Childhood leprosy: profiles from a leprosy referral hospital in West Bengal, India.

Monitoring childhood leprosy in terms of incidence and occurrence of deformities are crucial for better control and understanding the transmission of the disease. In this paper, a profile of all new untreated leprosy patients below 15 years of age who reported at a Leprosy Referral Centre in West Bengal during 2004-2006 are described. Of 151 children studied, 84 (55.6%) were males, 33% were multibacillary and of them, 30% were smear positive. 16% had already developed grade 2 disability (WHO). Multiple nerve involvement was seen in a quarter of children. These findings highlight the seriousness of leprosy among children and the great need to address these issues urgently. Awareness, active case detection especially among contacts and motivation are the essential needs of the hour to prevent tragedy of deformed children due to a totally manageable disease.

Impact of integration on the profile of newly diagnosed leprosy patients attending a referral hospital in South India.

This article compares the clinical profile of new untreated leprosy patients attending a referral hospital (The Schieffelin Institute for Health Research & Leprosy Centre, formerly known as SLR&TC, Karigiri, South India, in post-integration period (2005-2007) with that during the pre-integration period (1995-1996). A total of 529 patients--259 in pre-integration and 270 in post-integration period--were seen at this hospital. The clinical data culled from records for the earlier period were compared with data gathered prospectively for the latter period and was analyzed using SPSS software. The results showed a significant increase in the mean age of registration, percent multibacillary (clinical criteria) and grade 2 diabilities in post-integration period. Increase in proportion of cases with grade 2 deformities is a matter of concern and suggests continued need for referral hospitals for their management and also population based overall assessment whether actual numbers with deformities have increased or it is peculiar to a tertiary care hospital where the cases with problems may be coming. As the proportion of bacteriological positive cases was not found to change, it is a positive sign of effective coverage in the post-integration scenario in this population.

A study of steroid-induced diabetes mellitus in leprosy.

Steroids, while still the most powerful drugs to manage leprosy reactions, predispose some patients to other morbidities such as diabetes, glaucoma, hypertension etc. A prospective cohort study was done in Kolkata, India among leprosy patients in reaction to determine the extent of steroid induced diabetes mellitus (SID). All leprosy patients with type 1 or type 2 reactions or neuritis admitted in 2006 to the Leprosy Mission Hospital in Kolkata, who had no past or current history and whose blood sugars on fasting were <126 mg/dl or postprandial <200 mg/dl were monitored fortnightly while on steroid therapy, estimating blood glucose by a glucometer using standard strips. Of 81 patients, 19 (23.5%) manifested steroid-induced diabetes mellitus. Compared to those who didn't, there were significantly more LL/BL patients with positive BI among SID whose cumulative prednisolone dosage was nearly 9000 mg as compared to half the amount among others. Steroid induced diabetes is a serious complication among leprosy patients treated with prednisolone for reactions requiring careful monitoring for detection and appropriate clinical management.

Awareness and attitudes towards leprosy in urban slums of Kolkata, India.

Urban slums have proliferated in India with poor health and socio-economic status with no organized health system. They are at high risk for contracting communicable diseases including leprosy. In order to obtain reliable data on knowledge, attitudes and treatment of leprosy; a random sample cluster survey was done in Kolkata slums. House to house screening for leprosy was done in 6 representative random samples of slums, each with a population of at least 5000, using accepted methods for detection. Suspects were confirmed by medical officers. Intensive interviews were done by qualified male and female investigators. A majority had some knowledge of leprosy but hardly any knew early signs or symptoms or where to get proper diagnosis and treatment. Half the respondents felt leprosy must be treated separately from general patients but stated they had no hesitation in working with or visiting a leprosy patient. There were 11 suspects of which 9 were confirmed for leprosy and sent to nearest centre for MDT. Glaring gaps are noticed between knowledge and practice of slum population regarding leprosy. An integrated health program is needed urgently in urban slums to control leprosy and other diseases using a variety of resources including medical colleges.

Self-care programme to prevent leprosy-related problems in a leprosy colony in Champa, Chattisgarh.

A self-care programme aimed at preventing leprosy-related physical disabilities in a leprosy colony in Champa, Chattisgarh, India, is described. Once the initial resistance was overcome through persistent and caring attitudes, the residents accepted the challenges for self-care. The outcome at the end of one year showed significant decline (41%) in ulcer rates, significant use of MCR footwear (43%), and significant proportion (over 90%) of patients and their families practising and helping in self-care activities.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort.

AIM: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62%), lagophthalmos (4.20%), ectropion (0.42%), trichiasis (0.84%), blocked nasolacrimal ducts (1.68%), pterygium (11.34%), impaired corneal sensation (53%), corneal opacity (10.5%), corneal nerve beading (1.68%), punctate keratitis (1.26%), keratic precipitates (4.62%), iris atrophy (1.68%), and cataract (12.6%) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6% had blind eyes. Increasing age was associated with ocular complications. 80% of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71% had some limb deformity. 44% had only leprosy related ocular complications (LROC), 28% had only general ocular complications (GOC) while 14% had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100%) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort

Aim: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62 per cent), lagophthalmos (4.20 per cent), ectropion (0.42 per cent), trichiasis (0.84 per cent), blocked nasolacrimal ducts (1.68 per cent), pterygium (11.34 per cent), impaired corneal sensation (53 per cent), corneal opacity (10.5 per cent), corneal nerve beading (1.68 per cent), punctate keratitis (1.26 per cent), keratic precipitates (4.62 per cent), iris atrophy (1.68 per cent), and cataract (12.6 per cent) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6 per cent had blind eyes. Increasing age was associated with ocular complications. 80 per cent of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71 per cent had some limb deformity. 44 per cent had only leprosy related ocular complications (LROC), 28 per cent had only general ocular complications (GOC) while 14 per cent had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100 per cent) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.