ABSTRACT
The response to intradermal administration of Rees soluble skin test antigen was studied in 12,142 randomly selected individuals living in a highly endemic area in South India. Taking a cut-off point of 12 mm induration as the criterion for 'positivity', 73% of PB cases, 45% of MB cases and 63% of noncase population (67% in contacts and 63% in non-contacts) were found to be positive. Age-specific positivity rates were higher in males than in females and in adults than in children. The difference in age-adjusted positivity rates between cases, contacts an noncontacts in the female population was found to be significant. However, the differences in reaction response are not sufficient to identify the sub-populations of cases, contacts and noncontacts and as such this antigen is not likely to be useful in epidemiological studies of infection and evolution of clinical disease in high endemic populations.
Subject(s)
Adult , Antibodies, Bacterial/analysis , Antigens, Bacterial/immunology , Child , Feasibility Studies , Female , Humans , Male , Middle Aged , Mycobacterium leprae/immunology , Random Allocation , Skin TestsABSTRACT
Analysis of client-based data as a part of computerised management information system in a Government leprosy control unit in Tamil Nadu reveals that there was delay in initiating treatment of leprosy patients. The mean and standard deviation of the period of delay for cases registered before, within 6 months and after 6 months of start of MDT in the Unit were 6.80 +/- 6.40, 1.97 +/- 3.60 and 0.90 +/- 2.21 months respectively. Further, the delay was longer in PB, female and child cases. Giving priority to therapy for backlog cases and an effective monitoring system with specific indicator for time lag in starting treatment is indicated.
Subject(s)
Adult , Age Factors , Child , Female , Humans , India , Leprostatic Agents/therapeutic use , Leprosy/diagnosis , Male , Sex Factors , Time FactorsABSTRACT
A computerized system for monitoring district-wise operational performance and epidemiological progress using existing regular and special monthly reports of the National Leprosy Eradication Programme (NLEP) is presented. The same system, with some minor modifications could be used for programme assessment at the Leprosy Control Unit level also. The advantage of the system is the speed with which it can generate output in the form of comparative tables and graphs for different regions for use by programme managers for making overall assessments in time and for sending feedback reports to workers at various levels, for self-assessment and for taking timely corrective action. The system presented provides immediate and easy access to the stored and/or processed information (indicators etc.,) at any time. The system has been pilot-tested using monthly reports from eighteen districts of Tamil Nadu.
Subject(s)
Databases, Factual , Humans , India , Leprosy/prevention & control , Microcomputers , Minicomputers , SoftwareABSTRACT
With the help of sensitivity and specificity criteria, an attempt is made to quantify the gain in certainty in diagnosis with the use of various cardinal signs/symptoms (S/s) of leprosy in order to study their predictive value in correct diagnosis of paucibacillary leprosy (PB) by the Paramedical Workers. The study was based on the findings in 326 new cases of paucibacillary leprosy detected by 10 paramedical workers during a recent field survey. Observations in the present study confirm the scientific basis of presently used combinations of cardinal S/s for correct diagnosis of leprosy especially the combination of (skin) patch with loss/impairment of sensation. The detailed observations made in the study are discussed in this communication.
Subject(s)
Adult , Child , Child, Preschool , Humans , Hypesthesia/etiology , Leprosy/complications , Peripheral Nervous System Diseases/etiology , Predictive Value of TestsABSTRACT
21 patients of borderline lepromatous and lepromatous leprosy of both sexes were taken for study after exclusion of autonomic disorders. Autonomic functions pertaining to cardiovascular and genital system were carried out. Five healthy volunteers served as controls. Autonomic function tests indicate definite involvement of cardiovascular and genital system. The incidence of autonomic neuropathy in 21 patients studied was ranging from 14.3 to 57% for various tests. There is involvement of parasympathetic system (vagus nerve) which occurred early and more common than sympathetic. The sympathetic damage is always associated with parasympathetic damage. The severity of autonomic neuropathy is found to be high in leprosy of longer duration. Autonomic neuropathy widely occurs in leprosy as in diabetes mellitus.
Subject(s)
Adult , Autonomic Nervous System/physiopathology , Erectile Dysfunction/etiology , Female , Hemodynamics , Humans , Leprosy/complications , Male , Middle Aged , Neurologic Examination , Peripheral Nervous System Diseases/etiologyABSTRACT
21 patients of borderline lepromatous and lepromatous leprosy of both sexes were taken for study after exclusion of autonomic disorders. Autonomic functions pertaining to cardiovascular and genital system were carried out. Five healthy volunteers served as controls. Autonomic function tests indicate definite involvement of cardiovascular and genital system. The incidence of autonomic neuropathy in 21 patients studied was ranging from 14.3 to 57% for various tests. There is involvement of parasympathetic system (vagus nerve) which occurred early and more common than sympathetic. The sympathetic damage is always associated with parasympathetic damage. The severity of automatic neuropathy is found to be high in leprosy of longer duration. Autonomic neuropathy widely occurs in leprosy as in diabetes mellitus.
Subject(s)
Adult , Autonomic Nervous System/physiopathology , Autonomic Nervous System Diseases/etiology , Blood Pressure , Female , Heart Rate , Humans , Leprosy/complications , Male , Pain/physiopathology , Penile Erection , Sensation/physiologyABSTRACT
A randomized controlled chemoprophylaxis trial was carried out in Madras city using 560 disease-free household child contacts of 264 multibacillary cases as study subjects. In the study, 13 cases were diagnosed among 280 contacts who received 3 injections of acedapsone at 10 weeks interval as against 30 cases among 280 contacts who had the same number of placebo injections, during the follow-up period of 225 weeks. The difference in the incidences in the two groups was statistically significant. (X2 6.45; P less than 0.02). The protection due to the limited duration of acedapsone prophylaxis was 56.7 percent. There were no cases of multi-bacillary leprosy in either group. The efficacy of prophylaxis was significant in male children over 9 years of age and female children in the age-group 1-8 years. The other prognostic factors like the infectivity status of the index cases in the household and the duration of exposure to them could have possibly influenced the effectiveness of prophylaxis in preventing progression from infection to clinical disease among the subjects studied. Their effects could not be assessed in this study.
Subject(s)
Acedapsone/therapeutic use , Adolescent , Age Factors , Analysis of Variance , Child , Child, Preschool , Clinical Trials as Topic , Dapsone/analogs & derivatives , Female , Humans , Infant , Leprosy/prevention & control , Male , Sex Factors , Time FactorsABSTRACT
Two cohorts of bacterio-positive cases registered and started on treatment during 1960-62 and 1968-70 were studied for differences in their response to DDS monotherapy. Proportion of male and female cases, mean Bacteriological Index (B.I.) and the distribution of cases according to the initial BI did not differ between the two cohorts. 49.7% of the patients in the II cohort were taking regular treatment against 27.4% in the I cohort. At the end of 7 years of treatment, proportion of the cases that were bacteriologically negative were 68.6% and 83.0% in I and II cohorts respectively. Relapse rates in I and II cohorts were 14.3% and 7.9% respectively, over a period of 7 years. The findings showed that Dapsone continued to be an effective antileprosy drug and must be included in all multidrug regimens in the therapy of leprosy.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Dapsone/pharmacology , Drug Evaluation , Female , Humans , Infant , Infant, Newborn , Leprosy/drug therapy , Male , Middle Aged , Mycobacterium leprae/drug effects , Time FactorsABSTRACT
The Central Leprosy Teaching and Research Institute (C.L.T. & R.I.) Chengalpattu, took up studies on dapsone resistance in M. leprae from 1974. From 1978, the study was further strengthened by a project under THELEP (TDR) for eliciting information on the efficacy of certain drug regimens. The Thelep studies were to be conducted only on the dapsone sensitive untreated cases and, therefore, directed towards the detection of primary resistance, while the non-THELEP institutional studies were concentrated on secondary dapsone resistance problem. These two studies together detected 99 cases of dapsone resistance in the patients who attended CLTRI Hospital during 1974-81; 23 of them, were of primary origin, 16, 6 and 1 showing mild (RI), moderate (RII), and high (RIII) grades respectively. Of the remaining 76 cases of secondary resistance, 7 and 69 were of RII and RIII grades respectively. The need for vertical and horizontal monitoring of the drug resistance problem has been pointed out.