Diagnóstico de lepra en una comunidad ecuatoriana / Diagnosis of leprosy in an Ecuadorian community

Introducción: La lepra es una infección bacteriana compleja causada por el bacilo Mycobacterium leprae, puede causar discapacidad, afecta principalmente a la piel, los nervios periféricos, la mucosa de las vías respiratorias superiores y los ojos. Caso clínico: Paciente de 22 años de edad, con enfermedad de Hansen, facie Leonina, con lesiones nodulares diseminadas en la cara de color violáceo, deformidades en ambas manos, nódulos en ambos brazos y pies y pérdida de la sensibilidad superficial y profunda. Conclusiones: En el Ecuador la Lepra puede ser calificada como de baja endemia, la tasa de detección han ido descendiendo progresivamente en los últimos diez años(AU)

Introduction: Leprosy is a complex bacterial infection caused by the Mycobacterium leprae bacillus. It can cause disability and mainly affects the skin, the peripheral nerves, the mucosa of the upper respiratory tract and the eyes. Case report: 22 years patient with Hansen's disease, Leonine facies, with purplish colour nodular lesions spread out in the face, deformities in both hands, nodules in both arms and feet, and loss of superficial and deep sensitivity. Conclusions: In Ecuador leprosy can be qualified as low endemicity. The detection rate has been falling progressively over the past ten years(AU)

Study of Clinical Spectrum and Factors Associated with Disabilities in Leprosy: A Ten Year Retrospective Analysis

Leprosy/Hansen's Disease (HD) is associated with impairments and disabilities leading to stigma attached to the disease. Our study looks at the clinical spectrum and factors associated with disabilities over a 10 year period. It was a cross sectional retrospective analysis and included 240 patients which were followed in Christian Medical College and Hospital, Ludhiana, a Tertiary Care Hospital in North India. Objective of the study was to assess the pattern, prevalence and risk factors of disabilities in leprosy patients. The findings shows that the overall prevalence of disabilities was 57.9% (n=139) and was more common in males (73.4%). Patients, residents of Punjab had the maximum prevalence of disabilities (37.4%) followed by Bihar (27.3%). The commonest visible disability was madarosis (19.6%) followed by claw hand (12.1%). The maximum prevalence of clawing was noted in patients with BT-HD (31%) followed by TT-HD (27.6%). WHO Grade 1 disability was 24.5% while 60.4% had WHO Grade 2 disability. On multivariate analysis, positive skin smears and presence of lepra reaction at the time of diagnosis were found to be the risk factors associated with disabilities in leprosy. While the magnitude of disabilities in a referral tertiary care settings will not reflect true extent of problem in the community, information is relevant for improving the preventive and management strategies. Even in the post elimination era of leprosy, significant number and types of disabilities still persist. Like the tip of an iceberg, these findings imply that a more vigorous approach towards early and adequate treatment of complications like reactions is the need of the hour. Community based intervention studies in partnership with tertiary care hospitals may be useful in taking appropriate public health measures.

A 60-year-old lady with leonine facies: A rare diagnosis.

Systemic mastocytosis is a rare clonal disorder characterized by mast cell infiltration of one or more organs, with or without skin involvement. Leonine facies is a rare presentation and corresponds to the morphologic manifestation of diffuse dermal infiltration of the face as a result of long standing disease. Bone marrow aspiration and biopsy findings in a 60-year-old woman, who had extensive cutaneous infiltration due to systemic mastocytosis, resulting in 'leonine facies,' are described, and causes of leonine facies are discussed.