior tibial nerve in 24% (12/50) cases. Borderline tuberculoid was the most common type in 44% cases, followed by lepromatous leprosy in 22%, borderline lepromatous leprosy in 18% (9/50), and pure neuritic leprosy in 14%. Type 1 and type 2 lepra reactions were found in 18% and 14% cases, respectively. Also, 38% had grade 2 disability. Common reasons for the delay in treatment were financial constraints, lack of family support, and personal superstitious beliefs. The study was limited by its retrospective nature. Conclusion: Geriatric leprosy needs special attention as the elderly are more prone for deformities; also, because of low immunity, there is a high chance of developing multibacillary leprosy, and therefore, they are potential sources of infection to the community.

Updates on Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by IADVL SIG Leprosy.

The Special Interest Group (SIG) on leprosy thought it to be prudent to revisit its previous practice recommendations through this update. During this period, the pandemic course shifted to a 'second wave' riding on the 'delta variant'. While the number of cases increased manifold, so did the research on all aspects of the disease. Introduction of vaccination and data from various drug trials have an impact on current best practices on management of diseases including leprosy. The beneficial results of using steroids in management of COVID-19, gives elbow room regarding its usage in conditions like lepra reactions. On the other hand, the increase in cases of Mucormycosis again underlines applying due caution while recommending immunosuppressants to a patient already suffering from COVID-19. This recommendation update from SIG leprosy reflects current understanding about managing leprosy while the dynamic pandemic continues with its ebbs and flows.

Hemophagocytic lymphohistiocytosis: A rare, potentially fatal complication in subcutaneous panniculitis like T cell lymphoma.

Subcutaneous panniculitis-like T cell lymphoma is a rare subtype of cutaneous lymphomas with distinct clinical, histological and immunophenotypic characteristics, as well as an indolent clinical course. Rarely, it may be complicated with hemophagocytic lymphohistiocytosis: a hyperinflammatory syndrome which, if not diagnosed early, carries a dismal outcome. In this article, we describe a case of subcutaneous panniculitis-like T cell lymphoma in a middle-aged female patient which was complicated with secondary hemophagocytic lymphohistiocytosis with a favorable outcome following etoposide-based therapy. The various histological mimics of subcutaneous panniculitis-like T cell lymphoma and the management options are also briefly discussed.

Autonomic neuropathy impairing quality of life after completion of MDT: Are we managing enough?

A 26 year old male, treated case of lepromatous leprosy, presented with severe heat intolerance, loss of sensation and sweating over distal parts of both upper and lower limb of 12 years' duration. On examination, there was definite sensory loss over the extremities in glove and stocking pattern and thickening of the bilateral ulnar, common peroneal and radial nerves. There were three trophic ulcers over the plantar aspect of the right foot, atrophy of the small muscles of hand, reabsorption of the distal index, middle and ring fingers along with total clawing of both hands. A slit skin smear for acid fast bacilli revealed fragmented granular bacilli. A starch-iodine test was used to document the pattern of sweating which coincided with the glove and stocking pattern of sensory loss found in lepromatous leprosy. Even though the patient had completed WHO MDT and bacilli were dead, the damage to the autonomic system was extensive in the patient leading to widespread loss of sweating and severe heat intolerance affecting his quality of life. Also the patient had motor deformity in the form of total clawing which added to his disability. Therefore all cases should be followed up even after completion of MDT, counselled regarding the course of the disease, and trained to tackle the consequences of nerve damage in their daily life. We report the case as autonomic dysfunction that has been rarely documented in leprosy patients and also we emphasise the use of the starch-iodine test in such cases along with management of the disease in part by using hydro-oleo therapy.

Leprosy and women.

Leprosy has an impact on the physical, social, and psychological health of affected people. Women in developing countries seek health care late for any health-related issues. Leprosy, a disease known for its stigma, adds further to these facts. Also, close contact between women and family members, especially children, increases the chance of transmission to others and thereby increases the disease burden in the society. Hence, leprosy in women is an important issue for the affected patient, their family members, and society as a whole.

Family motivation card: An innovative tool for increasing case detection in a resource poor setting.

INTRODUCTION: Leprosy is a chronic infectious disease, causing various physical disabilities and deformities. Even today, stigma leads to late detection of new cases. Household contacts are considered a primary focus for the spread of infection. AIM AND OBJECTIVE: To find new cases among household contacts of leprosy patients by providing a family motivation card (FMC) to each leprosy patient, thereby enabling early diagnosis and treatment leading to a decrease in disease and disability burden in the community. MATERIALS AND METHODS: 100 patients diagnosed with leprosy (both new and old cases) were enrolled in the study. All patients were provided with a family motivation card. The purpose of giving the card was discussed in detail with each patient. New family contacts brought by old patients were examined thoroughly for the presence of leprosy. Digital color photographs were taken of all family contacts. Data analysis was done. RESULTS: 23 new cases of leprosy (15 (65%) MB and eight (35%) PB cases) were detected among family members of primary cases. Most cases belonged to the under 15 years (43.47%) and over 60 years (34.78%) age groups. CONCLUSION: Adoption of a simple, cheap yet effective strategy such as the FMC could act as a bridge between intensive case-finding approaches, such as the Modified Leprosy Elimination Campaign (MLEC) and voluntary reporting.