Role of target groups in integrated leprosy programmes.

The introduction of integrated leprosy services into the primary health care set-up has taken away active case-detection in the community and is replaced by passive reporting by the suspected, afflicted individuals. This can only be made operative effectively with intensive IEC activities in the community. A research study involving school-children (219,000) in leprosy work achieved spectacular success in new case-detection, effective monitoring, completion of MDT and coverage of a large number of individuals (750,000). The results evaluated on a representative sample of 20,000 school students (pre- and post-test), showed over 90% success in creating awareness about the cause of the disease, its symptoms, curability by fixed duration MDT and better attitudes and perceptions of the community towards leprosy-affected individuals. It is emphasised that, in view of the experience gained from the study, other more cohesive and disciplined target groups, such as scouts and guides, NCC cadets, NSS volunteers, should be identified for leprosy work throughout the country in a planned and coordinated manner in order to implement and sustain leprosy eradication activities in the near-elimination and post-elimination phases.

Sero surveillance of HIV infection in high risk groups and in suspected AIDS cases in a New Delhi hospital.

A total of 17,824 sera were screened for the presence of HIV 1 + 2 antibodies by Enzyme Immuno Assay (EIA) to determine (i) seroprevalence of HIV infection in hospital high risk groups (ii) time trend of HIV seroprevalence in STD clinic attendees (both STD patients and non STD patients), over a period of six years, (iii) relationship of the STD's with HIV seropositivity (iv) clinical profile and epidemiological characteristics of the AIDS cases. A progressive increase in the HIV seropositive STD patients showing a five fold rise over six years was seen. Most gave history of multipartner sex especially with female CSW's. The most common STD associated with HIV seropositivity was Syphilis followed by Chancroid and Gonorrhoea. All had HIV-1 infection. The AIDS cases (20) presented mainly with tuberculosis, both pulmonary and extrapulmonary. The mode of infection, both in the HIV seropositive and AIDS cases, was mainly heterosexual relationship followed by blood transfusion. In a few cases, infection was perinatally transmitted. In the limited number of HIV positive contacts studied, seven were confirmed as Western Blot positive. HIV infection, although a later introduction in Delhi compared to the coastal cities, has shown a clear increasing trend in the STD patients.

Domiciliary health counselling in patients with sexually transmitted diseases.

To improve treatment compliance, follow-up and attendance of STD patients and their contacts, a programme, based on domiciliary visits was attempted. The programme was limited to male defaulters not responding to written and telephone calls. House visits to 79 out of 169 defaulters were made. Approximately half the number of houses were found locked. Fourteen defaulting patients reported for completion of their treatment and follow-up. Of these 11 were directly interviewed. None of the 14 patients agreed to disclose the addresses of their extramarital partners. During the study period 51 female sex contacts reported for treatment as compared to 27 in the control group. Though the numbers were small the study revealed that direct contact with the patient yielded the best results. It is suggested that to make the system cost-effective the health workers should spend time with STD patients in the clinic to mark out the correct location and time for meeting the patient either in the work place or at home in case of a follow-up.

ACTH acts directly on melanocytes to stimulate melanogenesis--an in vitro study.

A total of 108 whole skin organ cultures taken from vitiliginous skin were incubated in MEM containing ACTH. It was observed that 53.7% that is 58 showed a positive response with an increase in pigment production and enzyme activity, as observed on frozen sections stained for dopaoxidase activity. On immunohistochemical staining for locating ACTH binding, it is observed that 27.3% control skin and 72.7% ACTH treated skin show positivity. The ACTH is seen to bind with the melanocyte membrane as well as the cytoplasm. This indicates that ACTH can bind to the MSH-receptors expressed by the melanocyte. Thus, ACTH acts directly on the melanocyte to enhance melanogenesis and does not require to act via the adrenal-pituitary axis. This also indicates that the response is not associated with immune suppression by ACTH.

Induction of lepromin positivity by a candidate anti-leprosy vaccine Mycobacterium w in lepromin negative healthy contacts of multibacillary leprosy patients.

In a hospital based study, 362 household contacts of multibacillary leprosy patients were screened for evidence of leprosy and 54 (14.9%) were found to be having leprosy. The remaining 308 apparently healthy contacts were lepromin tested and 109 (35.4%) were observed to be negative to Mitsuda lepromin. M.w vaccine was administered intradermally to 95 of these 109 lepromin negative contacts. Sixty eight of them could be retested for lepromin A reactivity. Fifty six (82.35%) manifested lepromin conversion. The twelve subjects who did not show lepromin conversion, received a second dose of the vaccine, and eleven subsequently became lepromin positive. The overall lepromin conversion rate was thus 98.5% (67 out of 68). Follow-up of these contacts upto a period of 30 months did not demonstrate reversion of lepromin positivity back to negativity status. No untoward effects of vaccination were observed except for local ulceration at the site of vaccine administration.

Leprosy in low endemic areas of India: an appraisal and suggested measures for control.

Prevalence of leprosy in the low endemic areas of India is described based on the observations of patients attending an Urban Leprosy Centre in the Union Territory of Delhi from the neighbouring states. The rising incidence in these so-called low to moderate endemic places is closely linked to factors related to urbanisation, movement of people in search of employment, etc., which necessitate fresh surveys in these areas. A significant number of leprosy patients attending the Centre were irregular (37.7%) in therapy and many absconded after the initial visit (35.3%), the reasons for which are discussed. These figures are compared to that from similar low endemic areas and known high endemic parts of the country. Suitable modifications to the control programme in these areas are suggested under the purview of the National Leprosy Eradication Programme.

Leprosy in the Union Territory of Delhi.

One hundred and seventy seven patients of leprosy residing in Delhi comprised 16.4% of the total Urban Leprosy Centre attendance in a three-year retrospective study with a M:F ratio of 3:1. The average age at onset of disease was 28.75% years and childhood leprosy was only 6.78%. The cases of pauci- and multibacillary leprosy were almost evenly distributed. Borderline leprosy (including BT, BB & BL of Ridley-Jopling classification) comprised the largest single group with 51.42%, followed by Lepromatous with 21.47%. In 90% cases the high probability of acquiring infection during period of stay in the city and the involvement of lower age-group are pointers towards the endemic nature of the disease in the region.

Vitiligo on tuberculoid patches--a case report.

A case of tuberculoid leprosy with complete depigmentation on its active margins, in a predisposed individual to vitiligo is presented. The postulated mechanism of hypopigmentation vis-a-vis leprosy lesions is discussed in brief in the context of the presenting unusual association.