Factors affecting perceived stigma in leprosy affected persons in western Nepal.

BACKGROUND: There are various factors which construct the perception of stigma in both leprosy affected persons and unaffected persons. The main purpose of this study was to determine the level of perceived stigma and the risk factors contributing to it among leprosy affected person attending the Green Pastures Hospital, Pokhara municipality of western Nepal. METHODS: A cross-sectional study was conducted among 135 people affected by leprosy at Green Pastures Hospital and Rehabilitation Centre. Persons above the age of 18 were interviewed using a set of questionnaire form and Explanatory Model Interview Catalogue (EMIC). In addition, two sets of focused group discussions each containing 10 participants from the ward were conducted with the objectives of answering the frequently affected EMIC items. RESULTS: Among 135 leprosy affected persons, the median score of perceived stigma was 10 while it ranged from 0-34. Higher perceived stigma score was found in illiterate persons (p=0.008), participants whose incomes were self-described as inadequate (p=0.014) and who had changed their occupation due to leprosy (p=0.018). Patients who lacked information on leprosy (p=0.025), knowledge about the causes (p=0.02) and transmission of leprosy (p=0.046) and those who had perception that leprosy is a severe disease (p<0.001) and is difficult to treat (p<0.001) had higher perceived stigma score. Participants with disfigurement or deformities (p=0.014), ulcers (p=0.022) and odorous ulcers (p=0.043) had higher perceived stigma score. CONCLUSION: The factors associated with higher stigma were illiteracy, perceived economical inadequacy, change of occupation due to leprosy, lack of knowledge about leprosy, perception of leprosy as a severe disease and difficult to treat. Similarly, visible deformities and ulcers were associated with higher stigma. There is an urgent need of stigma reduction strategies focused on health education and health awareness programs in addition to the necessary rehabilitation support.

Australia's notifiable diseases status, 2005: annual report of the National Notifiable Diseases Surveillance System.

In 2005, 60 diseases and conditions were nationally notifiable in Australia. States and territories reported a total of 125,461 cases of communicable diseases to the National Notifiable Diseases Surveillance System: an increase of 10% on the number of notifications in 2004. In 2005, the most frequently notified diseases were sexually transmissible infections (51,557 notifications, 41% of total notifications), gastrointestinal diseases (29,422 notifications, 23%) and bloodborne diseases (19,278 notifications, 15%). There were 17,753 notifications of vaccine preventable diseases; 4,935 notifications of vectorborne diseases; 1,826 notification of other bacterial infections (legionellosis, leprosy, meningococcal infections and tuberculosis) and 687 notifications of zoonotic diseases.

Australia's notifiable diseases status, 2004, annual report of the National Notifiable Diseases Surveillance System.

In 2004, 60 diseases and conditions were nationally notifiable in Australia. States and Territories reported a total of 110,929 cases of communicable diseases to the National Notifiable Diseases Surveillance System (NNDSS): an increase of 4 per cent on the number of notifications in 2003. In 2004, the most frequently notified diseases were sexually transmissible infections (46,762 cases; 42% of total notifications), gastrointestinal diseases (25,247 cases; 23% of total notifications) and bloodborne diseases (19,191 cases; 17% of total notifications). There were 13,206 notifications of vaccine preventable diseases, 6,000 notifications of vectorborne diseases, 1,799 notifications of other bacterial infections (includes, legionellosis, leprosy, meningococcal infections and tuberculosis) and 877 notifications of zoonotic diseases.

Effective treatment of erythema nodosum leprosum with thalidomide is associated with immune stimulation.

The immunomodulatory drug thalidomide is the treatment of choice for erythema nodosum leprosum (ENL), an inflammatory cutaneous and systemic complication of multibacillary leprosy. To elucidate the mechanism of action of thalidomide in this syndrome, we prospectively investigated 20 patients with ENL who were treated with thalidomide for 21 days. All patients responded to treatment, with the majority of them having complete resolution of cutaneous lesions within 7 days. This response was associated with a marked but transient increase in ex vivo mitogen-induced expression of interleukin (IL)-2 and interferon- gamma by CD4(+) and CD8(+) T cells that was observed on treatment day 7, but these returned to pretreatment levels by day 21. Plasma tumor necrosis factor- alpha levels were not high at baseline, and they increased modestly during treatment. Plasma levels of IL-12 increased steadily during thalidomide treatment. Hence, the therapeutic effect of thalidomide in ENL appears to be associated with transient immune stimulation, which suggests that the drug may promote an active immunoregulatory response.

Australia's notifiable diseases status, 2000. Annual report of the National Notifiable Diseases Surveillance System.

In 2000, there were 89,740 notifications of communicable diseases in Australia collected by the National Notifiable Diseases Surveillance System (NNDSS). The number of notifications in 2000 was an increase of 5.9 per cent over those reported in 1999 (84,743) and the largest reporting year since the NNDSS commenced in 1991. Notifications in 2000 consisted of 28,341 bloodborne infections (32% of total), 24,319 sexually transmitted infections (27%), 21,303 gastrointestinal infections (24%), 6,617 vaccine preventable infections (7%), 6,069 vectorborne infections (7%), 2,121 other bacterial infections (legionellosis, meningococcal infection, leprosy and tuberculosis) (2%), 969 zoonotic infections (1%) and only one case of a quarantinable infection. Steep declines in some childhood vaccine preventable diseases such as Haemophilus influenzae type b, measles, mumps and rubella, continued in 2000. In contrast, notifications of pertussis and legionellosis increased sharply in the year. Notifications of bloodborne viral diseases (particularly hepatitis B and hepatitis C) and some sexually transmitted infections such as chlamydia, continue to increase in Australia. This report also summarises data on communicable diseases from other surveillance systems including the Laboratory Virology and Serology Surveillance Scheme (LabVISE) and sentinel general practitioner schemes. In addition this report comments on other important developments in communicable disease control in Australia in 2000.

The paper grip test for screening on intrinsic muscle paralysis in the foot of leprosy patients.

Plantar intrinsic foot muscles provide structure to the foot during walking and thus regulate mechanical foot sole stresses. When paralyzed, for instance in leprosy patients with neuropathy of the distal part of the tibial nerve, there is a high prevalence of plantar ulceration and deformities, especially when muscle weakness goes together with loss of foot sole sensibility. These patients should get immediate care involving education, special footwear and reconstructive surgery before further foot impairment and deformity becomes manifest. Thus far, in leprosy patients little attention is paid to screening of plantar intrinsic muscles activity. This can be done with a new simple and non-invasive method, the Paper Grip Test (PGT). There are two variants for detecting intrinsic muscle weakness of the foot, PGT1 for the great toe and PGT2 for the combined lesser toes. In this study, 517 leprosy patients and 170 healthy volunteers were investigated with the PGT. Sensibility of the foot sole was tested by means of a 10 gram monofilament. Specificity to the PGT1 is found to be about 95.3% which is considered good for physical diagnostic tests. PGT2 is less specific than PGT1. Individual muscle power and understanding of the patient seems to influence the outcome of the test to a certain extent. Sensitivity can only be calculated when the diagnosis is confirmed by electromyography. Especially patients with anesthetic feet, females, older patients and patients with PN-, BB- or LL-types of leprosy appeared to have a higher prevalence of intrinsic foot muscle weakness. All results were analyzed by means of the bivariate Pearson correlation-analysis and proved to be statistically significant (p = < 0.05). It is concluded that the PGT1, more than the PGT2, is a useful screening test on the function of plantar intrinsic foot muscles in leprosy patients in hospitals and during fieldwork in developing countries.

The paper grip test for screening on intrinsic muscle paralysis in the foot of leprosy patients

Plantar intrinsic foot muscles provide structure to the foot during walking and thus regulate mechanical foot sole stresses. When paralyzed, for instance in leprosy patients with neuropathy of the distal part of the tibial nerve, there is a high prevalence of plantar ulceration and deformities, especially when muscle weakness goes together with loss of foot sole sensibility. These patients should get immediate care involving education, special footwear and reconstructive surgery before further foot impairment and deformity becomes manifest. Thus far, in leprosy patients little attention is paid to screening of plantar intrinsic muscles activity. This can be done with a new simple and non-invasive method, the Paper Grip Test (PGT). There are two variants for detecting intrinsic muscle weakness of the foot, PGT1 for the great toe and PGT2 for the combined lesser toes. In this study, 517 leprosy patients and 170 healthy volunteers were investigated with the PGT. Sensibility of the foot sole was tested by means of a 10 gram monofilament. Specificity to the PGT1 is found to be about 95.3% which is considered good for physical diagnostic tests. PGT2 is less specific than PGT1. Individual muscle power and understanding of the patient seems to influence the outcome of the test to a certain extent. Sensitivity can only be calculated when the diagnosis is confirmed by electromyography. Especially patients with anesthetic feet, females, older patients and patients with PN-, BB- or LL-types of leprosy appeared to have a higher prevalence of intrinsic foot muscle weakness. All results were analyzed by means of the bivariate Pearson correlation-analysis and proved to be statistically significant (p = < 0.05). It is concluded that the PGT1, more than the PGT2, is a useful screening test on the function of plantar intrinsic foot muscles in leprosy patients in hospitals and during fieldwork in developing countries.

Predicción casos muy positivos entre pacientes de lepra MB con parámetros clínicos

Aunque se sabe que los casos frotis muy bacilíferos presentan un riesgo elevado de recidivas después de ser dadas de alta de la MDT, los programas de control en el campo sin facilidades para efectuar frotis no disponen de un método alternativo para poder detectarlos. Este estudio presentó una prevalencia significativa de este tipo de casos entre 2.374 casos multibacilares nuevos recientemente detectados por frotis cutáneos en Nepal y análisis retrospectivos de 555 casos nuevos recien detectados, BL y LL sin tratar, para identificar parámetros clínicos y de laboratorio asociados con un frotis cutáneo muy bacilíferos. Mientras que alguno de estos parámetros presentan gran sensibilidad en precedir "casos muy bacilíferos", ninguno presenta simultáneamente elevada sensibilidad y especificidad.

Vaccination with DNA of the Mycobacterium tuberculosis 85B antigen protects mouse foot pad against infection with M. leprae

A DNA vaccine composed of the gene for the common mycobacterial secreted protein antigen 85B was demonstrated to protect the mouse foot pad against infection with Mycobacterium leprae. The protective effect was demonstrated by a 61%-88% reduction in the bacterial number, a protective effect less than that of BCG. The same DNA vaccine has been shown to protect mice against M. tuberculosis infection, and the importance of testing other candidate tuberculosis vaccines for their potential to protect against leprosy is discussed.

Predicción "casos muy positivos" entre pacientes de lepra mb con parámetros clínicos

Aunque se sabe que los casos frotis muy bacilíferos presentan un riesgo elevado de recidivas después de ser dadas de alta de la MDT, los programas de control en el campo sin facilidades para efectuar frotis no disponen de un mé todo alternativo para poder detectarlos. Este estudio presentó una prevalencia significativa de este tipo de casos entre 2.374 casos multibacilares nuevos recientemente detectados por frotis cutáneos en Nepal y análisis retrospectivos de 555 casos nuevos recien detectados, BL y LL sin tratar, para identificar parametros clínicos y de laboratorio asociados con un frotis cutáneo muy bacilíferos. Mientras que alguno de estos parámetros presentan gran sensibilidad en predecir "casos muy bacilíferos", ninguno presenta simultáneamente elevada sensibilidad y especificidad (AU)

Interferon-Gamma responses to candidate leprosy skin-test reagents detect exposure to leprosy in an endemic population

New tools for the detection of leprosy exposure in a community will be necessary for the eradication of leprosy. Candidate leprosy skin-test antigens derived from the fractionation of the leprosy bacillus into cytoplasmic and cell-wall proteins free of immuno-inhibitory mycobacterial lipoglycans and carbohydrates were used in an overnight blood test to determine whether exposure to leprosy can be detected by the production of the cytokine interferon gamma (IFN-gamma). Strong IFN-gamma responses were detected in leprosy contacts to both skin-test antigens compared with control subjects from the same endemic communities. There was little response in patients with tuberculosis. Responses were greatest in contacts with recent leprosy exposure. The implications of these findings for the application of these reagents in a field trial as skin tests to detect exposure to leprosy are discussed in light of the strong association between overnight IFN-gamma to PPD and the tuberculin skin-test responses previously reported.

Risk Factor for erythema nodosum leprosum

A retrospective study of new borderline lepromatous and lepromatous patients reporting for multidrug therapy (MDT) for leprosy at the Anandaban Leprosy Hospital, Kathmandu, Nepal, over an 8-year period was conducted to determine the prevalence of erythema nodosum leprosum (ENL), the time and frequency of reactions, and clinical and laboratory parameters associated with ENL. An overall prevalence of ENL in this cohort of 19% was found. One third of these reactions occurred in patients before MDT was given, one third in the first 6 months and one third after 6 months of treatment. Nearly 1 in 10 of the ENL reactions occurred in patients who had completed 2 years of MDT; 45% of patients with ENL had more than one episode. Data collected at the patients' first presentation was used to identify four major risk factors. Patients with lepromatous disease, skin infiltration or a bacterial index (BI) of > 4+ were at significantly increased risk. Patients older than 40 were at significantly decreased risk of ENL. There was a linear relationship in the risk of ENL with an increasing BI and an inverse relationship to increasing age. These observations should enable clinicians to recognize patients at first presentation who will be likely to develop ENL.

Rapid method for diagnosis of leprosy by measurements of antibodies to the M. leprae 35-kDa protein: comparison with PGL-1 antibodies detected by ELISA and Dipstick methods

A new rapid immuno-chromatographic test card for the detection of antibodies to the Mycobacterium leprae 35-kD protein is described. The new assay is compared in the same group of subjects with a direct enzyme ELISA method for 35-kD antibodies and with assays for anti-phenolic glycolipid-I (PGL-I) antibodies using a standard ELISA as well as the recently described [quot ]dipstick[quot ] method. Good concordance was found between the rapid methods and the corresponding ELISA methods. The detection of untreated paucibacillary leprosy by the 35-kD test card was 59% compared with 27% for the PGL-I dipstick; however, the specificity for the 35-kD test card was 90% compared with 100% for the PGL-I dipstick in an endemic population. The potential application of these new, rapid serologic methods for the diagnosis of leprosy under field conditions is discussed.

Contribution of type 1 reactions to sensory and motor function loss in borderline leprosy patients and the efficacy of treatment with prednisone

The changes in nerve function tests in 297 new leprosy patients over an average period of 30 months were measured. The impact of type 1 reactions (T1R) on sensory and voluntary muscle function was measured by standard tests. Sensory function was improved in patients with single episodes of cutaneous T1R, but not improved in patients with neural T1R or with multiple episodes of either kind of T1R. Patients over 40 years of age improved less than younger patients, and patients admitted for treatment of T1R improved more than those treated as outpatients. These data point to a need to find better regimens for the treatment of nerve damage in T1R.