ABSTRACT
This study investigated the clinical characteristics and somatosensory profiles of patients suffering from leprosy in Mumbai, India. A cross-sectional deep profiling study was conducted in 86 patients with leprosy (with and without pain) using an extensive battery of phenotyping measures including structured clinical examination, psychological state (General Health Questionnaire [GHQ-12]), and a quality-of-life condition-specific instrument (Brief Pain Inventory-short form). Quantitative sensory testing was performed according to the protocol of the German Research Network on Neuropathic Pain (DFNS) to assess the somatosensory profiles in the ulnar nerve innervation territory of all participants (dorsum of the hand). Reference data from 50 healthy Indian subjects were within the range of published DFNS values. Somatosensory profiles in leprosy patients with clinically or electroneurographically diagnosed neuropathy (with and without pain) revealed a profile of sensory loss to thermal and tactile stimuli combined with preservation of vibration and deep pressure detection. Sensory gain phenomena were not generally observed in patients with leprosy. In the group of subclinical neuropathy, a high degree of impaired thermal sensation was found, which could be clinically deployed to enhance identification of leprosy neuropathy at an early stage. Quantitative sensory testing can effectively document leprosy-associated neuropathy but does not distinguish between patients with or without pain. Patients with leprosy and neuropathic pain reported a poor quality of life and less psychological well-being compared with the pain-free patients with leprosy neuropathy.
ABSTRACT
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.
Subject(s)
Leprosy/diagnosis , Leprosy/ethnology , Population Surveillance/methods , Rural Population , Urban Population , Adolescent , Child , Child, Preschool , Female , Humans , India/ethnology , Leprosy/microbiology , MaleABSTRACT
UNLABELLED: Sixty two patients with relapsed leprosy seen between Jan 2004 and Dec 2009 were studied using clinical, bacteriological and histopathological parameters. The findings thus obtained were correlated to parameters such as trend and source of referral, clinical characteristics at diagnosis, treatment received, other events during or after RFT and duration between cessation of treatment and relapse. FINDINGS: Referrals per year have doubled since 2006. Most patients were referred by NGOs (58%), followed by Govt. hospitals (16%) and then by GPs (25%); 76% had received one of the WHO - MDT regimens including 16 treated with 24 months or more MB - MDT, 23 with 12 months MB - MDT and eight with 6 months PB - MDT. Of the remaining 14 cases, four had received DDS mono-therapy, seven had single dose of Rifampicin, Ofloxacin and Minocycline (ROM) and four Rifampicin and Ofloxacin (RO) daily for 28 days. The average incubation time of relapse, defined as duration between cessation of treatment and relapse was (SD) + 6-4 years. 59% of patients had positive slit skin smears on relapse. Relapse for the second time occurred in six BL cases including five from group 2 and one RO treated patient and 11/23 cases from group 2 conferred to BT-BB leprosy. Clinical features at diagnosis and on relapse were comparable in 47% of cases. CONCLUSION: All leprosy patients, regardless of their type and MDT regime, carry 'risk of relapse'. A shorter treatment duration reduces the incubation time to relapse. In group 2 (treated with 12 months MB-MDT regime) 11/23 were BT-BB cases and 5/23 (21%) were relapse for the second time, which further supports our earlier documented findings and maybe the efficacy of WHO-MDT regime is poor in a small subset of patients.
Subject(s)
Leprostatic Agents/therapeutic use , Leprosy , Minocycline/therapeutic use , Ofloxacin/therapeutic use , Referral and Consultation/statistics & numerical data , Rifampin/therapeutic use , Academies and Institutes , Adult , Aged , Biomedical Research , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , India , Leprosy/drug therapy , Leprosy/microbiology , Leprosy/pathology , Male , Middle Aged , Recurrence , Risk Factors , Skin/microbiology , Time Factors , Treatment Outcome , Young AdultABSTRACT
Se evaluaron mediante parámetros clínicos, bacteriológicos e histopatológicos 62 casos de recidivas, entre enero de 2004 y diciembre de 2009. Los hallazgos se correlacionaron con otros parámetros como posible sesgos y las causas de la derivación, características clínicas en el momento del diagnóstico, tratamiento recibido, otros eventos durante y después del cese del tratamiento RFT y periodo entre alta del tratamiento y la recidiva. Hallazgos: Las derivaciones por año se han doblado desde2006. La mayoría de los pacientes llegaron a través de ONGs (58%), seguido de hospitales gubernamentales (16%) y después por médicos comunitarios (25%); el 76% o más recibieron MB-MDT, 23 con 12 mese MB-MDT y 8 con 6 meses PB-MDT. De entre los 14 restantes, cuatro recibieron DDS monoterapia, siete una sola dosis de rifampicina, ofloxacino y minociclina (ROM) y cuator rifampicina y ofloxacino (RO) diarios durante 28 días. El periodo medio de incubación de las recidivas, definido como intervalo entre el cese del tratamiento y la recidiva (SD) fue de + 6.4 años. El 50% de pacientes presentaban fortis cutáneo positivo. Seis casos BL incluyendo cinco del grupo 2 y uno tratado con RO, y 11/23 casos del grupo 2 (BT-BB) recidivaron una segunda vez. Las características clínicas en el momento del diagnóstico y de recidivas resultaron comparables en el 47% de los casos. Conclusión: Todos los pacientes, independientemente de un tipo de lepra o pauta MDT, conllevaron el riesgo de recidivas. Un tratamiento más corto reduce el intervalo de aparición de la recidiva. En el grupo 2 (tratados con 12 meses de MB-MDT), 11/23 eran casos BT-BB y 5/23 (21%) eran recidivas por segunda vez, en consonancia con nuestros hallazgos anteriores 14,23 y quizás la eficacia de la pauta OMS-MDT es pobre en un pequeño subgrupo de pacientes (AU)
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