Résumé
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.
Résumé
Introduction: India was among the last few countries in the world to achieve leprosy elimination in 2005. However, wide variations in prevalence rates continue to exist across the states and regions in the country. Aims: The purpose of the study is to determine the current clinical profile of leprosy from a tertiary-level hospital in Navi Mumbai. Materials and methods: A retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care center, MGM Medical College & Hospital, Navi Mumbai (September 2011 to August 2015). Data regarding demographic details, clinical features, investigations, treatment, and complications were analyzed. Results: In total, 207 patients were registered over a 4-year period, with male:female ratio of 2.4:1 and children (≤ 14 years) constituting 7.2%. As per Ridley Jopling classification, borderline tuberculoid leprosy was the most frequent morphologic type, seen in 45.8%, followed by borderline lepromatous (28%), lepromatous leprosy (10.1%), and other forms in 11.5%. Multibacillary leprosy was the most common clinical type (81.1%). About 32.8% patients presented in reaction (type I in 22.7% and type II in 10.1%). World Health Organization (WHO) grade 2 deformities were diagnosed in 32.8%, with claw hand being the most common paralytic deformity (18.8%). Conclusion: The study shows that despite statistical elimination, multibacillary disease, leprosy reactions, and deformities are commonly seen as presenting manifestations. Large population of migrant workers in Navi Mumbai could be a possible contributing factor towards these findings. It highlights the need to sustain and provide high-quality leprosy services to all patients through general health services, including good referral system. Investigations, such as slit skin smear and biopsy must be carried out for all newly diagnosed patients.