Management of leprosy in the Department of Dermatology, Hospital Sultanah Aminah, Johor Bharu

ABSTRACT

Background Malaysia has achieved control of leprosy with an incidence rate of 1.1 case per 100,000 population, and a prevalence rate of 0.5 per 10,000 population since 19941. However, recently the incidence has increased with the influx of foreign workers, especially from Indonesia, Nepal and Bangladesh. In order to eliminate leprosy, certain issues of need to be addressed namely, imported cases, default from treatment and drug-resistant cases. Objectives 1. To determine the demography of leprosy patients who attended the Skin Department at Hospital Sultanah Aminah Johor Bahru (HSAJB) for treatment. 2. To determine the clinical subtypes of Hansen’s Disease, the incidence of erythema nodosum leprosum (ENL) and reversal reactions. 3. To review the management, side effects of treatment, and disease surveillance Materials and Methods A 15- year retrospective study of all new cases of Hansen’s disease attending the Skin Clinic from 1992 to 2006 was undertaken. Results A total of 166 patients were treated in the study period, of whom 74.4% were male. The median age at presentation was 37 years (range 4 to 85 years). 33% of the patients were immigrants, 34% local Malays, 27% local Chinese and 6% local Indians. Of the 166 patients, 59% had lepromatous leprosy (LL), 22% tuberculoid leprosy (TT), 9% borderline tuberculoid leprosy (BT), 8% borderline lepromatous leprosy (BL), 1% indeterminate leprosy and 1% neural leprosy. The mean bacteriological index (BI) was 1.63 ± 1.63 std deviations, and the mean morphological index (MI) was 0.77 ± 1.24 std deviations at the time of diagnosis. All patients achieved an MI of zero after three weeks of intensive therapy. 84.6 % of the patients received multiple drug therapy (MBCOMBI) in the blister pack distributed by WHO. The remainder was put on modified regimens, because of side effects or drug resistance. 43% of patients developed reactions. Of these, 21.1% had type I reaction and 22.9% had erythematous nodosum leprosum (ENL). 2 patients developed Lucio’s phenomenon at initial presentation. 53% of these developed reaction at presentation while 47% had reaction after a few months’ treatment. 9.6% of the patients developed side effects secondary to multidrug therapy which necessitated withdrawal of the drugs. The defaulter rate was 15 %. Limitations Retrospective analysis with inadequate documentation is a limitation of this study. In addition, the population studied was limited to referrals being made to the Skin Clinic, which is a tertiary referral center. Conclusions Control and elimination of leprosy still posed a problem as the majority of the foreign patients had lepromatous leprosy, and a high defaulter rate. Although leprosy in Malaysia has reached the elimination target set by the WHO, new cases will continue to be observed in small numbers due to the long incubation period of this disease.