Indian journal of leprosy最新文献

Leprosy as a social disease has been a major public health problem because of the social stigma and ignorance attached to it. This has made it difficult for our health care delivery system in their pursuit for early diagnosis and prompt treatment. This study was done with the objective of assessing the present knowledge, attitude and practice of leprosy affected persons and their family members in a rural setting. This cross sectional study was conducted by using a pre tested, structured questionnaire among 100 registered Leprosy patients and 100 adult members of patient's family in Thiruvallur district of Tamil Nadu. Data collected was analyzed and results were summarized in percentages and presented in tables. About 32% of the patients and 37% of family members were aware that leprosy is caused by a germ. Skin patches and loss of sensation as symptoms of Leprosy were known to 55% of patients and 73% of the family members. 84% of Patients and 64% family members said that leprosy was curable. About 90% of the patients and 82% of the family members stated that deformities can be prevented by early and regular treatment. The patients showed a negative attitude after contracting the disease. Most of the family members (73%) did not share articles used by patients. 91% of the family members felt leprosy patients can be employable. About 45% the family members opined that a cured leprosy patient can marry. About 90% of the patients participated in social functions and 64% didn't hesitate to take food along with others. All family members were found to be willing to support their leprosy affected relatives. This study revealed inconsistency and deficiencies in the knowledge, attitude and practice among the leprosy affected patients and their family members. The patients and family members had adequate average level of knowledge about leprosy, but their attitude toward the disease and their practices were not adequately favorable.

A 46 year old male diagnosed case of Acquired Immune Deficiency Syndrome (AIDS) on Highly Active Anti Retroviral Therapy (HAART) presented with raised nodular skin lesions of two months duration which on skin biopsy was diagnosed as Histoid leprosy. Individual was put on standard Multi Bacillary Multi Drug Therapy (MB MDT) for two months has shown exacerbation of lesion and was later put on daily Rifampicin, Ofloxacin and Minocycline (ROM) for which he responded. Interesting feature is rarity of association of HIV with Histoid Leprosy where the patient did not respond to the conventional MB MDT and later responded to daily ROM.

Histological changes suggestive of leprosy in clinically normal skin have been well documented in the lepromatous spectrum and rarely in the tuberculoid spectrum of the disease. This study attempts to evaluate the histology of clinically normal appearing skin in cases of borderline tuberculoid and tuberculoid leprosy. Biopsies from lesional and a clinically normal appearing skin from newly diagnosed patients with BT or TT leprosy seen in the outpatient department over a period of one year were evaluated by a blinded pathologist. Sixty five patients were included in the study. Six patients had granulomas in the normal skin, six others showed a histological pattern consistent with indeterminate leprosy in the biopsies taken from normal skin. The clinicians must be aware that a small percentage of cases in the TT spectrum also have involvement of normal appearing skin. These patients are at a high risk of under-treatment and may be a cause for paucibacillary relapse. This is a pilot study and a larger sample size is recommended to evaluate the real scenario.

Peripheral nerve involvement results in deformities formation in leprosy. High doses of (40-60 mg) steroids along with the anti-leprosy drugs is preferred even though the 70-75% cases develop deformity with the above treatment. 772 ulnar nerves, 120 median nerves and 108 posterior tibial nerves not responding to above medical treatment in 12 weeks, were undertaken for external and internal nerve trunk decompression. These cases were followed-up for 5-20 years at various intervals. The pain in nerves (neuritis) recovered in all cases of ulnar, median and posterior tibial nerves. Full sensory recovery with pin prick/feather or cotton wool touch was seen in 50% cases of all the three nerves. 20% cases maintain the pre-operative levels of sensory status. Plantar ulcers healed within 6 months after decompression of posterior tibial nerve. Only 6 cases showed reoccurrence. Overall motor recovery in ulnar nerve was seen 89% and 70% in median nerve. The sensory recovery restores protective sensation which prevents secondary injuries. The improvement of motor power gave better functional hands and improved the appearance which in absence of surgical intervention was not possible.

Present descriptive study was carried out for the assessment of hearing capability in leprosy patients. After getting approval from Institutional ethical committee, the present descriptive study was carried out on 60 subjects. All the patients were indoor-patients at the Leprosy Rehabilitation Center Maharogi Sewa Samiti Anandvan Warora, and were on multidrug therapy described by World Health Organization from an average period of 6 months. Study Group I consisted of 30 diagnosed Leprosy patients taking multidrug therapy from an average period of 6 months. Group II (Control group) consisted of 30 normal healthy individuals of same age. Patients suffering from acute or chronic ear discharge, Presence of wax in external auditory canal, diabetes mellitus, hypertension, impaired renal function and patients having history of trauma were excluded from the study. All the subjects underwent Pure tone audiometry, Tuning Fork test to check the level of hearing loss and type of hearing loss and detailed clinical examination for cranial nerve function was done in all the patients of study group and control group. Audiometry findings in study group patients showed that 23 patients (76.66%; 45 ears) of the leprosy patients had sensory neural hearing impairment and 7 patients (23.33%) showed normal hearing. Out of these affected patients, 10 patients (43.47%; 19 ears) had mild sensory neural hearing impairment, 10 patients (43.47%; 20 ears) had moderate sensory neural hearing impairment. 2 patients (8.69%; 04 ears) had moderate to severe hearing impairment, 1 patient (4.34%; 02 ears) showed severe sensory neural hearing impairment. In the absence of any local or systemic disease or drugs likely to have side effects on the cochleovestibular function, leprosy affects the cochleovestibular system, and effect on cochlear function is seen more often than effect on the vestibular system. Thus hearing loss which is seen in patients suffering from Hansen's disease is of cochlear origin.

Diagnosing and classifying leprosy solely on the basis of skin lesions as per WHO operational classification may lead to over or under diagnosis and inadequate treatment particularly of pauci-lesional multibacillary cases with consequent risk of resistance, relapse and progressive horizontal transmission. Announcing elimination of leprosy as public health problem in India under NLEP was probably ambitious aspiration. However, such a strategy is perhaps not justified scientifically at the moment in view of new case detection rate not showing significant decline. The fact remains that it is still highly desirable to provide sustained quality leprosy services to all individuals through general health services and good referral system. Being nearly of 100% specificity when performed expertly, slit-skin smear remains the simplest diagnostic technique available until new cutting-edge diagnostic tools become available for routine bedside use. However, the interest has been declining for learning this simple test among all the persons involved in leprosy work even in the teaching/training institutes. This is perhaps due to confusion over number and sites of smears, and its declining usefulness in WHO recommendations/guidelines. Various technical aspects of slit-skin smear testing are reviewed here keeping in view the need of leprosy workers in referral/teaching institutes.

This a retrospective analysis of the changes in 646 disabilities occurred amongst 3979 cases registered during 19 years from 1992 to 2010 in Malkangiri district. This amounted to 16.2% of cases with disability segregated to 310 (48%) Grade 1 and 336 (52%) Grade 2. In this project, managed by LEPRA India, POD care was in practice from the year 1992 and records were updated regularly. An analysis of the annual records showed that the next year-end balance increased up to the year 2001 followed by gradual decline. Within this period the total cases with disabilities declined by about 369 (57%) due to death by aging 204 (55%), migration from the area 77 (21%) and reversing to normal 88 (24%) in cases. Deletion due to recovery to normal especially with sensory impairment is fairly good with or without steroid. Disability percentage in new cases declined steadily especially Grade 2 from 30% to 1%, initial high rate attributed mostly to backlog cases. In later years the rate is erratic high amongst low number of new cases. Absolute number indicates the situation better. Such study helps to roughly extrapolate the existing disability load in a particular area and assists in planning for care and prevention.

Leprosy is characterized by a long and variable incubation period and a chronic clinical course. Diagnosis of leprosy is essentially based on clinical features. Although the majority of cases can be diagnosed clinically yet alternative methods for diagnosis are required especially for early cases. Immunocytochemistry and in situ hybridization can be a valuable tool for diagnosis for early cases. The present study is aimed to assess the diagnostic value of immunocytochemistry and in situ hybridization in cytological specimens and to compare these techniques with Z.N. staining. This prospective study was carried out in 26 patients below 18 years of age of leprosy. Clinical examination of each patient was done and categorized according to IAL. After taking consent, three skin smears was taken, one for Z.N. staining and remaining two for immunocytochemistry and in situ hybridization respectively. Routine skin smear examination by Z.N. staining method confirmed the diagnosis in 4/26 (15.83%) and these belonged to BB, BL category. Immunocytochemistry showed positivity in 10/15 (66.6%) in BT and 72.7% in BB/BL leprosy. Immunocytochemistry improved the diagnosis by 53.85%, and the results were statistically significant (p < 0.01). In situ hybridization showed the positive results in 80% cases of BT leprosy and 90.9% cases of BB/BL leprosy. In situ hybridization improved the diagnosis by 70% in comparison to ZN staining and the results were statistically significant (p < 0.01). This study supports that immunocytochemistry and in situ hybridization enhance the diagnosis of leprosy when compared to routine skin smears stained by Z.N staining. They are important diagnostictoolsfor definitive diagnosis in early as well as established cases of leprosy.