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PubMed2004

Prevention of disability in leprosy.

Leprosy is curable now-a-days if initiatives are taken for prevention of disability along with complete and regular chemotherapy. Common disabilities encountered in leprosy are: Claw hand, foot drop, lagophthalmos, plantar ulcers and depressed bridge of nose. Objectives of prevention of disabilities are preservation of nerve function, preservation of vision, to regain functional ability and self-esteem. Measures to prevent disabilities include early diagnosis and treatment with effective chemotherapy, to train leprosy cases to perform self-care practices, providing them with protective aids and referring the cases for surgery if indicated. Lepra reactions are episodes of sudden increase in the activity of the disease. Lepra reactions are treated by bed rest, analgesics rest to affected nerve by splints and a suggested course of prednisolone. Besides, leprosy-affected persons should be encouraged for self-care practices. Counselling and holding care and concern camps (POD camps) are very much integrated wtih the prevention of disabilities.

Activities of Daily Living↗
PubMed2005

Factors contributing to delay in diagnosis and start of treatment of leprosy: analysis of help-seeking narratives in northern Bangladesh and in West Bengal, India.

The objective of our research was to identify factors contributing to delay in diagnosis and start of treatment in leprosy, focussing on patients' narratives of help-seeking behaviour. Our research took place in Purulia, West Bengal, India and in Nilphamari, northern Bangladesh. Between January and August 2000, we conducted semi-structured interviews with 104 patients that explored each individual's narrative of help-seeking behaviour and the context of beliefs and attitudes towards leprosy. Subsequently we surveyed 356 patients currently receiving treatment for leprosy and recorded specific aspects of each help-seeking action and their reports of local beliefs and attitudes towards leprosy. Delay was estimated from time of first symptoms through to start of effective treatment (mean 18 months, median 9 months in Purulia and mean 20 months, median 12 months in Nilphamari). The number of help-seeking actions ranged from 1 to 7. Time committed to first actions contributed 86% (Nilphamari) and 79% (Purulia) to total delay. The most important contributor to delay in the first action occurred when people simply monitored or ignored first symptoms, 80% in Nilphamari and 67% in Purulia. With delay longer than 12 months as outcome, logistic regression analyses identified age over 35 years, multiple visits to practitioners in traditional medicine and multiple visits to health service practitioners as predictive of delay. Attending a nearby clinic and exposure to health education materials were predictive of early presentation reduced delay.

Adult↗
PubMed2005

Squamous cell carcinoma arising in chronic ulcers in leprosy.

Squamous cell carcinoma (SCC) arising in chronic ulcers of leprosy patients is uncommon. A retrospective analytical study of 416 biopsy specimens of chronic ulcers during 1976 - 2000 occuring on the extremity of leprosy patients was performed. Pathologic examination showed that 217 specimens (52.2%) were reported as pseudoepitheliomatous hyperplasia (PH). A total of 102 (24.5%) specimens reported as SCC, involving 100 individual patients (69 males, 31 females). SCC was localized on the lower extremity in 87 specimens (85.3%). No significant difference was observed between left and right foot using Chi-square test. The sole was the commonest site of involvement, and then the heel. SCC on the upper extremity which was much less common, presented in 15 specimens (14.7%). The tumor was localized on the palm in 10 specimens (right: 9, left: 1). SCC in chronic ulcers of leprosy patients were much more common on the lower extremity than on the upper extremity. Most of the tumors on the upper extremity were localized on the right palm. This emphasizes the need for an active policy of prevention of disability in leprosy control programs.

Adult↗
PubMed1979

Factors contributing to impairment of the mixed lymphocyte reaction in leprosy.

Whereas the mixed lymphocyte reaction was essentially normal in inactive lepromatous leprosy and tuberculoid leprosy, it was severely impaired in active lepromatous leprosy. The impairment was found to be contributed by certain unknown factors in their plasma and subnormal reactivity of their T lymphocytes. The plasma derived from active lepromatous leprosy patients depressed the reaction of normal cells and normal plasma enhanced the reaction of active lepromatous lymphocytes. The cellular factor was studied by using a one-way reaction in which one of the two lymphocyte preparations was inactivated with mitomycin C. The impairment of blastogenesis of active lepromatous lymphocytes was partially reversed by substituting inactivated normal cells for similarly treated leprous cells, and conversely the response of normal allogeneic lymphocytes was depressed by substituting inactivated leprous lymphocytes as the stimulator cells.

Adult↗
PubMed1979

Concanavalin A induced suppressor activity in human leprosy.

Peripheral blood lymphocytes from nine normal subjects and 40 patients with leprosy were pretreated in vitro with Concanavalin A (Con A). Cells from normal subjects pretreated for 24 hours showed consistent and effective generation of suppressive activity which inhibited mitogen induced transformation of autologous lymphocytes. Prolongation of Con A pretreatment to 40 hours resulted in maximal suppressive activity. Tuberculoid leprosy patients had lymphocytes in their blood which on 24 hour pretreatment with Con A exerted suppressive effects markedly greater than the maximal suppression noted with 40 hour pretreated normal lymphocytes. In contrast, untreated patients with polar lepromatous leprosy showed a decrease in suppressive activity which could not be altered by prolongation of Con A pretreatment: the loss of suppressive activity noted in this form of leprosy was restored during erythema nodosum leprosum.

Concanavalin A↗
PubMedDate not supplied

Leprosy elimination campaigns in Orissa.

Four Modified Leprosy Elimination Campaigns (MLECs) were conducted in Orissa by March 2003. Their impact on various leprosy indicators was analyzed. More than 70% of the people of the State were examined during these campaigns. The suspect rate decreased from 1.44% to 0.37% towards the fourth MLEC. About 15% of the suspects were clinically confirmed to be having leprosy. The total number of new cases detected during the MLEC years was on the decrease. A marked fall in new case-detection rate was observed during inter-MLEC years. This has resulted in fluctuation in the prevalence rate during the MLEC years, but the overall PR/10,000 population decreased from 12.18 in 1996-97 to 7.3 in March 2003. More than 40% of the total new cases and about 45% of total new child cases for the corresponding year were detected during the MLECs, and the proportion of total new case-detection was as high as 60.8% during the first MLEC. The proportion of female cases detected during succeeding MLECs improved and an almost equal number of female cases were detected during MLECs III and IV. Considering the present leprosy situation in Orissa and the effectiveness of MLECs in case-detection, it was recommended that such campaigns should be undertaken in select high prevalent blocks of the State at regular intervals, along with the strengthening of the integration of NLEP activities into primary health care activities.

Female↗
PubMedDate not supplied

Leprosy: contribution of mast cells to epineurial collagenization.

BACKGROUND: Leprosy, a disease caused by Mycobacterium leprae, is an important health problem worldwide. It is responsible for an irreversible nerve damage in which fibrosis plays an important role. The existence of an interaction between mast cells and different fibrotic conditions has long been observed. Tryptase, the most abundant protein product of human mast cells, has been shown to be mitogenic for fibroblasts and to increase type I collagen production. PATIENTS AND METHODS: In order to explore the possible relationship between tryptase-rich mast cells and nerve fibrosis in leprosy, we studied 24 sural nerve biopsies of patients with leprous neuropathy. Mast cells stained with mouse antihuman mast cell antitryptase clone AA1 as well as fibrosis, were quantitatively estimated in both epi- and endoneurial compartments. RESULTS: There was a remarkable association between collagen increase and tryptase-rich mast cell density in the epineurium but not in the endoneurium of leprous nerves. CONCLUSION: Since the epineurium in leprosy is type I collagen rich, the present findings support a tryptase-rich mast cell contribution to epineurial collagenization in leprosy through their tryptase secretion.

Adolescent↗
PubMedDate not supplied

A study on the impact of FD-MDT on 200 leprosy patients.

A study was carried out from June 1999 to June 2001 to assess the impact of fixed duration multidrug therapy (FD-MDT) in newly detected cases of leprosy in terms of clinical and neurological improvement and changes in the bacillary index of skin smear for AFB. 200 new leprosy cases (both PB & MB) were started on FD-MDT. Of these 200 cases, 16 were of pure neuritic leprosy. After treatment, out of 184 cases with typical skin lesions of leprosy, all 26 PB cases showed inactivity of skin lesions, and, of the remaining 158 MB cases, 40.5% showed inactivity and 59.5% showed complete resolution of skin lesions. Out of 68 skin smear-positive cases, 42 cases with a BI of < or = 3 became smear-negative, while others showed gradual fall in the BI. Such heavily bacilliferous cases were continued with treatment for 1 more year to prevent relapse. As FD-MDT alone does not cure established sensory and motor impairment, it did not show any change in 19% of the patients presented with permanent sensory motor disturbance. FD-MDT prevents progression of sensory/motor disturbance.

Adolescent↗
PubMedDate not supplied

Leprosy among adolescents in Kolkata, India.

Leprosy, manifesting during adolescence when significant physical and emotional changes are taking place, poses further stress and strain both on the individual and on the family. Based on hospital records, focus group discussions and in-depth interviews, data on 258 adolescent leprosy patients seen at a leprosy referral hospital in Kolkata, India, are presented. The male-female sex ratio was 1.93:1, 56.6% were multibacillary patients and 13.2% had grade 2 disability. At the time of final follow up, 10% of PB and 33% of MB patients had already discontinued treatment. The commonest complication was reaction (14.5%). Adolescents were still dependent on their parents for health matters. Data obtained from questionnaires confirmed the role of social stigma in hiding, delay in starting of MDT and defaulting. Frequent hospital admissions resulted in loss of jobs and disruption of studies and caused psychological disturbances. It is critical to identify and treat adolescent leprosy on a priority basis. Health education and counselling programmes must be more focused and acceptable. Further research is necessary.

Adolescent↗
PubMed1992

Diagnostic exploration of enlarged peripheral nerves in suspected cases of leprosy. An analysis of 55 cases.

In 55 cases presenting with enlarged peripheral nerves without any skin lesions, a rice grain-sized biopsy of the nerve lesion was taken for histopathological examination. As a result definitive diagnoses could be established: leprosy was diagnosed in 32 cases. In 23 cases the cause of nerve enlargement was not leprosy: post-traumatic neuritis 9, cysts 5, hypertrophic neuritis 3, nonspecific 4, neurofibroma 1, and amyloidosis 1. In all of these cases there was a deficit of the nerve function and postoperatively there were no complications. The authors, as a result of this experience, believe that surgical exploration and biopsy is a harmless diagnostic tool for establishing a definitive diagnosis of leprosy in cases presenting with enlarged peripheral nerves without any skin lesions. In 23 out of 55 such cases the nerve enlargement was proved to be other causes than leprosy.

Adolescent↗
PubMed2005

The INFIR Cohort Study: assessment of sensory and motor neuropathy in leprosy at baseline.

AIM: To compare different method(s) to detect peripheral neuropathy in leprosy and to study the validity of the monofilament test (MF) and the voluntary muscle test (VMT) as standard tests of nerve function. DESIGN: A multi-centre cohort study of 303 multibacillary (MB) leprosy patients. METHODS: Newly registered MB patients requiring a full course of MDT were recruited in two leprosy outpatient clinics in North India. Controls were people without leprosy or neurological conditions, attending the dermatological outpatient departments of the same clinics. Nerve function was evaluated electrophysiologically using standard parameters for sensory and motor nerve conduction (NC) testing, warm and cold detection thresholds (W/CDT), vibration perception thresholds, dynamometry, MF and VMT. The latter two defined the outcomes of sensory and motor impairment. RESULTS: 115 patients had nerve damage or a reaction of recent onset at diagnosis. Sensory and motor amplitudes and WDTs were the most frequently abnormal. Among the nerves tested, the sural and posterior tibial were the most frequently impaired. In the ulnar nerve, sensory latencies were abnormal in 25% of subjects; amplitudes in 40%. Ulnar above-elbow motor conduction velocities were abnormal in 39% and amplitudes 32%. WDTs were much more frequently affected than CDTs in all nerves tested. The thresholds of all test parameters differed significantly between controls and patients, while only some differed between patients with and without reaction. Good concordance was observed between MF results and sensory latencies and velocities (direct concordance 80% for the ulnar). However, a proportion of nerves with abnormal MF results tested normal on one or more of the other tests or vice versa. Concordance between VMT and motor conduction velocities was good for the ulnar nerve, but for the median and peroneal nerves, the proportion impaired by VMT out of those with abnormal motor conduction was very low. CONCLUSIONS: Concordance between monofilaments and other sensory function test results was good, supporting the validity of the monofilaments as standard screening test of sensory function. Concordance between VMT results and motor nerve conduction was good for the ulnar nerve, but very few median and peroneal nerves with abnormal conduction had an abnormal VMT. A more sensitive manual motor test may be needed for these nerves. Of the nerve assessment tests conducted, NC amplitudes and warm sensation were the most frequently affected. Therefore, nerve conduction studies and WDT measurements appear to be most promising tests for early detection of leprous neuropathy. The pattern of concordance between tactile and thermal sensory impairment failed to support the hypothesis that small fibre neuropathy always precedes large fibre damage. Warm sensation was more frequently affected than cold sensation. This could indicate that unmyelinated C fibres are more frequently affected than small myelinated Asigma fibres.

Adolescent↗
PubMed2005

STEP: an intervention to address the issue of stigma related to leprosy in Southern Nepal.

This paper focuses primarily on the extent to which a Stigma Elimination Programme (STEP) affected the social participation of people affected by leprosy in southern Nepal. The Participation Scale (popularly known as The P Scale) was applied to compare leprosy affected people who participated in STEP groups with a control group comprising leprosy affected people who lived in villages where STEP had not been implemented. It was found that STEP participants had significantly higher levels of participation compared with controls and that their levels of social participation were higher than would be expected even for the general population. It was also found that leprosy affected people without visible deformity or ulceration (whether in the STEP group or not) do not appear to suffer participation restriction in southern Nepal.

Efficiency, Organizational↗
PubMed2006

Delay in the diagnosis of leprosy in the Metropolitan Region of Vitória, Brazil.

This paper reports on the time between the onset of the first lesion and diagnosis, defined as delay, and is based on results obtained by interviewers from a survey carried out amongst 450 leprosy patients in a leprosy endemic area in the Metropolitan Region of Vitória (MRV), state of Espirito Santo, Brazil. The mean age at diagnosis in all cases was 41.47 years and the median was 42.5 years. The mean age at diagnosis in MB (42.9 years) was greater than in PB (38.5 years). The mean of the delay in all cases was 25.25 months, median 12 months and range 0-360 months. The mean of the delay in MB (27.2 months) was greater than in PB (21.3 months). The results of this study suggest that although the delay in leprosy diagnosis in this region of Brazil was not too long when it was compared with other studies in endemic countries, it is still a problem: 65.4% of patients were diagnosed after a delay of 6 months. The Leprosy Control Programme in this state needs more effective health education in order to reduce the current period of delay before diagnosis.

Adolescent↗
PubMed2005

Visible deformity in childhood leprosy--a 10-year study.

Deformity seen in children with leprosy has not often been studied, as the disease itself is less common in children. Deformity, being synonymous with the stigma of leprosy, is a definite social problem in children. In this study we have focused on the burden of deformity in children with leprosy, and various factors responsible for the deformities are discussed. We have observed an incidence of 10.5% of Grade II deformities in children with leprosy, which is very high compared to the community rate of 1.4%. Various factors which contributed significantly to the deformities in our study were: increasing age of children, delay in accessing health care, multiple skin lesions, multibacillary disease, smear positivity, multiple nerve involvement, and reaction at the time of presentation to the hospital. Logistic regression analysis showed that children with thickened nerve trunks had 6.1 times higher risk of developing deformities compared to those who did not have nerve enlargement. Children with the above risk factors should be followed up more frequently so as to detect any deformity as early as possible.

Adolescent↗
PubMed2005

Leprosy profile in Isfahan (A province of Iran).

In Iran, there have been a few cases of leprosy in several provinces, however, native physicians believe that leprosy is not present primarily in an Isfahan endemic area. We performed an investigation either to approve or rule out this idea. We found 25 lepra patients who were registered and followed in Isfahan Leprosy Health Registeration Center, all of whom were infected in other regions and migrated to Isfahan city at a later time. Final analysis proved that there are not any cases of leprosy by itself in Isfahan as an endemic region at the time of this study (1975 to 2002).

Adolescent↗
PubMed1991

Leprosy and AIDS: a review of the literature and speculations on the impact of CD4+ lymphocyte depletion on immunity to Mycobacterium leprae.

The potent effects of HIV infection on the human immune system, the complexity of the host-parasite interaction in leprosy, and the paucity of current information on the natural history of co-infected patients makes this area a fertile ground for clinical and immunologic investigation. Several studies have now validated the prediction that there exists a large cohort of patients, particularly in Africa, who are concurrently infected with HIV and M. leprae. Sparse but tantalizing evidence suggests that infection with HIV may increase the incidence of leprosy among individuals with subclinical infection with M. leprae, either through shortening the incubation period or by increasing disease penetrance. Similarly, active mycobacterial disease may accelerate the course of HIV disease, as has been postulated to occur during concurrent infections with certain other viral and bacterial pathogens in HIV-positive patients. A subtle and complex interplay between HIV and leprosy may thus result which will impact the observed epidemiology of both illnesses in regions where both are prevalent. Possible effects of the HIV epidemic on leprosy control programs have been outlined by the World Health Organization and in an editorial by Turk and Rees. The published experience provides few guidelines for the clinical care of co-infected patients. The initial response to conventional therapeutic regimens appears to be excellent, but no follow-up data have been included. The possible absence of ENL in these patients would simplify care for multibacillary disease, if this observation is confirmed in larger field studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1991

The diagnostic value of IgM to natural trisaccharide phenylpropionyl bovine serum albumin in leprosy patients: a preliminary report from Taiwan.

An evaluation was made of the serum anti-phenolic-glycolipid-I (PGL-I) IgM levels of leprosy patients in the Taiwan area by enzyme-linked immunosorbent assay (ELISA) with a specific synthetic PGL-I antigen and natural trisaccharide phenylpropionyl bovine serum albumin (NT-P-BSA). Fifty-five blood samples were collected from 24 tuberculoid and 31 lepromatous leprosy patients and 21 healthy age- and sex-matched subjects. Among these groups, lepromatous patients had the highest levels of IgM and anti-NT-P-BSA IgM with a good correlation between these two levels (p less than 0.01). Tuberculoid patients also had higher levels than normal subjects. Wide variation in the standard deviation and decreased levels within the cutoff value of some lepromatous patients may be due to various periods of anti-leprosy treatment. Serial anti-NT-P-BSA IgM assessments in response to anti-leprosy treatment may provide more information and serve as a guideline for therapy.

Adult↗
PubMed2006

From contagious to chronic: a life course experience with leprosy in Taiwanese women.

This study used the narrative analysis method to explore stories told by Taiwanese women who had suffered from leprosy. Twenty-one women from a leprosarium, a long-term care centre, and the community participated in either focus group discussions or individual interviews. The age range for the participants was 54-88, with an average of 68 years old. Physical impairments and disabilities of the participants included skin scars, claw fingers, drop feet, amputated legs, and facial disfigurement. Their stories were analysed in two phases: structural and holistic content analyses. Structural analysis identified four life stages: before being diagnosed, after being diagnosed, living with leprosy, and the future. Holistic content analysis uncovered common themes in each life stage. Findings indicated that stigma was experienced throughout the life course of these women. At this stage of life, these women were facing not only physical impairments and disabilities from the leprosy, but also the usual chronic health problems of the elderly. This study suggests that prevention and treatment of leprosy-related physical impairments and chronic diseases are important.

Aged↗