ABSTRACT
Background: Leprosy has been a major public-health problem in many developing countries for centuries. According to the National Leprosy Elimination Programme report of March 2012, there were a total of about 0.13 million cases of leprosy in India, 9.7% of which were children. Numerous studies have investigated child leprosy amongst reported cases however, studies pertaining to proportion and characteristics of undetected childhood cases in the community are very few. Aim: To examine the clinical, bacteriological, and histopathological characteristics of newly detected child leprosy cases in the community. Methods: The population survey conducted from June to September 2007 and the defined rural areas, which included five primary health centers of Panvel Taluka, in Raigad district and urban areas, which included M-east ward of the municipal corporation of greater Mumbai of western Maharashtra, India. Results: House-to-house survey yielded 32 and 37 so far, undetected child cases of leprosy in the rural and urban region, and the prevalence rate was 10.5 and 1.5 per 10,000, respectively. The age of child leprosy cases detected, ranged from 3 to 14 years with a mean of 10.06 ± 3.35 years in the rural and 9.97 ± 3.12 years in the urban area. Most of the cases were paucibacillary (62%). A large proportion of children (49%) had single skin lesion (SSL). Of the 19 SSL cases examined histopathologically, 15 (99%) showed features of borderline tuberculoid, 1 (5%) borderline lepromatous and 3 (16%) had indeterminate type of leprosy. Tuberculoid leprosy was not seen in any, indicating less likelihood of self-healing. Overall, three cases had deformity (grade 1 = 1 and grade 2 = 2) and 31% of multibacillary cases were smear positive. Conclusion: The clinical, bacteriological, and histopathological characteristics of newly detected child cases in the community evidently indicate the grave nature of the problem of undetected child leprosy, recent active transmission, and highlight implications on individual patients and the community. Key Message: Most of the cases were paucibacillary (62%). A large proportion of children (49%) had SSL and (55%) had it on the face followed by arms and leg (27%) and trunk (17%). The mean duration of symptoms exceeded one year which can be attributed to poor knowledge of leprosy or barriers in access to health care or its utilization.
ABSTRACT
AIM: This study assesses the utility of a Buddemeyer type radiorespirometric (RR) assay in detecting viable Mycobacterium leprae in clinical samples taking the mouse foot pad (MFP) test as gold standard. METHODS: A total of 131 skin biopsy specimens comprising of 56 untreated, smear-positive, borderline lepromatous and lepromatous leprosy (BL-LL) and 75 untreated, smear-negative, borderline tuberculoid and mid-borderline (BT-BB) specimens were processed by both the methods. The cut-off value (in counts per minute, cpm) for test samples in the RR assay was determined using nonleprous (normal) skin biopsy specimens. RESULTS: In the untreated BL-LL and BT-BB groups, 86 and 56% of the cases tested positive in the RR assay respectively, which was comparable to the results of the MFP test (80 and 45% respectively). The overall concordance between the two tests was 74.79%, whereas the sensitivity and specificity were 75 and 74.3% respectively. A Kappa value of 0.459 indicated a fairly good agreement between the two methods. There was no linear relationship observed between the bacteriological index (BI) and the morphological index (MI) with the counts per minute (cpm) output. CONCLUSION: The results indicate the ability of this RR assay to detect viability; however a comparison with another sensitive method would further validate the assay system.