Current trends in leprosy transmission in eastern India in the era of 12-month multi-drug treatment: a hospital-based retrospective study.

OBJECTIVES: Our objective was to study current trends in the occurrence of new cases of leprosy (Hansen's disease [HD]) a decade after significant operational changes in the National Leprosy Elimination Program (NLEP) were enacted by shortening the duration of multi-drug treatment for multibacillary cases of HD to 12 months and stopping post-treatment follow-up. METHODS: The percentages represented by newly diagnosed cases of HD among all new patients attending the dermatology outpatient department (OPD) from April 2008 to March 2011 were calculated from hospital records. Patient age and sex, and type of disease were noted in each case, and annual data were compared. The OPD data were also matched with population data for the catchment area of the hospital (i.e. the South 24-Parganas district). RESULTS: There was a slight annual decline in the percentage of new cases represented by HD, but this was not statistically significant. This trend broadly corroborated changes in the annual new case detection rate in the catchment area of the hospital. In addition, the percentage of HD cases represented by paucibacillary disease was significantly higher than that represented by multibacillary HD (P=0.0072). CONCLUSIONS: To the best of our knowledge, this is the first study of this type to be conducted in eastern India. The present data indicate that significant transmission of HD is ongoing in the community.

Leprosy revealed in a rheumatology clinic: a case series.

AIM: Leprosy classically presents with cutaneous and neural involvement. Rheumatological manifestations are frequent, although often under-recognized. At times, these may present to a rheumatology clinic prior to the diagnosis of leprosy. Herein, we present our experience with patients referred with various rheumatological disorders who were subsequently diagnosed as having leprosy. METHODS: This retrospective study (January 2001-September 2010) was carried out at the Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, in northern India. Patients who were confirmed as having leprosy were included. Details regarding demographic and clinical presentations were collected. RESULTS: Forty-four cases (30 male, mean age 40 ± 13.6 years and mean disease duration 18.7 ± 24.3 months) were identified. Musculoskeletal manifestations included arthritis (n = 22), swollen hands and feet syndrome (SHFS) (n = 11), tenosynovitis (n = 9), painful swollen feet (n = 9), arthralgias (n = 7) and vasculitis (n = 1). Distribution of joints mimicked rheumatoid arthritis (n = 14) and spondyloarthropathy (n = 7). Arthritis and/or tenosynovitis were part of spontaneous onset lepra reaction in 28 cases. Other clinical manifestations were: paresthesias (n = 28), erythematous nodules (n = 25) and anesthetic patches (n = 7). Thirty-one patients had thickened nerves (ulnar n = 28, common peroneal n = 21). Eight patients did not have any cutaneous manifestations and had presented with SHFS and arthritis or tenosynovitis. These were labeled as pure neuritic leprosy. Most of the patients responded to multidrug anti-leprosy therapy and glucocorticoids. CONCLUSION: Rheumatological presentations of leprosy may mimic RA, spondyloarthropathy or vasculitis. Pure neuritic variety and spontaneous type 2 lepra reaction pose unique diagnostic challenges. Increased awareness may avoid delay in diagnosis.

Revalidation of various clinical criteria for the classification of leprosy--a clinic-pathological study.

UNLABELLED: WHO guidelines classify leprosy patients clinically into PB and MB group based on the number of skin lesions (NSL) with > or = 6 skin lesions as a criterion for MB leprosy. Other clinical criteria for classification are based on the number of body areas affected (NBAA) and on size of the largest skin lesions (SLSL). They are also fairly simple and easily practicable in the field. OBJECTIVES: The objective of this study is to explore whether sensitivity and specificity of the WHO classification can be improved by addition of clinical criteria based on NBAA and SLSL to WHO classification. STUDY DESIGN: Among 100 newly diagnosed untreated leprosy patients classified into PB and MB group according to WHO classification, the NSL and NBAA were recorded and the size (longest diameter) of largest skin lesion was measured in centimeters. The Receiver Operator Characteristic (ROC) curves were plotted for each parameter to find the best cut off point (with highest sensitivity and specificity). RESULTS: The sensitivity and specificity of the WHO classification tested, using slit-skin smear (SSS) and skin biopsy results as the gold standard, was found to be 63% and 85% respectively. The ROC curve for NSL found the best cut off of three and more lesions for MB group (sensitivity 90% & specificity 80%). Similarly, ROC curves for NBAA and SLSL found the best cut off points for classification into MB group to be two or more (sensitivity 90% & specificity 75%) and 5 cm or more (sensitivity 87% and specificity 65%) respectively. On combining all these criteria together sensitivity was increased to 98.5% with no significant change in specificity, which was 77.5%. CONCLUSION: The study concluded that the sensitivity of the present clinical classification can be further improved by addition of two other clinical criteria.

Skin lesions in renal transplant recipients: a single center analysis.

BACKGROUND: The chronic use of immunosuppressants in renal transplant recipients (RTRs) predisposes them to a variety of skin manifestations. Studies on skin lesions in RTRs from India have been limited. AIM: To study the prevalence and clinical spectrum of skin diseases in RTR in patients attending the Nephrology clinic of a tertiary care hospital in South India. METHODS: Between October 2002 and June 2003, 365 RTRs were evaluated for skin lesions, including 280 examined after renal transplant (group A) and 85 examined once before and then monthly after transplant for a period of 6 months (group B). RESULTS: A total of 1163 skin lesions were examined in 346 RTRs (94.7%) including lesions of aesthetic interest (LAI) [62.3%] followed by infections [27.3%]. All LAI were drug-related manifestations, making it the most common skin lesion, while fungal (58.7%) and viral (29.3%) infections constituted majority of lesions caused by infection. Lesions related to neoplasms were relatively uncommon (2.1%) and all lesions were benign. Miscellaneous lesions constituted 8.3% of skin lesions, which included vaccine-induced necrobiotic granulomas at the site of Hepatitis B vaccination and acquired perforating dermatoses. CONCLUSION: Skin lesions among RTRs from India consist predominantly of drug-related LAI and infections and are different from the West in view of the paucity of neoplastic lesions.

Profile of acne vulgaris--a hospital-based study from South India.

BACKGROUND: Acne vulgaris is believed to be the most common disease of the skin. There is no Indian study on the profile of acne vulgaris, markers of severe forms of acne vulgaris and a possible correlation between acne vulgaris and markers of androgenicity in females. AIM: To study the profile of acne vulgaris, its seasonal variation, relationship with smoking and possible correlation between acne vulgaris and markers of androgenicity in females. METHODS: The study was conducted between August 2006 and June 2008. All patients with acne vulgaris who consented to participate in the study were included. The parameters evaluated included age, gender, age of onset, duration of lesions, site of lesions, grade, relation with menstrual cycle, markers of androgenicity, number of acne lesions such as comedones, papules pustules and nodules, number and site of post-acne scarring, post-acne hyperpigmentation, seasonal variation and history of smoking. RESULTS: A total of 309 patients with acne vulgaris were included in the study. The frequency of acne vulgaris in our study was 1.068%. Mean age of the study group was 19.78 years. Male to female ratio was 1.25:1. The most common age group involved was 16 to 20 years (59.8%). Mean age of onset was 15.97 years. Face was involved in all the patients, followed by back (28.2%), chest (20.1%), neck (9.4%) and arms (10%). In the older age groups, women were more likely to report having acne vulgaris than men (P = 0.01). The closed comedones outnumbered open comedones by a factor of 4.9:1. A total of 186 patients (60.2%) had grade 1 acne vulgaris, 85 (27.5%) had grade 2 acne, 8 (2.6%) had grade 3 acne and 30 (9.7%) had grade 4 acne vulgaris. There was a higher incidence of scarring (39.5%) and post-acne hyperpigmentation (24.6%) in our study. In female patients, 57.7% had premenstrual flare and 12.4% had cutaneous markers of androgenicity. There was no association between severity of acne vulgaris and other markers of androgenicity (P = 0.108). Seborrheic dermatitis (21.35%) was the most common disease associated. Seasonal variation was observed only in 80 patients (25.9%); 71 patients (23%) exacerbated in summer and 9 patients (2.9%) in winter. Smokers had more severe grade of acne vulgaris compared to nonsmokers (P = 0.001). CONCLUSION: This study brings out the clinical profile of acne vulgaris in a tertiary care hospital in South India.

A descriptive study of MDT services in Chhattisgarh.

INTRODUCTION: The study was conducted to ascertain the registration status, time lag and reasons for non/delayed registration, pattern and sources of MDT, among new cases of leprosy, initially reporting to a tertiary level institution and subsequently referred after diagnosis, to Primary Care institutions. METHODOLOGY: All new cases referred from RLTRI, Raipur to three adjoining blocks between Nov. 2005 and Oct. 2006 were listed and followed at monthly interval at the PHC/CHC, Sub center and household levels, from 2 to 6 months after RLTRI visit. RESULTS: A total of 371 cases were referred, of which 326 (87.9%) could be traced. The level of PHC/ CHC registration of cases, which was 58.0% after 2 months, rose to 80.4% after 6 months of follow up. 82.9% of the registered cases collected subsequent doses of MDT from the nearest Sub center or PHC. Main reason for non/ delayed registration were delay in reporting from patient side (30.7%), non availability of MDT at PHC (24.1%), non-availability of concerned staff (7.3%) and other operational problems (38.0%). CONCLUSION: The study highlights the need to strengthen the "MDT Services" through monitoring and supervision of leprosy activities delivered by General Health Services in post integration phase.

Comparative profile of new leprosy cases coming to a referral institute in pre- and post-integration periods.

This article presents findings from a retrospective analysis of 3031 new leprosy cases attending the Out-patient Department of the Regional Leprosy Training and Research Institute, Raipur, Chhattisgarh, during the period January 2000-December 2005. The analysis was carried out in order to compare the profiles of new leprosy cases between pre- and post-integration periods. The cut-off date, in order to distinguish between the two groups, was determined as 31st December 2002. A comparison was made between the two groups on identified host- and disease-related variables and its significance was tested using suitable statistical tests. The results showed that there was more than 50% increase in the number of new leprosy cases coming to the OPD of the RLTRI during the post-integration period. The mean age at registration showed an increase of 0.9 years, while the proportion of child and female cases showed a decrease of 7.7% and 4.3% respectively during the same period. Significant decline was also recorded in the proportion of grade II deformity cases (11.8%) and cases with type I lepra reaction (11.4%) during the post-integration period. The study emphasizes the need for developing an effective referral mechanism and proper screening of cases at the PHC level for better utilization of referral institutions in a need-based manner.

Uma experiencia: caracterizacao da populacao atendida no ambulatorio do Instituto Lauro de Souza Lima / An experience: characterization of the population assisted at the clinic of Souza Lima's Instituto Lauro

O presente estudo caracteriza o perfil dos usuários do ambulatório do ILSL. Num primeiro momento preocupou-se com a fundamentação teórica, a qual enfoca-se aspectos gerais no âmbito da saúde, localizando o Instituto como parte do Sistema Único de Saúde. A prática do assistente social na área de saúde, dentro da expressão dos direitos de cidadania e educação, frente a um sistema sócio-econômico excludente, marcado pelas sequelas do capitalismo. No fundo existe uma ironia, mas que é profundamente lógica: direito é algo incondicionalmente devido; porém só se efetiva, se conquistado. A maioria da população acredita receber favores, e não percebe o mau serviço que lhe é oferecido. No segundo momento, o estudo, refere-se a coleta de dados, ou seja a pesquisa de campo apresentando, o estudo, refere-se a coleta de dados, ou seja a pesquisa de campo apresentando os resultados obtidos, bem como a análise e interpretação dos dados. Conclui-se que se trata de uma população diversificada, que necessita fazer valer seu direito de cidadão.

Ocular impairments in an impairment survey of leprosy-affected persons in Nepal.

An impairment survey was carried out in Nepal. The study subjects (n = 318) were a mixture of out-patients and patients admitted less than one month before the survey. Of the subjects, 101 were attending the hospital out-patients clinic or were admitted and the rest were examined in the field. The patients studied included those on MDT and care-after-cure cases. Ocular impairments were found in 25% of these cases. The most common ocular impairment was poor vision followed by lagophthalmos and insensitive cornea.

An approach to leprosy work in south Bombay--a preliminary communication.

The city of Bombay with its teeming eight million citizens is characterised by varied types of living pattern in its different parts and the approach to leprosy control work should be flexible to suit these facets of living conditions. Earlier reports (Ganapati and Girija 1979) have indicated the possibility of the successful application of techniques based on mass surveys in North Bombay where people belonging to low socio-economic strata live in somewhat organised slums or shanty towns. However, extreme South Bombay is marked by the paucity of such vast slums and one is struck by the more permanent multistoreyed housing structures. Living in commercial establishments as well as footpath dwelling are common. This presentation consists of an attempt to gauge the leprosy problems in this part of the city taking advantage of 425 patients registered at a leprosy clinic run in conjunction with the dermatology out patient department of a big general hospital over a period of 40 months. 212 cases (50%) hailing from South Bombay proper were the subject matter for analysis. 66% (140) belonged to progressive types of leprosy classifiable as BT through LL and of the Ridley-Jopling classification and 30.7% were bacteriologically positive. 42.9% of the patients had some degree of deformity. Males formed 80% of the sample and 76% were above 15 years of age. Analysis of duration of residence revealed that 68% were living in Bombay for over six years and 53.5% were residing in the city for 11 years or more. This finding is contrary to the expectation of leprosy patients in Bombay belonging to a "floating population". Attempts at field work revealed the following findings: Slum pockets being few (only four), patients were expected to live in residential buildings; but it was found that 25% of population were staying in work places. 17% were footpath dwellers and 18.9% shared their accommodation with people other than family members. 10.4% were domestic servants staying in the residences of their employees. The labour class constituted 50.5% the unemployed housewives group formed 21.7% and beggers 0.9%. 4.2% only were slum dwellers. Locating and examining contacts of patients was difficult as 42.9% could not be traced owing to faulty addresses or patients having changed residences or shifted to native places. Of the 111 patients (52.3%) contacted, 26.4% were living with families and 26.1% were staying alone or with others.(ABSTRACT TRUNCATED AT 400 WORDS)

Integrated leprosy control in Guyana.

Guyana instituted a "find and treat" leprosy program in 1971 that made use of existing out-patient facilities and staff. The program, based on an integrated domiciliary approach to diagnosis, treatment, and examination of contacts, has proved successful. This article describes development of the program and discusses the prospects for control and eventual eradication of leprosy in Guyana.

Intergrated leprosy control in Guyana

Guyana instituted a "find and treat" leprosy program in 1971 that made use of existing out-patient facilities and staff. The program, based on an integrated domiciliary approach to diagnosis, treatment, and examination of contacts, has proved successful. This article describes development of the program and discusses the prospects for control and eventual eradication of leprosy in Guyana (AU)