A review of trends in new case-detection in Subarnapur district of Orissa.

Trends in new case-detection are analysed by reviewing the demographic and leprosy epidemiological data and current indicators in Subarnapur district, Orissa State and India. Population-specific new case-detection rates were calculated for analysis. The trend of skin-smear positive cases over a period of 10 years was reviewed in respect of smear positive cases of 1991. During the years 2002 to 2004, a sudden fall was noticed in the new cases detected in both India and Orissa state, whereas the decline in Subarnapur district was more gradual. The fall in the female-specific new case-detection rates is found to be rapid from 11 to 2.5 over the last three years. This also indirectly indicated the health-seeking behaviour of women in accessing health services and hence required a changed strategy. A similar rapid decline was observed in child-specific new case-detection rates. On analysiS, the decline of highly bacilliferous cases from 1991 to 2001 was found to be statistically significant. The analysis also brought out the fact that cases with bacterial index of 1+, 2+ and 3+, though small in numbers, were detected during the last three years indicating continued presence of cases with low bacterial density in the community. The review indicates a definite decline in the occurrence of new cases in all groups. Caution needs to be exercised about continued presence of cases with low bacterial index though in small numbers. The rapid decrease of cases in all groups during the years 2004 and 2005 warrants meticulous surveillance. The surveillance activities could include monitoring of population-specific new case-detection rates and skin-smear positive cases at district and state levels in order to advise on leprosy eradication programme strategies.

Reaction cases treated at the Regional Leprosy Training and Research Institute, Aska, Orissa: a retrospective analysis.

This study is a retrospective analysis of 147 cases of leprosy reaction selected out of 942 cases of leprosy registered between 1992 and 2002 at the RLTRI, Aska (Orissa). The occurrence of reaction was about 16% with a slight increase over the years. There was a preponderance of males, with about 80% cases among males, and the peak occurrence of reaction was found in the age-group of 21-49 years. Reversal reaction (RR) was seen in 68.7% and ENL in 31.3% of cases. Single episode of RR and ENL reactions was seen in 61.2% and 43.5% respectively. In either type the last episode was seen even after about 32 months after RFT. There was a dissociation between nerve and skin manifestation, with both skin and nerve manifestation in 78.96%, skin lesions only in 21.1% and nerve lesions only in 50.9% of cases. About 88% of reaction was seen in MB patients, with a higher proportion of RR, because of inclusion of more borderline cases. Prednisolone was the drug of choice in both types of reaction, though in 17 cases of steroid dependency, thalidomide was proved to have an edge over steroids. Both types taken together, in half of the cases the first episode of reaction developed within 6 months of starting treatment. Multiple episodes were more common with ENL.

Cellularity of macrophage granuloma and morphological index.

In the present study, morphological index (MI) and average macrophage count per microscopic field in skin sections of 94 lepromatous (LL) patients is correlated. The subjects included 14 cases with some histoid features. The MI in the lepromatous cases varied from less than one to 40 and the corresponding macrophage counts ranged from 40 to 156. In cases with histoid changes the MI varied from 30 to 60 and the cell count ranged from 215 to 360. The histoid cases showed a higher MI and cell count compared to the other lepromatous cases. There was a positive correlation between MI and macrophage count and the hypercellular state appears to depend on living and multiplying bacteria.

Non acid-fast fluorescent M. leprae (?) in skin smears from leprosy patients.

Smears from 74 known smear negative cases of leprosy were examined after staining with Auramine 'O'. 40.54% cases were positive for fluorescent bacilli. 60.52% of cases on treatment and 19.44% cases after RFT had fluorescent bacilli in the skin smears. Results suggest the possibility of a non acid-fast fluorescent positive variant of M. leprae.

BI of patient vs BI of individual sites.

An analysis of 200 skin smear results from multibacillary patients showed that the average bacteriological index (BI) of a patient varied considerably from his site-wise highest BI. The average BI was equal to site wise highest BI only in 17.5% of cases and in the rest, it ranged from 99% to as low as 36% of the highest site-wise BI. In follow-up smears, site-wise consistency of the highest BI was found in 96% of cases. It is suggested that for follow-up purposes, repeating smear from only one such site would be adequate.

Epithelioid and polygonal cells in histoid leprosy.

Salient histological features of 36 histoid leprosy were presented. Usual features like whorls and interlacing bundles of spindle cells, histoid habitus of the bacilli were noticed in all the cases. Pseudocapsule was present in 6 cases. Circumscribed islets of epithelioid cells were seen in the deeper part of the granuloma in 5 cases. Acid-fast bacilli were absent or rare in these cells. Polygonal, foamy macrophages were found in 12 cases. Presence of epithelioid and polygonal cells in histoid leprosy is rare and its significance needs to be explored.

Cutaneous rhinosporidiosis in a patient of lepromatous leprosy--a case report.

A rare coincidence of cutaneous Rhinosporidiosis and Lepromatous leprosy is reported. The clinical course of the cutaneous nodules simulated the feature of certain histoid nodule with ulceration.