Leprosy - an overview of clinical features, diagnosis, and treatment.

Leprosy is a chronic infectious disease caused by Mycobacterium (M.) leprae. Worldwide, 210,758 new cases were diagnosed in 2015. The highest incidence is found in India, Brazil, and Indonesia. While the exact route of transmission remains unknown, nasal droplet infection is thought to be most likely. The pathogen primarily affects the skin and peripheral nervous system. The disease course is determined by individual host immunity. Clinically, multibacillary lepromatous variants are distinguished from paucibacillary tuberculoid forms. Apart from the various characteristic skin lesions, the condition is marked by damage to the peripheral nervous system. Advanced disease is characterized by disfiguring mutilations. Current treatment options are based on WHO recommendations. Early treatment frequently results in complete remission without sequelae. While paucibacillary forms are treated with rifampicin and dapsone for at least six months, multibacillary leprosy is treated for at least twelve months, additionally requiring clofazimine. Leprosy reactions during therapy may considerably aggravate the disease course. Besides individual treatment, WHO-supported preventive measures and strategies play a key role in endemic areas.

Gender differential on characteristics and outcome of leprosy patients admitted to a long-term care rural hospital in South-Eastern Ethiopia.

INTRODUCTION: In previous studies, women are less aware of causation and symptoms of leprosy and have less access to health care coverage than men, thus contributing to their delay in seeking for treatment. We assess the gender differences in leprosy cases admitted to a rural referral hospital in Ethiopia for 7 and a half years. METHODS: Retrospective data of the leprosy patients admitted to referral hospital were collected using leprosy admission registry books from September 2002 to January 2010. Variables were entered in an Excel 97 database. RESULTS: During the period of study, 839 patients with leprosy were admitted; 541 (64.5%) were male, and 298 (35.6%) female. Fifteen per cent of female patients, and 7.3% of male patients were paucibacillary leprosy cases while 84.8% of female patients and 92.7% of males were multibacillary leprosy cases (p<0.001). Female leprosy patients were younger than male ones (median: 36 versus 44 years) (p<0.001). In the multivariate analysis, age (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.96-0.98; p<0.001), admission for cardiovascular diseases (OR: 7.6, 95% CI: 1.9-29.3; p=0.004), admission for gastroenteritis (OR: 14.0; 95% CI: 1.7-117; p=0.02), admission from out patients clinic (OR: 2.04; 95% CI: 1.1-4.01; p=0.02), and mortality as final outcome (OR: 3.1, 95% CI: 1.2-8.0; p=0.02) were independently associated with female gender. CONCLUSIONS: Female patients with leprosy admitted to hospital were younger, had a different profile of admission and a higher mortality rate than male ones.

Long term sustainability and efficacy of self-care education on knowledge and practice of wound prevention and management among leprosy patients.

In a chronic disease like leprosy, assessment of self-care education of long duration is necessary to find out its effectiveness and to bring out sustainability both in the point of view of the provider and of the recipient. Self-care education was imparted to patients for 8 years in the Katpadi Block as part of 'prevention of impairment and disability' programme from the year 2000 onwards. The patients were provided with knowledge regarding 'inspection' for pre-disposing factors of wound development and about external causes (trauma) or dangerous environments for wound development. Additionally, they were given practice on self-care techniques for prevention and management of wounds. Staff as part of their routine work has been doing this. An evaluation, done by independent assessor, compared the effect of this programme with a control area where no such programme was going on. This showed that the self-care education resulted in very high level of knowledge and practice compared to the control area, even up to 100% practice in some aspects. Self-care education is effective, can be sustained for a long time and also can be carried out as part of routine work.

Incidence of acute nerve function impairment and reactions in leprosy: a prospective cohort analysis after 5 years of follow-up.

BACKGROUND: Nerve function impairment (NFI) is the key outcome of the pathological processes of infection with Mycobacterium leprae, which can continue after completion of multidrug therapy (MDT) and lead to disability after leprosy patients are released from treatment. The objective of this study was to assess the need for and duration of surveillance of NFI. METHODS: Prospective cohort study of 2664 new leprosy patients in Bangladesh, with an observation period of 36 months in paucibacillary (PB) patients, and 60 months in multibacillary (MB) patients. Incidence rates (IR) were calculated with the number of patients developing NFI, type 1 and type 2 reactions, and silent neuritis for the first time after registration as the numerator, and cumulative person-years at risk (PYAR) as the denominator. Survival curves to the first event of NFI were also calculated. RESULTS: The IR of first event of NFI amongst MB patients was 16.1 per 100 PYAR, with 121/357 (34%) developing NFI during the observation period. Of the 121 with a first event of NFI, 77 (64%) had this within a year after registration, 35 (29%) in the second year, and the remaining 9 (7%) after 2 years. The IR of first event of NFI amongst PB patients was 0.9 per 100 PYAR, with 54/2153 (2.5%) developing NFI during the observation period. Of the 54 with a first event of NFI, 48 (89%) had this within a year after registration, 3 (5.5%) in the second year, and the remaining 3 (5.5%) cases after 2 years. The percentage of PB patients with no NFI at registration surviving without developing NFI during the observation period was 99% and for PB patients with NFI at registration 92%. In MB patients without NFI at registration, the percentage surviving with no NFI during the observation period was 84% and for MB patients with NFI at registration only 36%. CONCLUSION: New episodes of NFI and reactions after registration are common, in particular in MB patients with long-standing NFI at registration. The study highlights the importance of continuing surveillance for NFI of this risk group after registration for 2 years. Active surveillance beyond 2 years is not indicated.

Treatment duration of reversal reaction: a reappraisal. Back to the past.

In this paper, earlier data on the length of prednisolone treatment are re-examined. Based on those data and supported by the literature and the author's own observations, it can be concluded that type I leprosy reaction should be treated with prednisolone for a longer period than the 12 weeks, advised by the WHO. The paper also warns against silent nerve damage that may occur when prednisolone is discontinued early.

[Clinical aspects and therapy of early lepromatous leprosy with a case example]. / Klinik und Therapie der frühen lepromatösen Lepra an einem Fallbeispiel.

Taking into account the increase in worldwide human migration, leprosy is of growing importance in the differential diagnosis of dermatological diseases encountered in Central Europe. We report on the case of a young man from Ghana who developed hypopigmented maculae and plaques on his trunk and proximal limbs. The diagnosis of lepromatous leprosy could be made in consideration of the histological pattern of infiltrating leucocytes and detection of numerous acid-fast mycobacteria on skin biopsy. The results of the physical examination as well as routine laboratory and immunological parameters were consistent with this form of leprosy. Due to glucose-6-phosphate-dehydrogenase deficiency, treatment with dapsone was contraindicated. With high-dose rifampicin and clofazimine therapy, the skin changes cleared over the course of 11 months following a leprosy reaction type II (erythema nodosum leprosum) that developed during a phase of discontinued therapy due to low patient compliance.

Leprosy today.

Leprosy is a disease common to developing countries. It is relatively rare in Europe. There are an estimated 5.5 million patients in the world, of which two-thirds are found in South East Asia. Currently, 3.1 million are registered for treatment. Mycobacterium leprae, the causative organism of leprosy, is an intracellular acid-fast organism not cultivable in vitro. The disease is transmitted from man to man mainly through inhalation. The disease occurs in several types depending upon the immunological status of the individual. They are generally grouped into two main categories, multibacillary and paucibacillary. The diagnosis of leprosy, which is generally not difficult, is based on characteristic skin lesions, sensory loss, thickening of the nerve trunks and the presence of acid fast organisms in the skin smears. Complications in leprosy include reversal reaction and erythema nodosum leprosum. Currently, the treatment of leprosy is based on the administration of a combination of drugs, referred to as multidrug therapy, which for multibacillary leprosy is treatment with rifampicin, clofazimine and dapsone and for paucibacillary treatment with rifampicin and dapsone. The treatment of complications such as reversal reaction and erythema nodosum leprosum essentially involves the use of prednisolone. Multidrug therapy has been found to be highly effective in curing leprosy and in preventing relapse, although the duration of treatment is still considered long. The optimistic situation in leprosy treatment has led to WHO establishing a target of eliminating leprosy as a public health problem by the year 2000, defining elimination as attaining a level of prevalence below one case per 10,000 population.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term clinical toxicity studies with clofazimine (B663) in leprosy.

Fifty-one leprosy patients receiving long-term clofazimine have undergone systematic clinical laboratory testing in a search for any toxicity secondary to the drug. In approximately 220 patient-years of observation and in analyzing approximately 40,000 test results, no statistically significant changes in the direction of abnormality have been observed in SGOT, thymol turbidity, serum globulins, uric acid, alkaline phosphatase, white blood cell count or differential, hematocrit, hemoglobin, BUN, serum creatinine, serum cholesterol, serum albumin, serum potassium, serum calcium, stool for occult blood, routine urinalysis, or reticulocyte count. Statistically significant changes toward abnormality were found in fasting blood sugar and total serum bilirubin. These statistically significant changes in the direction of abnormality were of a small magnitude, were not associated with related clinical signs or symptoms, and do not seem to be of major clinical significance. Despite the accumulation of relatively massive amounts of the drug in various tissues, clofazimine appears remarkably free of serious or life-threatening toxicity clinically. Although the skin and gastrointestinal side effects of clofazimine limit its usefulness, on the evidence to date, its advantages outweigh its disadvantages in those leprosy patients for whom it is indicated.