Interesting and Unusual Presentation(s) of Leprosy Resulting in Delayed diagnosis

In the post elimination phase of leprosy programme, it continues to be an important health problem in India. Further various atypical forms are seen resulting in delayed diagnosis. A retrospective analysis of 2 years (January 2016 to December 2017) records of all in and out patients of leprosy cases who were treated at a service hospital in northern India was done. At this hospital a total of 97 leprosy cases were seen during the study period out of which 18 (18.5%) cases where the diagnosis was missed due to various reasons resulting in delay in initiation of MDT were included. These cases were examined to describe the clinical presentation, delay in diagnosis and its significant outcome. 61% (11/18) were males while 39% (7/18) females. 22.2% (4/97) had Histoid Hansen's disease; 22.2% (4/18) had chronic symmetrical polyarthritis, there was no hypoaesthetic or anesthetic patches or enlarged nerves in these patients and these were initially diagnosed and managed as Rheumatoid arthritis. 16.6% (3/18) had spontaneous ulceration of extremities and had no skin infiltration or thickened nerve on examination. Interestingly two of these three patients had associated hypoaethesia of extremities which was not taken into consideration for making diagnosis as no suspicion of leprosy was made, one patient in this group had developed foot drop (L) and Right ulnar claw. 16.6% (3/18) had pure neuritic leprosy while greater auricular nerve thickening was seen in 11.1% (2/18) atypical cases. 5.5% (1/18) patient had swelling of upper lip but there no lesion on face or nerve and was managed by a Dentist. Lichenoid lesions were seen in 5.5% (1/18) cases. Out of 18 atypical cases 83.3% (15/18) were in multibacillary pole while 16.6% (3/18) were in paucibacillary pole. 27.7% (5/18) each were BL and LL while 22.2% (4/18) each were Pure neuritic and Histoid Hansen's. 83.3% (15/18) patients were Bacillary positive. Grade 2 deformity developed in 22.2% (4/18) of these cases. The total duration elapsed between presenting to the primary care giver and the dermatology center where the final diagnosis was made ranged from 2 weeks to 3 years. Increase in awareness about various presentations of leprosy in post-elimination era should be emphasized to the health care physicians as well as other workers involved in detection/diagnosis of leprosy

Current Problems and Future Prospects of Leprosy Control in Vietnam / 国際保健医療

<b>Objectives</b><br> Vietnam, where leprosy used to be highly endemic, through governmental implementation of MDT in 1983 and nationwide disease control efforts, has achieved WHO's leprosy elimination goal at a national level since 1995. <br> However, a number of patients who suffered from leprosy prior to the governmental control programme remain institutionalised. Although these patients have severe physical disabilities, social services provided to improve their quality of life appear inadequate.<br> The purpose of this study is to report the findings of an investigation of the current state of leprosy and to clarify the problems of leprosy control in Vietnam.<br><b>Methods</b><br> 402 leprosy patients from two leprosy hospitals and four leprosy resettlement villages in Vietnam were investigated their disabilities on upper limb, inferior limb, and facial appearance. And their disabilities classified according to the WHO classification scheme for disabilities in leprosy patients.<br><b>Results</b><br> The group “Visible deformity or damage present” (G2) made up 70.1% of the study participants; the group “Anaesthesia present, but no visible deformity or damage” (G1) made up 18.9%; the group “No anaesthesia, no visible deformity or damage” (G0) made up 10.9%. More than half of those with visible physical disabilities were in their 60s or 70s. The level of disability of pre-MDT leprosy sufferers was significantly more severe than that of the post-MDT group.<br><b>Conclusions</b><br> The effect of MDT for prevention of occurrences of physical disability was reaffirmed, but for many patients who contracted the disease prior to the implementation of MDT in Vietnam, the after-effects of leprosy are ongoing and they are forced to live in resettlement villages due to their disability. Vietnam has reduced the prevalence rate, but there are still a number of former patients who are not receiving adequate help. Providing help that is needed to raise their quality of life is the next step.

Drugs in leprosy / 나학회지

Chemotherapy is a main component of treatments for leprosy. The World Health Organization (WHO) recommends multiple-drug therapy (MDT) consisting of dapsone, clofazimine and monthly rifampin as the first-line drugs against leprosy. Minocycline, clarithromycin and certain fluoroquinolones can be used as substitutes in dapsone or clofazimine. For management of reactions, type I reactions should be treated with corticosteroids while thalidomide is the drug of choice for type II reaction. This review summarizes pharmacologic effects of drugs being used in leprosy including mechanisms of action, side effects, drug interactions and drug resistance.

The Change of Bacillary Index during WHO Standard Multi-drug Therapy in Multi-bacillary Leprosy: Among the patients in The National Sorokdo Hospital / 대한피부과학회지

BACKGROUND: There were no effective methods to monitor the treatment of leprosy. Anti-PGL-1 ELISA test and polymerase chain reaction(PCR) were used for monitoring the treatment, however many restrictions have been found to apply to those methods in the field. Bacillary index(BI) is a popular and not an expensive method. For this reason, the exact data to assess the efficacy of the standard multi-drug therapy(MDT) with BI is required for evaluation of the treatment in Korea. OBJECTIVE: The purpose of this study was to clarify the change of bacillary index during MDT in multi-bacillary leprosy(MB) cases. METHODS: A total of 72 patients in the National Sorokdo Hospital were included in this study. With the retrospective method, BI, type of leprosy, relapse, age, and duration of treatment were evaluated. RESULTS: The results were as follows; 1.In this study, the mean duration of BI changing from 6 to 5 was 5.7 months, from 5 to 4 was 6.6 months, from 4 to 3 was 13.1 months, from 3 to 2 was 13.8 months, from 2 to 1 was 12.4 months, from 1 to 0 was 29.4 months. 2.The time of initial change of BI after MDT were as follows: within 3 months(26.4%), 4-6 months(29.2%), 7-12 months(26.4%), 13-18 months(8.3%), 19-24 months(4.2%), 25-48 months(5.5%). The mean duration was 8.9 months. 3.The mean cumulative time of BI to 0 was 68.4 months CONCLUSION: These results suggest that after MDT, in most of MB, BI decreased within one year and it took 68.4 months for BI to be 0. At first, BI decreased relatively fast, however a longer period was required to become a state of BI 0.