Relapse rates following Leprosy multidrug therapy

This is a retrospective study of relapses among leprosy patients who received multiple drug therapy in Trinidad and Tobago between January 1982 and Decembe 1994. The results of the study reveal a relapse of 0.65 percent for multibacillary cases and 1.5 percent for paucibacillary cases. These results are comparable to the relapse rates reported by the World Health Organisation.(Au)

Relapse rates following Leprosy multidrug therapy

This is a retrospective study of relapses among leprosy patients who received multiple drug therapy in Trinidad and Tobago between January 1982 and Decembe 1994. The results of the study reveal a relapse of 0.65 percent for multibacillary cases and 1.5 percent for paucibacillary cases. These results are comparable to the relapse rates reported by the World Health Organisation.

The face of leprosy - then and now

Leprosy is believed to have existed since 1400 BC,although the first full description was written in 600 BC in India. This disease continues to be a major challenge- its diagnosis, treatment, management of complications including disabilities and possibilities for prevention such as vaccination. Although a declining incidence was recorded globally for several years before the onset of the Multidrug Therapy (MDT) recommended by the World Health Organization,one cannot deny the impact that the new drug regimes had on prevalence. Statistics reported in 1991 cited a prevalence of 5.5 million cases worldwide. In 1993, prevalence was estimated at about 3 million cases with two thirds of these registered for treatment and just over 50 percent of registered cases receiving MDT. In the Caribbean, there has been a fall in prevalence with countries such as Antigua, Barbuda, Dominica and Montserrat reporting no new cases for the past five years. Yet St.Lucia and Suriname can still be considered as having a public health problem regarding leprosy. With diseases like AIDS taking the forefront and the observed resurgence of other mycobacterial diseases such as tubercolsis and atypical mycobacteria with HIV/AIDS, one wonders where leprosy is headed in the next century. No retrovirus-related increase in leprosy incidence has been recorded but health workers must remain vigilant. (AU)

Tinea capitis in Trinidad

Characteristics of clinically diagnosed cases of tinea capitis from Trinidad are discribed. Tinea capitis comprised 29. percent of all dermatophytoses seen at one general hospital out-patient dermatology clinic during a one-year period. Males were more often affected than females and there was a predominance of patients of African descent. Among the dermatophytes cultured Trichophyton tonsurans was the most prevalent (52.9 percent), followed by Microsporum canis (20.0 percent) and M. audouin ii (18.6 percent). Less frequent isolates included M. gypseum (1.9 percent), T. mentagrophytes var granulare (1.4 percent) and T. rubrum (1.4 percent) (AU)

Cushing's syndrome from tropical glucocorticoids

A case of Cushing's syndrome is described in a woman who self-treated psoriasis with a variety of potent tropical glucocorticoids over 15 years. She was successfully weaned off corticosteroids and was treated with alternative anti-psoriatic drugs. The disappearance, nine months later, of most features of Cushing"s syndrome, and the normal supression of cortisol in response to dexamethasone, excluded endogenous hypercorticolism. The apparent widespread availability across the counter of potent corticosteriods is a cause of concern. (AU)

Hansen's disease in Trinidad and Tobago: the past decade: eradication by the year 2000? - abstract

Hansen's disease is still endemic in Trinidad and Tobago, although at low levels, with a prevalence rate of 0.8/10,000 population. Eradication is perceived as a goal which can be achieved, although it is difficult to make projections for this based on epidemiological trends observed in the existing control programme which is about twenty years old. While the incidence of disease has fallen and remained at a constant level of 0.3 cases per 10,000 population, there is still a significant proportion of children among the new cases (33 percent in 1989). Although these cases are pauciabillary, it is important to recognize that disease transmission is still occurring and this factor may make eradication difficult. The programme, however, is still at an early stage and it may be some time before clear trends emerge that will lead to eradication. Public education, increased awareness among health personnel, increased case-finding, early diagnosis and case-holding are important steps toward this goal (AU)

Attitudes towards leprosy (Hansen's disease) among physicians and nurses in a general hospital - abstract

This study was designed to determine some of the attitudes to leprosy among physicians and nurses working in a general hospital in Trinidad. Twenty-two physicians and 31 nurses of varying grades were administered a brief questionnaire which sought to reveal personal attitudes to, and any superficial knowledge of leprosy. It was found that while most respondents had heard about leprosy before entering medical or nursing school, they were ignorant of important facts about the disease. Many gave subjective responses to the diagnosis that were not based on fact, but rather on personal fears. While doctors were slightly more informed than nurses regarding the need for isolation and were less hesitant in caring for leprosy patients, overall there appeared to be no solid knowledge of leprosy. It is concluded that there should be more effective teaching about leprosy in our medical and nursing schools so that the disease can be diagnosed and treated early, and thus prevent the stigma associated with the patient with untreated, destructive late leprosy (AU)

Cutaneous infections in Trinidad

Skin infection is common in patients with any skin diseases where pruritus is a prominent feature. A retrospective analysis was performed on the results of skin swab cultures from patients with eczema and a variety of other conditions. This paper presents the findings of bacteriologic culture and sensitivity testing of 131 swabs from 122 patients over a period of 22 months and examines the results in terms of the reported relationship between scabies and acute poststreptococcal glomerulonephritis. Staphylococcus aureus was most often isolated, and this appears to indicate that antistaphylococcal antibiotics should be the first line of treatment in the absence of the results of cultures. (AU)

A second report on multidrug therapy for leprosy in Trinidad and Tobago

Multidrug therapy consisting of rifampicin, ciofazimine and dapsone, was introduced to Trinidad and Tobago in January 1982. This was with slight modification of the WHO regimens. Since then 717 patients have completed multidrug therapy up to the end of December 1987. Of these, 272 patients have completed surveillance and have been discharged from clinic attendance. Thirty-four patients died before completing surveillance and three are known to have migrated. Of the remaining 408 cases still under surveillance, the majority are multibacillary. This paper reviews the outcome of multidrug therapy in Trinidad and Tobago between January 1982 and December 1987--a period of 6 years, and presents some of the statistics related to the newly diagnosed patients within the same period. (AU)

Primary idiopathic cutaneous amyloidosis: can coconut oil be a contributing factor? - abstract

Twenty patients who presented clinically with either macular or lichen amyloidosis at clinics at the Port of Spain General Hospital or the St. Joseph Health Centre had skin biopsies done. Two control groups of male and female patients were randomly selected. They presented with other unrelated skin conditions and either used coconut oil only occasionally or used other types of oil. Skin biopsies were stained with haematoxylin and eosin and congo red/methyl violet. The study group were all female Indo-Trinidadians who had daily applied coconut oil to the arms, legs and hair for an average period of 31 years (range 4 months - 40 years). In 15 patients, there was histological confirmation of amyloid. Seven patients had at least 1 family member with a similar skin condition. Papular and macular skin lesions were seen on the anterior aspect of the leg and the extensor aspect of the arm and scapular region. It is proposed that the common practice among female Indo-Trinidadians of daily application of coconut oil to arms, legs and hair is a risk factor in the development of primary cutaneous amyloidosis and that genetic and familial factors are also involved in this condition (AU)

Acute intermittent porphyria in a 17-year-old Trinidadian girl

We report the first case of acute intermittent porphyria in Trinidad and Tobago. This condition is most commonly described in people of European origin and is considered to be rare in blacks. This girl is of African descent and has no family history of acute intermittent porphyria (AU)

Cutaneous histoplasmosis in the acquired immune deficiency syndrome: a report of three cases from Trinidad

Three cases are reported of patients with the acquired immune deficiency syndrome (AIDS) and cutaneous histoplasmosis. Their initial presentation was that of a generalised malculopapular rash. Two patients were bisexual males and the third was an unmarried female. The range of opportunistic infections seen in AIDS patients in Trinidad is mentioned and clinicians are alerted to the fact that in areas endemic for histoplasma capsulatum maculopapular rash in patients with AIDS may suggest disseminated histoplasmosis. The value of skin biopsy is mentioned. (AU)

Skin biopsy and cutaneous histoplasmosis in the acquired immune deficiency syndrome in Trinidad - abstract

Eighteen patients with the acquired-immunodeficiency syndrome (AIDS) presented with primary skin manifestations at the Port-of-Spain General Hospital in 1986. The lesions included local (3) and generalised (4) dermatitis, pustules, plaques (2), crateriform ulcers (2), erythematous lesions (4) and maculo-papular rashes (7). Some patients had a mixture of lesions. The maculo-papular rashes were commonest. Full-thickness skin biopsies were stained with periodic acid-Schiff and methamanine silver; yeast forms of Histoplasma capsulatum were found in 11 cases. Three of these cases had a post-mortem examination; this revealed the presence of the fungus in all the tissues sampled which included brain, liver, spleen and lymph nodes. The skin lesions were the only presenting clinical manifestations of disseminated histoplasmosis in these patients. Histoplasmosis capsulatum is endemic in Trinidad and Tobago but clinical infection was extremely rare before the advent of the AIDS epidemic. In areas endemic for H. capsulatum, clinicians should be alerted to the fact that cutaneous lesions in patients with AIDS may suggest histoplasmosis. Given the facts that cultures may be negative and unnecessarily delay treatment, that the histoplasmin skin test is of doubtful value and that serological titres are unreliable in the immunocompromised, we advocate full-thickness skin biopsy to diagnose histoplasmosis in AIDS patients (AU)

A second report on multidrug therapy for leprosy in Trinidad and Tobago

Multidrug therapy consisting of rifampicin, clofazimine and dapsone, was introduced to Trinidad and Tobago in January 1982. This was with slight modification of the WHO regimens. Since then 717 patients have completed multidrug therapy up to the end of December 1987. Of these, 272 patients have completed surveillance and have been discharged from clinic attendance. Thirty-four patients died before completing surveillance and three are known to have migrated. Of the remaining 408 cases still under surveillance, the majority are multibacillary. This paper reviews the outcome of multidrug therapy in Trinidad and Tobago between January 1982 and December 1987 - a period of 6 years, and presents some of the statistics related to the newly diagnosed patients within the same period. (AU)