Childhood Leprosy Scenario at a Tertiary Level Hospital: A Four - Year Retrospective Study

Childhood leprosy is an important marker of the status of any ongoing leprosy control programme because it is an indicator of active disease transmission in the community. Studies pertaining to proportion and characteristics of paediatric cases from Bihar are few in number. Hence, present study was carried out to know the scenario of childhood leprosy. A retrospective analysis of 4 year records of leprosy patients aged up to 14 years in a tertiary care hospital of Bihar, was carried out from June 2014 to May 2018. A total number of 72 (9.31% of total leprosy) cases of childhood leprosy reported to AIIMS, Patna, Bihar, India during this 4-year period. The majority of cases belonged to the age group of 11-14 year (84.72%) with a male preponderance. Borderline tuberculoid was the commonest clinical type (44%) followed by tuberculoid type (29%). Borderline lepromatous, Indeterminate form, Histoid leprosy and Pure Neural type was seen in 2, 4, 1, 2 cases respectively. Multibacillary (MB) cases constituted a total of 39 (54.16%), while remaining 33 (45.83%) were of paucibacillary (PB) type. A solitary skin lesions either a hypo-pigmented or an erythematous patch with decreased sensation with or without thickened nerve was the most frequent manifestation in 34 cases (47.22%) followed by 2-5 skin lesions in 29 (40.27%) and more than 5 skin lesions or diffuse infiltration in 9 (12.5%) patients. Although nerve thickening was seen in 32 (44%) cases, neuritis and lepra reactions were less common. Disability was noted in 15.27% cases (Grade1 disability in 2.7% and Grade 2 disability in 12.5%). History of contact was found in 51.38% cases. Continuous and sustained efforts for early case detection of leprosy cases in the community in general, and a close follow-up of susceptible children amongst household contacts of leprosy cases will be desirable to treat these cases of childhood leprosy early before they develop any disability. Intense efforts are thus required to achieve the target of zero disability in child leprosy cases set in the Global Leprosy Strategy 2016-2020.

A Clinico-epidemiological Scenario of Leprosy at a Tertiary Care Centre in Sub-Himalayan Region: A Seven Year Retrospective Study

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.

Childhood Leprosy in the Light of Global Leprosy Strategy 2016-2020

Achieving zero grade 2 disability among children diagnosed with leprosy was one of key targets identified in Global Leprosy Strategy (2016–2020). Considering this we decided to study the clinico-epidemiological features of childhood leprosy in the post elimination era, with special reference to disabilities, over a period of 10 years (2006 to 2015 ). These childhood cases were among the patients attending the leprosy clinic of Govt. Medical College Thrissur, a tertiary care hospital in South India. Data from the case records of all patients with leprosy aged < 15 years registered in our leprosy clinic were compiled and analysed. Out of 409 leprosy patients registered, 24 (5.9% ) were children < 15 years. In the first half of the study period (2006-2010) there were 13 childhood cases (6.2%) and in the second half (2011-2015) there were 11 (5.5%). Males (10) out numbered females (3) in the first half of study period where as in the second half, the sex ratio was almost equal (M=5, F=6). The commonest age group affected was 6 - 10 years during both halves of the study period. In both halves of the study period, majority had skin lesions of less than one year duration at the time of presentation. The commonest type of leprosy was borderline tuberculoid (n=19; 79%). All patients were smear negative for acid fast bacilli. Four patients (16.7%) had peripheral nerve thickening but none had visible deformity. Percentage of childhood leprosy (5.9%) in our study is lower than the national (8.94%) and state (6.97%) NLEP figures for the year 2015-2016. Absence of Grade 2 disability is a unique feature of our study. Zero Grade 2 deformity observed in our study is consistent with the Kerala and Tamil Nadu state NLEP data for the year 2016-2017. Zero Grade 2 disability in all our patients possibly points to the early treatment seeking behaviour of population in Kerala leading to early diagnosis and prompt management of lepra reactions.

Diagnóstico de lepra en niños mediante seguimiento serológico de anticuerpos contra el glicolípido fenólico I / Leprosy diagnosis in children by antibodies serologic follow up against the phenolic glycolipid I

Introducción: Los niños contactos de pacientes con lepra se consideran las personas con mayores posibilidades de desarrollar la enfermedad. Objetivo: Valorar la utilidad del seguimiento serológico de anticuerpos contra el glicolípido fenólico I para el diagnóstico de lepra en niños. Métodos: Investigación prospectiva. Se incluyeron todos los niños contactos de pacientes diagnosticados con lepra en las provincias de La Habana, Santiago de Cuba y Guantánamo entre enero 2013-junio 2015. Los menores se evaluaron clínicamente mediante examen dermatoneurológico y se determinó la presencia de anticuerpos contra el glicolípido fenólico I de Mycobacterium leprae para el estudio serológico. Los niños con serología positiva se siguieron, con estos dos métodos, cada seis meses durante dos años. La confirmación de un caso nuevo de lepra se realizó mediante baciloscopía y biología molecular. Resultados: Se estudiaron 151 niños, de ellos 44 (29,13 por ciento) resultaron positivos al glicolípido fenólico I. Se diagnosticaron durante el período 12 casos, de los cuales 11 tuvieron serología positiva. Presentaron sospecha clínica 10 niños de los estudiados, solo se confirmó un caso nuevo, el cual tuvo serología negativa. En ocho de los niños diagnosticados se detectó presencia de bacilos ácido alcohol resistente en la lámina de baciloscopía. En los restantes cuatro niños el diagnóstico se confirmó por la reacción en cadena de la polimerasa. Conclusiones: Los resultados de esta investigación denotan la utilidad del seguimiento serológico de anticuerpos contra el glicolípido fenólico I en el diagnóstico de lepra en niños, en apoyo a la vigilancia clínica(AU)

Introduction: Children having contact with leprosy patients are considered the contacts with greater possibilities of developing the disease. Objective: To assess the usefulness of antibodies´ serologic follow up against the phenolic glycolipid I (PGL-1) for the diagnosis of leprosy in children. Methods: Prospective study in which were included all children contacts of patients diagnosed with leprosy in Havana, Santiago de Cuba and Guantanamo provinces between January 2013 and June 2015. They were evaluated clinically by the dermato-neurological examination and the presence of antibodies against the PGL-1 of M. leprae was determined. Children with positive serology were followed up using these same two methods every six months for two years. The confirmation of a new case of leprosy was made by smear microscopy and molecular biology / PCR-Rlep. Results: A total of 151 children were studied. Of these, 44 children (29.13 percent) were positive for phenolic glycolipid I. A total of 12 children were diagnosed during this period, of which 11 had positive serology. Only 10 children of the studied ones presented clinical suspicion and of these only one new case was confirmed, which had negative serology. In eight of the diagnosed children, the presence of acid-fast bacilli was detected in the smear microscopy. In the remaining four children, the diagnosis was confirmed by the PCR result. Conclusion: The results of this investigation show the usefulness of the antibodies´ serologic follow up against the phenolic glycolipid I in the diagnosis of leprosy in children as a support to clinical surveillance(AU)

Clinical, bacteriological, and histopathological characteristics of newly detected children with leprosy: A population based study in a defined rural and urban area of Maharashtra, Western India.

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.