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PubMedDate not supplied

Multidrug therapy--the pathway for global leprosy elimination.

Introduction of dapsone therapy paved the way for better and more humanitarian way of dealing with the leprosy victims who, prior to 1943, were simply rejected and segregated from society. Emergence of dapsone-resistant M. leprae and mycobacterial persistence provoked our quest for another solution. More drugs were discovered for treatment of leprosy. But the real breakthrough was the recommendation of regimens of multidrug therapy (MDT) for the treatment of leprosy by the WHO Study Group on Chemotherapy of Leprosy in October 1981. Subsequent world wide development of leprosy control activities was phenomenal. The impact of MDT has led to the cure of over eight million leprosy sufferers and the saving of one million patients from becoming crippled. Leprosy prevalence has decreased by 80% in ten years. By the end of May 1999 the leprosy burden remained concentrated in only 12 countries of the world. These achievements are mainly attributed to the development and worldwide adoption of the MDT programme.

Drug Therapy, Combination↗
PubMed2003

Leprosy in China: epidemiological trends between 1949 and 1998.

OBJECTIVE: To report the epidemiological trends of leprosy in China from 1949 to 1998. METHOD: Data for the study were obtained from the computerized database of the National System of Leprosy Surveillance. FINDINGS: A total of 474,774 leprosy patients were detected during this 50-year period. Case detection rates per 100,000 population were highest in the 1950s and 1960s, with peaks appearing in 1957-58, 1963-66, 1969-70, and 1983-84, corresponding to mass surveys or screening surveys carried out in most areas or selected areas of the country. While the duration of the disease at the time of detection fell over the period, the disability rates, which were > 50% in the early 1950s, have decreased gradually to 20.8% by 1997-98 but are still too high. More than 50% of cases were found through active methods in the periods 1955-58, 1965-66, and 1969-76, but in recent years cases are mostly detected through dermatological clinics or by voluntary reporting. The peak prevalences of the 1960s (i.e. > 2 per 10,000 population) decreased annually from the 1970s onwards. By the end of 1998 the prevalence was 0.05 per 10,000 population. CONCLUSIONS: This study shows that leprosy was well controlled in China and that the WHO goal of elimination of leprosy as a public health problem has been achieved at the national and subnational levels. However, leprosy is still unevenly distributed in the country. According to the criterion for leprosy elimination in China--defined as a prevalence of < 1 per 100,000 in county or city--there are still more than 10% of counties or cities where this target has not yet been reached. Special attention must therefore be given to achieve elimination and final eradication of leprosy in China.

China↗
PubMedDate not supplied

Is soil an alternative source of leprosy infection?

Leprosy is believed to be transmitted only through human contacts. However, many anomalous observations had gradually accumulated which had weakened such beliefs. These are: only 1/3 rd cases of leprosy give a definite history of being transmitted from other known cases; life-long spouses, in whom only one has leprosy, seldom lead to leprosy to others; while MDT applied intensively in most leprosy endemic countries, could successfully reduce incidence of leprosy, however, simultaneously new cases arise unabated. Besides, a close look at animal leprosies also suggested a mode of transmission other than human-type contact. Thus, a search for alternative hypothesis led to the findings that leprosy bacillus (LB) could be a soil chemoautotroph and could facultatively live both in the human body and the soil which could serve as an alternative source of infection. Evaluation of accumulated evidences points to this possibility.

Adult↗
PubMed2002

Childhood leprosy in an urban clinic, Hyderabad, India: clinical presentation and the role of household contacts.

A retrospective case note study was done of children below the age of 14 years who attended Dhoolpet Leprosy Research Centre (DLRC) over the decade 1990-1999. The aim of the study was to describe the pattern of clinical presentation, the role of household or near neighbour contacts and the incidence of neuritis and reactions. In all, 3118 leprosy patients were registered during this period, of whom 306 were children [182 (60%) male]; 95 children had a single patch, 159 had five or fewer than five patches and 37 had multiple patches. The youngest case detected was 9 months old. The spectrum of leprosy in these children was: TT 62 (20.3%); BT 203 (66.3%); BB 3 (1%); BL 23 (7.5%); LL 5 (1.6%) and PNL 10 (3.3%). Twenty-nine cases (9.4%) were smear positive. Ninety-one children (29.7%) developed a reaction, 86 type I and five type II. A history of contact was present in 119 (38.8%) cases, family contact in 113 (95%) and other than family in six (5%). Classification of the contact was available in only 60 patients. Among the contacts of the index case, 21 (35%) suffered from PB leprosy and 39 (65%) from MB leprosy. All contacts were from the immediate family. This study shows that childhood leprosy cases continue to present in significant numbers to this outpatient clinic. There is a high level of family contact with leprosy in these cases, strengthening the strategy of screening children in leprosy-affected households. The high incidence of reactions and nerve damage in children emphasizes the importance of early detection and treatment.

Adolescent↗
PubMed2002

Anti-leprosy protective vaccination of rhesus monkeys with BCG or BCG plus heat-killed Mycobacterium leprae: lepromin skin test results.

Groups of rhesus monkeys (RM) were vaccinated and boosted with living Mycobacterium bovis Bacillus Calmette-Guerin (BCG) or BCG + low dose (LD) heat-killed Mycobacterium leprae (HKML) or high dose (HD) HKML or were unvaccinated. Animals vaccinated with BCG + LD and HD HKML were lepromin skin tested 2 weeks after boosting. All groups were lepromin tested 37 and 46 months after challenge with live M. leprae. Fernandez (72 h) and Mitsuda (28 day) responses were recorded. Ten of 10 rhesus monkeys in each of the two BCG + HKML-vaccinated groups significantly converted to strong positive Fernandez status within 2 weeks of boosting, compared to one of six positives in the unvaccinated unchallenged normal control group. Both BCG + HKML groups were significantly protected from clinical leprosy. Six of 10 in each of the two BCG + HKML groups significantly converted to Mitsuda positivity within 2 weeks of boosting compared to zero of six in the normal control group. The sizes of the Mitsuda responses were larger in the LD group than the HD HKML vaccinated/boosted group, suggesting suppression by vaccination with higher doses of HKML in combination with BCG. Fernandez responses were negative in normal RM as well as in the unvaccinated, ML-challenged group and the BCG-vaccinated, ML-challenged group at 37 or 46 months after ML inoculation, although the BCG-vaccinated group was significantly protected from leprosy and the unvaccinated group was not. In contrast, at 37 months the Fernandez reaction was positive in the BCG plus LD and the BCG plus HD HKML-vaccinated groups, both of which were significantly protected from clinical leprosy. By 46 months, the Fernandez responses were below significance in all groups. Thus, Fernandez reactivity is not a reliable correlate to protection from experimental leprosy in RM. Mitsuda responses became strongly positive in all four ML-challenged groups by 37 months and remained strongly positive at 46 months after ML inoculation, suggesting that strong Mitsuda reactivity reflects responses to living ML. BCG or BCG + LD or HD HKML vaccination/boosting of RM produced significant clinical protection from leprosy and there was a good correlation between protection from LL forms of leprosy and positive Mitsuda skin test responses after challenge with live ML. Positive Mitsuda responses were generated in essentially all individuals after challenge with live ML, and this response was primed by prior vaccination/boosting with BCG + HKML as shown by conversion to positivity 2 weeks after boosting. The data show that resistance to clinical leprosy is reflected by Mitsuda responses in ML-exposed RM, similar to results from human studies, and confirm the suitability of RM as a model for leprosy vaccine studies.

Animals↗
PubMed2002

A comparison of Rapid Village Survey and Leprosy Elimination Campaign, detection methods in two districts of East Java, Indonesia, 1997/1998 and 1999/2000.

A Rapid Village Survey (RVS) was planned to estimate the extent of the leprosy problem in two well documented endemic districts of East Java, Indonesia. Furthermore, the aim was to investigate the efficacy of the routine programme in detecting new and early cases, as well as the feasibility of RVS in detecting disabled people affected by leprosy in the community. A random sample survey (RVS: a simple method compared to a Population Sample) was used to determine the extent of the leprosy problem. In addition, a Leprosy Elimination Campaign (LEC), was used particularly to detect new and backlog cases in the community. Both RVS and LEC involve a health education campaign followed by the examination of persons voluntarily reporting. Routine programme case finding, involving passive case finding and contact examinations, was also carried out. The RVS prevalence rate of 12 per 10,000 was more than twice the known prevalence rate of 5 per 10,000. The LEC prevalence rate was less than the rate found by RVS, but was within the RVS confidence interval. During the RVS, many children with leprosy were detected, and 10% of all RVS new cases already had disability grade II. The population disability grade II rate due to leprosy was 9 per 10,000. Despite the fact that an active leprosy control programme had been carried out in the surveyed endemic area over a period of many years, the actual prevalence rate found was more than twice the known prevalence. Many children were found during the RVS, thus indicating continuing widespread transmission. In general, it seems that there is still a serious delay in detecting new cases under the routine programme. Consequently, there are substantial numbers of persons affected by leprosy in those districts in need of rehabilitation.

Adult↗
PubMed2002

[Systematic search for parasites among leprosy patients in Mali].

Practice of multidrug therapy in leprosy (combination Dapsone + Rifampicine + Clofazimine) established since 1981, has significantly reduced the incidence of the disease. However, immunosuppression due to treatment of multi-drugs therapy induced adverse reactions with glucocorticoid and the change in host immune response due to the leprosy itself, might increase the risk of parasitic infections. To test this hypothesis, we carried out a case-control study at the "Institut Marchoux" in Bamako. Stool and urine samples from all patients included in the study were examined for parasites identification. In addition, we performed thick and thin blood film to identify malaria infection and skin biopsy (snip) to detect onchocerciasis. A total of 121 cases of leprosy and 219 controls aged 10-84 years old were included in the study from March 1999 to February 2000. Sixty two percent (n = 121) of cases were treated with glucocorticoid. The prevalence of infection due to Entamoeba coli and Entamoeba histolytica were higher in cases than in controls (p = 0.02). The prevalence of infection due to hookworms was higher in cases than in controls. There was no difference of the infections to the other intestinal parasites. Three cases of cryptosporidiosis and one case of isosporosis were observed in leprosy group vs none in the control group. There was no significant difference between cases and controls with regard to prevalence of Schistosoma haematobium, Trichomonas vaginalis and Onchocera volvulus. The prevalence of Plasmodium falciparum was 4.9% (6/121) in the leprosy case and 7.8% (17/219) in the control group. In conclusion, despite the corticotherapy and immunosuppression due to leprosy, there was no difference in prevalence of pathogenic parasites. Entomoeba coli, Entamoeba histolytica which have significantly higher prevalence among the cases were not pathogen therefore there was no higher risk of severe intestinal parasitosis among the cases of leprosy. Treatment with glycocorticoid in patients with leprosy did not suggest any impact on the prevalence of this parasitic infections. In addition, multidrug therapy did not show any effect on the carriage of Plasmodium falciparum.

Adolescent↗
PubMedDate not supplied

Knowledge and practice of eye-care among leprosy patients.

In one hundred and thirty leprosy patients attending the Schieffelin Leprosy Research and Training Center, Karigiri, Tamil Nadu, India, the knowledge, attitude and practice of eye-care were ascertained using a questionnaire developed by Mathews & Mangalam. 74.6% the patients surveyed were aware of the disease, 60% knew about the early signs of leprosy, 74.6% considered leprosy curable and 36.9% knew the duration of treatment with MDT. Less than half of the patients (40.8%) knew that blindness occurred in leprosy and was preventable. More males had this knowledge (46.5%) than females (22.6%) (P = 0.001). Knowledge on how to take care of the eyes (26.9%), that eyes become anaesthetic due to leprosy (27.7%), and that precautions should be taken if sensation is lost (27. 7%) was very poor. Knowledge on prevention of damage in eyes (57.7%) and the fact that rubbing eyes could cause damage (55.4%) was found in more than half the patients. More males (64.6%) had knowledge on the prevention of damage in eyes than females (35.5%) (P = 0.008). Only 25.4% of the patients tried some measures to prevent eye injury, 21.5% used home remedies and all had the help of family members in their eye-care. More males (26.3%) used home remedies than females (6.5%). The older age group had better knowledge on taking care of the eyes than those aged 40 and below (P = 0.026). Although more patients with existing complications knew to take care of their eyes than those who did not have complications, the knowledge and practice of eye-care in both these groups were poor. Knowledge of leprosy in illiterate patients was not different from those who had some formal schooling, but the practice of eye-care differed significantly (P = 0.02). Health education must be undertaken to increase the knowledge of eye-care among leprosy patients, especially among illiterate persons, women and younger patients.

Adolescent↗
PubMed2003

Ocular complications in incident relapsed borderline lepromatous and lepromatous leprosy patients in south India.

PURPOSE: To determine the magnitude of ocular complications that present in incident cases of relapsed borderline lepromatous (BL) and lepromatous leprosy (LL) patients. METHOD: From 1991 to 1997, all new BL and LL patients who had relapsed from an earlier disease, detected by active case finding in the geographically defined area of Gudiyattam taluk, were invited for ocular examination after their leprosy status was confirmed clinically and histopathologically. RESULTS: Sixty relapsed lepromatous patients, 45 male and 15 females, were examined. Fifty-two patients had relapsed after receiving only dapsone mono-therapy, 4 after receiving paucibacillary multi-drug therapy (PB-MDT) preceded by dapsone mono-therapy and 4 after only PB-MDT. Three (5%) patients had lagophthalmos, 1 (1.6%) patients each had ectropion and trichiasis, 32 (53%) patients had impaired corneal sensation in both eyes, 2 (3.3%) patients each had corneal opacity (associated with reduced vision), corneal nerve beading, punctate keratitis, keratic precipitates, and iris atrophy, 4 (6.6%) patients had cataract associated with decreased vision, 1 (1.6%) patient had blocked naso-lacrimal duct and 13 (21.7%) patients had pterygium. Seven (12%) patients had a visual acuity of 6/18 or less, 4 (6.7%) patients had 6/60 or less and one patients had vision below 3/60. General ocular complications rather than leprosy-related ocular complications were responsible for reduced vision. Lagophthalmos was associated with increased duration of the disease (P = 0.009), Grade II deformity (P = 0.001), punctate keratitis (P < 0.001) and cataract (P < 0.001). Beaded corneal nerves were associated with lepromatous leprosy (P < 0.001) and high mycobacterial infection (P = 0.05). Patients whose initial disease was categorised as BL and LL had greater impairment of vision (P = 0.037), more iris atrophy (P = 0.013), increased keratic precipitates (P = 0.013) and more corneal nerve beading (P = 0.013), when compared with the group comprising Tuberculoid-tuberculoid (TT), Borderline-tuberculoid (BT) and Intermediate (IND). CONCLUSION: This first report on ocular complications in relapsed lepromatous patients demonstrates that general and leprosy-related ocular complications occur in these patients. However, they are not in excess of those reported in other leprosy groups. Borderline and lepromatous leprosy patients tend to have had more ocular complications than patients with tuberculoid leprosy.

Adult↗
PubMed1992

Treated-cured indeterminate leprosy: a search for predictive histopathological and immunohistochemical parameters in skin biopsies taken from patients at admission and at clinical discharge.

In a previous study an index (sigma 3) resulting from the summation of three parameters, i.e., presence of bacilli, even in small numbers, in various dermal structures, multiple positive antigen sites as detected by anti-BCG antiserum and dermal nerve involvement, identified 72.22% of cases of indeterminate leprosy which progressed to multibacillary leprosy. The present study was undertaken to investigate possible parameters which might be indicative of indeterminate leprosy which would persist unchanged or be cured (treated cured patients). Thirty treated cured indeterminate leprosy patients were selected from the files of the São Paulo Health Institute and studied by histopathological, immunohistochemical and statistical methods similar to those employed in the previous study. The sigma 3 index was 4.10 +/- 0.60, a finding that places this group of patients in a position close to that of patients changing to paucibacillary leprosy but statistically different from that of patients progressing to multibacillary leprosy. Moreover, it was found that patients belonging to this group have heterogeneous single parameters, some of them suggestive of multibacillary and others of paucibacillary leprosy. Immunologically based techniques mainly employing rabbit anti-BCG serum as the primary antibody have proved to be valuable to detect antigen sites in biopsies from indeterminate leprosy patients and should be used together with the bacillary index during the follow up and clinical discharge control of such patients. In the present study, we show that clinical discharge of these patients did not mean a complete clearance of bacillary antigens.

Academies and Institutes↗
PubMed2004

Leprosy in Toronto: an analysis of 184 imported cases.

BACKGROUND: Leprosy is a rare but serious mycobacterial infection. Immigration from areas where the disease is endemic has resulted in the importation of leprosy into countries where it is not endemic and where physicians and health care workers have little or no experience in diagnosis and therapy. In this study we characterized leprosy patients seen in a tropical disease unit that manages most of the reported leprosy cases in Canada. METHODS: We reviewed the clinical records of all 184 leprosy patients who were referred to the Tropical Disease Unit at Toronto General Hospital between 1979 and 2002 and abstracted demographic and clinical information. RESULTS: Patients were more likely to be male (122 or 66.3%) and of Indian (44 or 23.9%), Filipino (49 or 26.6%) or Vietnamese (37 or 20.1%) origin. Patients experienced symptoms for a mean of 4.8 years before referral to the Tropical Disease Unit. Most had no family history of leprosy (152/172 or 88.4%). Most patients presented with either borderline tuberculoid (80 or 43.5%) or borderline lepromatous (37 or 20.1%) disease. On average, patients presented with 5.8 skin lesions. Upper- and lower-extremity nerve dysfunction was common at presentation, with up to one-third of patients demonstrating either sensory or motor loss. A significantly greater lag time to presentation was observed in patients who emigrated from low-prevalence regions (p < 0.001). INTERPRETATION: Leprosy is a chronic infectious disease that is associated with serious morbidity if left untreated. Leprosy is uncommon in developed countries, but it is important for physicians to have a high index of suspicion when a foreign-born patient presents with chronic dermatitis and peripheral nerve involvement.

Adult↗
PubMed2003

[Generalized adenopathy as a manifestation of type 2 reactional leprosy].

Generalized adenopathy as a manifestation of type 2 reactional leprosy Leprosy patient's reactions are severe clinical manifestations of acute inflammation of chronic lesions, capable of producing irreversible and invalidating damage. We studied a 46 year-old man with a type 2 leprosy reaction, who presented fever, cutaneous nodules, nasal obstruction and generalized adenopathy. The hemogram showed leucocytosis with neutrophilia. None of the initial diagnoses included leprosy. A lymph node biopsy revealed extensive necrotic areas infiltrated with polymorphonuclear lymphocytes, and foamy macrophages. Eosinophylic necrosis and thrombosis of venules with lymphoid nodule depletion was also in evidence. Ziehl Neelsen stain was not done, but the Gomori stain clearly showed Hansen's bacilli. These were were not detected by the pathologist and therefore a final diagnosis was not provided. Twenty months later, the patient presented similar symptoms, but with more generalized lymphadenopathy and presence of cutaneous nodules. Nodule biopsy showed lepromatous leprosy with erythema nodusum leprosum or type 2 reaction. Polychemotherapy treatment and anti-reaction treatment with thalidomide cured the patient. No sequelae were noted in 3 years following the treatment. A literature review of the type 2 reaction in leprosy is provided, including discussion of risk factors, histopathology, differential diagnosis for leprosy adenopathy, pathogenesis, prognosis, and treatment. Type 2 leprosy must be treated immediately upon diagnosis as it can cause serious and permanent tissue damage. As had occurred in the above patient, the disease can proceed with generalized and symptomatic lymphadenopathy.

Diagnosis, Differential↗
PubMed2004

HLA associations in leprosy patients from Mumbai, India.

Genetic predisposition to both disease susceptibility and to host immune response has been postulated. In India, about 64% of leprosy prevalence and 78% of new case detection of the worlds estimated 719,330 cases occur. Convincing results have been reported from studies on HLA class II association in leprosy. However data on HLA class I association are limited and inconsistent. The HLA A, B and C allele distribution in 103 leprosy patients and 101 normal healthy control individuals were studied by microlymphocytotoxicity assay. Further 32 multibacillary leprosy patients along with the 67 controls were studied by molecular high-resolution PCR-SSOP technique. The significant results from the present study were: 1) serologically, a significant increase in HLA A2, A11, B40 and Cw7, while a decrease of A28, B12, B15 and Cw3 were observed among the leprosy patients when compared with the controls; 2) molecular subtyping in multibacillary leprosy patients revealed a significant increase in frequency of HLA A*0203, A*0206, A*1102, B*1801, B*4016, B*5110, Cw*0407 and Cw*0703 while a decrease in the frequency of HLA A*0101, A*0211, B*4006, Cw*03031, Cw*04011 and Cw*0602 leprosy patients was observed when compared with the controls; 3) further haplotypes A*1102-B*4006-Cw*1502; A*0203-B*4016-Cw*0703; A*11-B*40 was significantly increased among the multibacillary leprosy patients when compared with the controls. It seems that HLA class I alleles play vital roles in disease association/pathogenesis.

Alleles↗
PubMedDate not supplied

"Instant" new leprosy case-detection: an experience in Bihar State in India.

The National Leprosy Eradication Programme (NLEP) is based on survey, education and treatment, including coverage of all the registered cases with multi-drug therapy (MDT). The Government of India introduced MDT in all leprosy endemic districts through a vertical set-up, and through mobile leprosy treatment units in low endemic districts. Anti-leprosy work has not been uniform in all the states and needed push-start in some, such as Bihar. There have been spurts of leprosy elimination activities and the entire populations of the regions have not been covered because of various administrative reasons and logistic problems. In Singhbhum district of Bihar, a successful attempt was made to cover the maximum population by campaign approach. The strategy was to involve all the field workers of the leprosy programme in the district, supported by a small group of experienced personnel. The campaign, lasting for 39 working days, resulted in detecting leprosy cases equivalent to 64% of cases detected during the previous one full year. The entire operation helped the local staff to gain experience that would be useful for the future of the NLEP, and also provide an insight into working practices. Similar campaign approach can be used in situations where case-detection activities are feeble and the implementation of MDT is slow. If such campaigns are repeated at appropriate intervals, it will be a great support to achieving the goal of leprosy elimination.

Community Health Workers↗
PubMedDate not supplied

Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers.

Integration of the vertical leprosy programme into the existing horizontal health programme poses various administrative and operational challenges to programmers. In order to understand the preparedness of the PHC workers for integration of leprosy into primary health care services, 71 PHC workers were interviewed using a structured interview schedule. The results showed that about 42% of the staff have heard of the concept of integration earlier and 90% of the PHC staff are willing to treat leprosy patients in the primary health care centre, but only 72% were in favour of integration. The reasons for favouring integration were (1) wider coverage with MDT, (2) frequent field visits by the worker, (3) better rapport with the community, (4) timely treatment and (5) cost-effectiveness. About 28% of the staff members did not favour integration for the reasons that the leprosy programme would suffer, targets cannot be met, supervision would be difficult, knowledge of the staff was inadequate and importance cannot be given to leprosy as family planning is always a priority in PHC centres. About 43% of the staff felt that the performance of the leprosy programme would be better after integration. With regard to workload, 60% of the sample felt that there would be increase in the workload in the field, record maintenance and supervision. The difficulties foreseen by the workers were grouped into 6 categories, viz., administrative, managerial, technical, personnel, social and miscellaneous. It is worth noting that 91% of the staff that included all categories said they were not afraid of leprosy, but needed training in leprosy work. About 50% of the staff expected increase in salaries and promotions if integration took place.

Attitude of Health Personnel↗
PubMedDate not supplied

End-stage renal disease in leprosy.

BACKGROUND: Leprosy or Hansen's disease (HAD) undoubtedly remains an emergency in certain countries. It is an ancient deforming disease caused by Mycobacterium leprae. The countries with the highest endemic leprosy rate in 2000 were Brazil, India and Madagascar. In Italy, the old epidemic has been defeated and there are approximately 400 patients under constant monitoring with three to four new cases per year involving Italian residents. The kidney is one of the target organs during the splanchnic localization of leprosy. The histopathological renal lesion spectrum includes glomerulonephritis (GN), renal amyloidosis (RA) and interstitial nephritis (IN). Both proteinuria and chronic renal failure are the main clinical expressions of renal damage in leprosy. To the best of our knowledge, very little is reported concerning end-stage renal disease (ESRD) in leprosy patients both in the most important national and international renal registries and in the available literature. This study aimed to report the long-term experience of our department in this field. METHODS: To achieve this, we analyzed retrospectively the HAD Center (Gioia del Colle) database at ourhospital. RESULTS: Eight leprosy patients were dialyzed from 1980 to June 2003 (six males and two females), with a mean age of 61.0+/-8.9 SD yrs (range: 51-76) and a mean HAD duration of 36.1+/-5.1 yrs. The first clinical nephropathymanifestations were non-nephrotic proteinuria associated with chronic renal failure in four patients, and nephrotic proteinuria in four patients. Kidney biopsies performed in three patients showed two had RA, and one had IN. Two patients were treated initially by peritoneal dialysis; they were then switched to hemodialysis (HD) after 3 and 10 months because of recurrent peritonitis. HD treatment lasted 40.6+/-31.4 months (range: 9-101). Six patients died, one due to hyperkalemia, one because of a technical dialysis accident, and the remainder due to causes unrelated to the dialysis treatment. Two patients are still alive, treated with HD for 17 and 44 months. CONCLUSIONS: Uremia represents a late complication of leprosy and has a multifactorial genesis, although RA is among the most frequent causes, conventional bicarbonate HD appears to offer good results in the treatment of uremia in leprosy patients.

Aged↗
PubMed2004

[Psychiatric disorders and disability among leprosy patients; a review].

As a gross estimate, leprosy currently affects 11-16 million patients worldwide There are currently 3600 registered patients in Turkey. The social stigma connected to leprosy makes this disease completely different from others. Even nowadays people affected by leprosy have to leave their village or are socially isolated. The physical deformity ratio is approximately 25% in other countries whereas it is more than half in Turkey. The prevalence of mental disorders among leprosy patients is higher than that among the general population. Depression is the most common psychiatric disorder among leprosy patients. Another important finding is that the long duration of the illness and physical handicaps raise the risk of psychiatric disorders. Nevertheless, the results of two studies conducted in Turkey on this subject contradict the results of international studies. Leprosy patients experience functional disabilities that limit their lives and ability to establish relation ships with others both in social and occupational fields. The physical disability rate is high (75%) in Turkey. A review of the literature revealed several papers on the psychosocial aspects of illness but few references to the degree or pattern of psychiatric disorders among leprosy patients. The main purpose of this paper is to review psychiatric disorders and disabilities in leprosy patients and to obtain concrete results.

Persons with Disabilities↗
PubMed2004

A study on transmission and a trial of chemoprophylaxis in contacts of leprosy patients: design, methodology and recruitment findings of COLEP.

In this article, we describe the design, methodology and recruitment findings of the COLEP study. The objectives of this study were to determine the effectiveness of chemoprophylaxis with a single dose of rifampicin in the prevention of leprosy among close contacts of leprosy patients, and to find characteristics of contact groups most at risk to develop clinical leprosy. These characteristics should be usable by routine leprosy control programmes. COLEP consists of a cluster randomized, double-blind and placebo-controlled trial, a cohort study to determine risk factors characterizing the sub-groups most at risk within the total contact group of a patient, and a cohort study using a reference group from the general population to determine the prevalence and incidence of leprosy in the total population of the study area. The follow-up period will be 4 years. A coding system was developed describing the physical and genetic distance of the contact person to the patient. This study in Bangladesh includes 1037 newly diagnosed and previously untreated leprosy patients and their 21,867 contacts. The prevalence of leprosy among contacts was 7.3 per 1000. A total of 21,708 contacts without signs and symptoms of clinical leprosy are included in a trial of chemoprophylaxis with single dose rifampicin, and randomized at contact group level in treatment and placebo arms. The results of this large field trial will become available in the years to come.

Adolescent↗