Ulnar nerve abscess in a multibacillary patient during post-multidrug therapy surveillance.

An old borderline-lepromatous leprosy patient, treated initially with DDS monotherapy followed by MDT, 11 years later during surveillance presented with 3-month-old asymptomatic cystic swelling, arising from the right ulnar nerve without exhibiting any evidence to document relapse of the disease. It responded promptly to corticosteroid therapy. This unusual clinical presentations of ulnar nerve abscess has not been reported elsewhere.

Diffuse alopecia of the scalp in borderline-lepromatous leprosy in an Indian patient.

A case of borderline-lepromatous leprosy exhibiting alopecia of the scalp along with lepromatous lymphadenitis of suboccipital lymphnode is reported. To our knowledge generalized leprous alopecia of the scalp with lepromatous lymphadenitis of the suboccipital node is a rare occurrence in female Indian patients.

Transmission of health information on leprosy from children to their families: another approach to health education.

A controlled study was carried out in the North Arcot District of Tamil Nadu, South India to determine whether health information given to schoolchildren would influence the knowledge and attitudes of their families concerning leprosy. A total of 41 children and almost all of their household members participated in the study. The study, conducted by questionnaire, involved a pre-test of knowledge and attitude about leprosy of seventh standard students and their families. After one group of children received health education about leprosy and the other received information about tuberculosis, an identical post-test questionnaire was administered to all participants. Although significant improvement in knowledge about leprosy was detected in the leprosy educated group of children compared with controls, no transmission of information on leprosy was detected in the family members of either group. The attitudes of the children who had been educated about leprosy may have been adversely affected by the health education session. The reasons for our failure to detect significant transfer of information about leprosy in this setting are discussed, as well as the need for additional research in this area.

Effectiveness of multidrug therapy in multibacillary leprosy: a long-term follow-up of 34 multibacillary leprosy patients treated with multidrug regimens till skin smear negativity.

The World Health Organization (WHO) Field Trials of multidrug therapy (MDT) started at Schieffelin Leprosy Research and Training Centre (SLR & IC), Karigiri, India in December 1981. The patients were treated with two MDT regimens. The first (regimen A) consisted of 600mg rifampicin and 300mg of clofazimine given under supervision on 2 consecutive days monthly, 225mg injection of acedapsone bimonthly and dapsone 100mg daily. The second regimen (regimen B) was the conventional MDT (WHO/MDT), rifampicin 600mg and clofazimine 300mg supervised once a month, dapsone 100mg and clofazimine 50mg daily, unsupervised. Both the regimens were administered for a minimum period of 2 years or until skin smear negativity, whichever occurred later. Thirty-four newly detected previously untreated MB patients, 16 of whom received regimen A and 18 regimen B, were reassessed. Both regimens were well accepted and well tolerated by the patients. Clofazimine discolouration was the only adverse effect of MDT seen in these patients. After completion of treatment with MDT, the patients were followed up for a total duration of 466 person-years with a mean of 13.7 +/- 1.4 years per patient. No relapse was seen.

Leucocytopenia after rifampicin and ofloxacin therapy in leprosy.

New antimycobacterial agents and combined treatment regimens are being introduced for the treatment of leprosy. Ofloxacin is one such broad spectrum antimicrobial agent. In this study rifampicin plus ofloxacin were administered daily for 4 weeks (daily supervised dose). Two patients (and possibly a third patient who refused all investigations) out of 125 patients developed leucocytopenia during the third week of therapy. It was associated with fever, malaise, nausea and loss of appetite. They recovered after cessation of drug treatment. Patients receiving ofloxacin should be monitored for constitutional symptoms suggestive of this complication even though the risk of such complication may be minimal.

Origin of new leprosy cases during general surveys in relation to previous survey findings.

As part of the leprosy control activities in the area of Gudiyatham Thaluk, general surveys are done once every three to five years. The percentage of examination is about 90%. An analysis of all new cases registered for treatment between 1990-94 was done to study whether these cases had been examined in the previous general survey. Of the new cases detected and registered, 566 cases (32.6%) were not examined during the previous survey. The significance of these findings in relationship to cost-effectiveness of general surveys, case-detection methodology and possible continuing of transmission of leprosy are discussed.

Childhood leprosy in an endemic area.

A study was done on 794 new cases of leprosy among children (aged 0-14 years) detected and treated with MDT during 1990-1995 in Gudiyatham Taluk, South India. Incidence rates of leprosy and proportion of multibacillary cases increased with age, while bacillary + tuberculoid was most common. Over 80% had a single patch and most children were detected through surveys. Nearly 30% had history of household contacts with leprosy, mostly parents or grandparents. Reactions and relapses were not uncommon. The findings emphasize the need for more careful surveys for case detection and better follow-up in case management.

Surveillance in leprosy.

Surveillance in leprosy forms an integral part of leprosy control activities. Usually contact and school surveys are done annually and general population surveys are done once every 3-5 years. Data is presented which suggest that frequently done surveys may not be cost effective as a means of case detection. Carefully done general surveys once every 3 years, covering contacts as well as school children may be adequate and more cost effective in endemic areas, whereas contact surveys, surveys of high risk groups and contact tracing, may be more relevent in low endemic areas.

An evaluation of the Semmes-Weinstein 6.10 monofilament as compared with 6 nylon in leprosy patients.

In a previous study Birke and Sims (1986) identified the 5.07 (10 y) Semmes-Weinstein monofilament, as the most useful tool, in measuring protective sensation in the sole of the foot of leprosy patients. This study has demonstrated that the standard 6 Nylon being used in Karigiri, is as good as the monofilament, in assessing protective sensation in leprosy patients. However there is a need for standardising procedures for measuring sensory loss in leprosy patients.

Are defaulters with paucibacillary leprosy a problem?

This study examined the risk of relapse in 421 paucibacillary patients who had defaulted after varying periods of dapsone monotherapy; short of the recommended course. The 421 patients contributed a total of 2,162 person years of risk; 10 patients relapsed, giving a relapse rate of 4.6 per 1000 persons years of risk, or a crude relapse rate (RR) of 2.4%. This paper discusses the issue of defaulters with paucibacillary leprosy and the findings of the study suggest that defaulters with paucibacillary leprosy are not a serious problem in terms of leprosy control.

Incidence of "chance" smear positivity among MB leprosy patients after MDT.

Multidrug therapy (MDT) was introduced in 1982. Nine hundred eighty multibacillary (MB) leprosy patients had successfully completed the MDT administered for a minimum of two years or till skin smear negativity, whichever was later, as recommended by the World Health Organisation (WHO). During surveillance, 2.24% of them revealed presence of acid-fast bacilli (AFB) in the skin smear. They did not have any clinical evidence suggestive of relapse. Subsequent followup (without antileprosy chemotherapy) for periods ranging from one to eight years was uneventful. We have called this as "chance smear positivity" where a few bacilli, yet to be cleared by the immune system, were picked up by routine skin smear examination.

A leprosy survey in a taluk headquarters town and the role of dermatological services and active health education in its success--a preliminary report.

A report of two general surveys done in 1984 and 1987 in Gudiyatham town, is presented. The first survey covered 89.2% and the second survey 82% of the population. The new case detection rate was 3.4 per 1000. The success of the survey was due to the co-operation obtained from the public, most probably because of the intense and sustained health education, combined with leprosy services integrated with a dermatology clinic.

Incidence rates of leprosy among household contacts of "primary cases".

The data consisted of information from 1,564 "Primary cases" of leprosy of all classification and 9,162 of their household contacts. Household contacts of Indeterminate (Ind), Borderline (BL) and Lepromatous (LL), "Primary case" (PC) had an incidence rate (IR) of 5 per 1000 person years of risk (PYR). Household contacts of Tuberculoid (TT) and borderline tuberculoid (BT) patients had an IR of 3.2 and 3.8 per 1000 PYR respectively. Compared with an incidence rate of leprosy of 1.6 per 1000 PYR among individuals not exposed to leprosy in the same area, household contacts of Non-lepromatous patients had a relative risk of twice as high and contacts of lepromatous and borderline lepromatous patients a relative risk of 3 times as high. The incidence rate was higher among household contacts of bacteriologically positive patients, among contacts closely related and in households with multiple cases. The peak age specific incidence rate among household contacts was between the ages 5-9 years of age. The significance of these findings are discussed.

Time trends in the analysis of incidence rate of leprosy among household contacts.

Analysis of time trends in the Incidence Rates among 9.598 household contacts of 1,614 primary cases of leprosy, showed that the incidence rates (IR) remained high even 10 years after treatment was started in the Primary Case. The IR during the 1st year of follow-up was 3.8 per 1000 person years of risk (PYR) and the IR was 3 per 1000 PYR after 10 or more years of follow-up. The significance of these findings in relationship to the Epidemiology of leprosy among household contacts in an endemic area for leprosy is discussed.

Leprosy among inmates of a prison.

A leprosy survey carried out in a district prison revealed a gross prevalence of 20 cases per 1000, and active prevalence of 10 cases per 1000 whereas, prevalence of leprosy in the state was 1.12 per 1000. Such prisons thus form hyperendemic pockets. The inmates are a closed community and there is a risk of cases among inmates spreading infection to others inside the prison during their sojourn there and to the community when they are released from the prison. Special efforts are required to identify and eliminate all identifiable sources of infection, especially at this point of time when we are aiming at elimination of leprosy as a public health problem.