ABSTRACT
Leprosy is the oldest disease affecting humankind since ancient times. Despite MDT’s availability for disease curability, vast pockets of multi-bacillary (MB) cases persist in the community. We conducted this study to know the clinico-epidemiological trends of leprosy over four years and five months in this era of the COVID-19 pandemic (C19P). A total of 90 cases were registered; 59 (65.5%) were males, and 31 (34.5%) were females. The majority (69%) of cases were in the 15-45 age groups. Childhood leprosy was detected in 3(3.3%) cases. A history of contact with leprosy patients could be established in 16 (17.8%) cases. The cases comprised 54.5% local inhabitants and 45.5% were migrants. The MB cases 77 out of 90 (85.6%) were in higher proportion than pauci-bacillary (PB) cases. In the clinical spectrum, BL leprosy was most common in 39% of cases, followed by LL and BT leprosy. Thirty-seven (41%) patients were suffering from lepra reactions (LR), and out of them, 59.4% had type 2 reactions (T2R), and the rest had type 1 reactions (T1R). Disabilities were found in a total of 56 (62.2%) cases, and grade 2 disabilities (G2D) were recorded in 25 (44.6%) patients. Ulnar nerve (UN) was most commonly affected nerve in 64.4% of cases, followed by lateral peroneal (LPN) and posterior tibial nerve (PTN). We observed the impact of Covid 19 infection peak C19P in two ways; firstly, during the C19P peak in 2020, there was a drastic fall in total registered cases (TRC) to 4/year against 22/year in pre-C19P with a relative increase in LRs and disabilities. In post-C19P peak periods, not only was there a marked rise in TRC (20/5 months), but LR (50%) and disabilities (75%) also showed a significant rise. A high proportion of MB cases, LRs and disability rates indicate the need for population-based studies and subsequent public health measures for early diagnosis and treatment. Further large sample-sized, in-depth studies can tell the exact impact of C19P on leprosy.
ABSTRACT
Despite leprosy being an eliminated disease from most of the countries in the world including India, it continues to remain as a major burden on public health expenditure. The purpose of this study was to determine the current clinico-epidemiological profile of leprosy at tertiary care health institution in Himachal Pradesh. This retrospective study was conducted in the Department of Dermatology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. All patients registered from April 2010 to April 2017 were included in this study. Hospital records of 221 patients were analysed according to age, gender, region of permanent residence, history of contact with leprosy patients, number of patients within state or immigrants from nearby state/country, type of disease-multibacillary (MB) or paucibacillary (PB), type of lepra-reactions and grade of disability patient developed. Out of a total 221 patients majority were in the younger age group of 15-30 years (38.9%), with male predominance (male:female ratio 2.7:1). Majority had MB leprosy (85.5%), and had significant proportion of grade II disability (G2D) compared to national and global data. In clinical disease spectrum, Lepromatous Leprosy (LL) and Borderline lepromatous (BL) leprosy were the most common presentations. Migrants from other states or immigrants from neighbouring country constituted a significant proportion (44/221, 20% approximately). Pure-neuritic disease was diagnosed in 7 (3.2%) patients, childhood cases were only 5 (2.3%) patients, indeterminate leprosy in 3 (1.4%) patients and histoid leprosy in 1 patient (0.004%). To know the exact status of leprosy in the country, knowledge and understanding of the epidemiological profile is an essential pre requisite as it will assess and address public health needs and will help in efficient programme planning and management of leprosy cases in the country. High proportion of MB cases and very high disability percentage shows the need to increase the awareness in the community as well as health care workers so that cases report early, are diagnosed early and managed appropriately so that disabilities become zero in near future. Partnerships among different medical institutions in the state are expected to strengthen the quality referral services and research aimed at eradication.
ABSTRACT
Type 2 reactions may occur in the early stages of the anti-leprosy treatment, however, many cases may present 2–3 years after leprosy diagnosis. Some of such patients have been reported to develop episodes as late as 7 years after starting treatment. A 45 years old male, with a past history of intake of multi drug therapymultibacillary (MDT-MB) pack 15 years back presented with fever, generalized bodyache along with development of vesiculo-bullous lesions over the existing annular lesions of borderline lepromatous (BL) leprosy. Possibility of relapse was ruled out clinically as well as histopathologically and the patient was successfully treated with tapering doses of steroids as a case of severe type 2 reaction. Type 2 reaction is less commonly seen in BL leprosy as compared to lepromatous lepromatous (LL) leprosy. Moreover, development of vesiculo-bullous lesions in an annular pattern over existing lesions of BL leprosy as a manifestation of type 2 reaction has rarely been reported in literature. This case is even rarer as the patient is continuing to get type 2 reaction even after 15 years of completion of MDT-MB and that too in an annular pattern over the existing lesions.