Indian journal of leprosy最新文献

Early diagnosis of nerve damage in leprosy is quite important for preventing the deformities. With an aim to find a good marker we have investigated Krox-20 as early peripheral nerve damage indicator in leprosy. Ambulatory patients of Kediri Leprosy Hospital, Malang, Indonesia have been studied. Degree of disability was measured based on WHO's criteria. Immunohistochemistry was.used to study the expression of Krox-20 on Schwann cells on nerve twigs in skin biopsies from leprosy cases. Receiver Operating Characteristic (ROC) curve was used to determine cut off value. Of all 79 leprosy patients studied, 36 patiens had degree of disability 0, and 43 patients had degree of disability 1. Analysis of ROC curve shown that cut off value for Krox- 20, was 8 and the cases in whom degree of disability was 0 (zero) had significantly higher mean values than those with degree of disability 1 (mean: 12.56 vs 4.24 (p<0.05)). Krox-20 appears to be a potentially good biomarker to identify early peripheral nerve damage in leprosy.

Early case detection and prompt treatment have been identified as key strategies for effective control and elimination of leprosy disease. Hence, control efforts should include among others treatment of the disease and disability prevention. This study is aimed at determining prevalence and pattern of disability among leprosy patients treated in a Leprosy Center in Abia State, Nigeria. Records of 287 leprosy patients treated in Uzoakoli Leprosy Center, Abia State between 2002 and 2006 were reviewed and analysed. Findings showed 23 (9.9%) with childhood leprosy, 206 (83.7%) multi-bacillary type and 64 (28.4%) with grade 2 disability among the leprosy cases.Four children (15.4%) presented with grade 2 disability at diagnosis. Prior to treatment 80 (27.9%) had grade 2 disability, while 11 (6.6%) at the end of the treatment.,Based on EHF score 85 patients (50.9%) out 167 patients who completed treatment had impairment before treatment; on completion of treatment 133 (89.9%) of them improved, while 5 (3.4%) deteriorated. The lower limb (92.6%) was the most affected site in the leprosy patients,, while the eye (3.4%) was the leastaffected. The current leprosy control efforts should be intensified to ensure early case detection and prompt treatment in order to reduce the leprosy burden, including disabilities in individuals and community at large.

The rheumatological manifestations of leprosy occur singly or in varying combinations, particularly during lepra reactions. Despite being third most common, these remain under diagnosed and under reported. This study has been carried out to study the spectrum of rheumatological manifestations in leprosy patients. One hundred consecutive patients of leprosy presenting during January to December 2013 were studied for rheumatological manifestations. Complete hemogram, serum biochemistry, urinalysis, rheumatoid factor, ASO titer, C-reactive protein, ANA, and x-rays for hands, feet, chest and involved joints were performed. These 100 (M:F 66:34) patients aged between 16-80 years had indeterminate (2 patients), TT (4 patients), BT (26 patients), BB (2 patients), and LL leprosy (32 patients). 27 patients had rheumatological manifestations; arthritis involving large or small joints in 23 patients being the commonest. 7 of 24 patients in type-1 lepra reaction had enthesitis in 3 patients and oligoarthritis in 4 patients. Rheumatoid arthritis-like polyarthritis was noted in 19 patients with type-2 reaction. Tenosynovitis, dactylitis, bony changes were also noted. Except for one case, these features were present in patients having lepra reactions. Rheumatoid factor in 14, ANA in 15, C-reactive protein in 45 cases was positive. ASO was positive 34 cases. Symmetrical polyarthritis involving small joints of hands and feet, oligoarthritis, enthesitis and dactylitis are common in leprosy particularly with borderline leprosy, type-2 lepra reaction especially in the presence of positive RAfactor.

Since time immemorial, stigma has been associated with leprosy mainly due to deformity and disability which in turn affects the physical, psychological, social and economical well being of some of the leprosy afflicted persons (LAPs). To prevent and correct deformities Government of India has focused on early diagnosis and appropriate treatment. In addition government has been providing services of Reconstructive Surgery (RCS). RCS corrects the deformity and is expected to help in reducing the stigma in society and reintegrate the affected persons in to society so that they become economically self reliant and carry out their normal livelihood activities without any prejudice. As the stigma has cultural background, this study has.been carried out with to assess the existing stigma level in pre RCS in society in parts of Odisha and compare with that of post RCS. The study was conducted in Sonepur district of Odisha. The sample size is the entire universe of all the 60 patients who had undergone the RCS process, during these the recent years. The methods adopted for data collection were the tools like questionnaire schedules, interview, observation, FGD and in depth case studies. Almost 86% of these Leprosy afflicted persons (LAPs) were very satisfied due to improvement in acceptance by their family, friend, relatives and society after surgery because of the correction of deformity by RCS as it enabled them to get back into normal life. The economical status improved in 8/60 (13%) after RCS, some becoming capable of earning more than Rs. 10,000/- per month after RCS. To conclude, in this settings of Sonepur (Odisha). RCS appeared to help the LAPs in improving their social acceptance thereby reducing stigma and also improving their economic status thus empowering them to lead their life as a normal human beings. There is need to enlarge and expand these studies to other parts of state/region so that the link with beliefs, type of disabilities and also type of surgery could be better understood and the knowledge generated could be applied to get optimum results.

Atypical manifestations are not rare in leprosy and they may present diagnostic challenges. We report a series of five cases having atypical presentations. First case presented with an asymptomatic buccal lesion and later developed skin lesions. Second patient had secondary Anti-phosphospholipidsyndrome (APS) due to leprosy. We also report another interesting case of annular vesiculobullous lesions and erythema nodosumleprosum (ENL) following intake of antibiotics for pneumonia. Other two had exacerbation reactions (ER). Two of these patients were had irregular/incompleteanti-leprosy treatment earlier., These profiles will be of interest to clinicians who may encounter cases with such manifestations.

This study has been carried out to assess the comparative efficacy of Prednisolone alone or thalidomide alone for the first attack of T2R, and combination of prednisolone plus thalidomide or prednisolone plus clofazimine for chronic and recurrent T2R. Efficacy of all four regimens was assessed on the basis of clinical recovery of T2R measured by reaction severity scores (RSS) ,visual analogue scale (VAS) and other relevant parameters, requirement of extra dose of steroid for clinical recovery, recurrence of T2R and side effects observed in each regimen. The designof study was an open prospective longitudinal single centre investigation. In the first episode T2R group I (prednisolone alone) the efficacy was 58.8% (10/17) compared to 93.75% (15/16) in Group 2 treated with thalidomide alone. This difference was statistically significant p <0.05 when compared using unpaired ttest. When clinical outcome was compared in recurrent/relapse of T2R Groups 3 and 4, it was observed to be statistically significant p<0.05 when compared using unpaired t test. It was 82.35% (14/17) in Group 3 (prednisolone plus clofazimine) and 10/16 (62.5%) in Group 4 (prednislone plus clofazimine). To conclude, for the management of recurrent/chronic ENL, both the combinations-prednisolone with thalidomide or clofazimine appear to be efficacious. While prednisolone with thalidomide appears to be better than prednisolone and clofazimine, however, by 20 weeks difference narrows down. As of now these findings may be considered indicative and larger experience on more number of cases using robust statistical design is required for marchingtowards making recommendations for clinical application.

Leprosy is an infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. In the last stage it can afflict the skeleton with a series of specific and non-specific bone changes. The possibility of studyingthe skeleton of an individual who lived in the pre-antibiotic era (Roman period) with skeletal changes in the rhino-maxillary region and hand and foot bones, permitted skeletal lesions to be analyzed directly. In addition, the localization and the complexity of the bony lesions could be attributed to the presence of leprosy. The importance of this approach was the possibility to verify the nature and typology of the primary and secondary bone changes in leprosy in absence of clinical therapy.

Multi Drug Therapy (MDT) is the main weapon against leprosy since its inception in 1981. India achieved the level of elimination (< 1 case/10,000) on 31st December 2005. It has been proved in few studies that despite 2 years of regular therapy 10% of the patients continue to harbour viable persisters. There are many problems related with FD-MDT. Many cases have residual disease activity after completion of treatment. Aims of the present study was to study the profile of RFT cases in leprosy treated with FD-MDT, who required extended MDT, duration between completion of FD -MDT and clinical presentation, Acid Fast Bacilli (AFB) status, histopathology and type of leprosy at the time of presentation. A prospective study of 35 RFT (Released FromTreatment) cases with signs of activity were recruited in period betveen May 2007 to November 2001. All cases were diagnosed clinically and investigations were done for AFB smear, histopathological examination and Fite Faraco staining. We found that all the 35 cases, which required extended MDT, age group ranged from 10 to 65 years. Majority (71.4%) had taken previous Multi-Bacillary (MB) treatment for 1 year duration. Eleven (31.42%) of cases came within one year, 17 (48.57%) between one to two years and 7 (20%) cases after two years of stopping FD-MDT. AFB smear was positive in 36.84% of cases in which done. Majority of previously diagnosed MB cases presented as BT/TT in histopathology. Thus there is need to search for reliable prognostic markers for therapeutic purposes.