Leprosy profiles in post-elimination stage: a tertiary care hospital experience

Prevalence and risk factors for disability in leprosy patients in Indonesia during the post-elimination era

Leprosy has been nationally eliminated in Indonesia, but it continues to be a public health problem, with disability contributing to the disease burden. Disability caused by leprosy often results in stigmatization, leading to decreased quality of life. This was a retrospective cross-sectional study using secondary data from primary healthcare centers in one of the districts in the region with the highest number of leprosy patients in Indonesia. All leprosy patients between 2016-2022 were included. Among 189 leprosy patients (mean age 46 years old, 65.6% male), 19% had grade 1 disability and 29.6% had grade 2 disability. Duration of disease, nerve enlargements, leprosy reactions, and symmetric lesions were identified as risk factors for both grade 1 and 2 disability. Being male and having a positive smear test was associated with a higher risk of only grade 2 disability. Disability due to leprosy is still prevalent in the post-elimination era despite the decline in new leprosy cases. Improvement in early case detection and prevention of disability are still needed in the post-elimination era.

Global epidemiology of leprosy from 2010 to 2020: A systematic review and meta-analysis of the proportion of sex, type, grade 2 deformity and age

The objectives of this study were to explore global epidemiological characteristics of leprosy, and to provide reference for the construction of prevention strategies for leprosy. Computer retrieval of the study on the epidemiology of leprosy from 2010 to 2020 in Web of Science, PubMed, and SCOPUS databases were summarized. The included studies were assessed for the quality of the AHRQ; the proportions of the study indices were meta-analyzed with Stata 16.0. A random effects model was adopted to merge categories, including sex, type, grade 2 deformity (G2D) and age group for meta-analysis. The subgroup analysis used region as a stratification factor to analyze whether there were differences in the indicators. The meta-analysis included 30 studies totaling 11,353 cases. The global pooled proportion of male to female subjects with leprosy was 63% (95% CI 59%, 66%) to 37% (95% CI 34%, 41%), respectively. The pooled multibacillary proportion and paucibacillary proportion were 69% (95% CI 62%, 76%) and 31% (95% CI 24%, 38%), respectively. The pooled grade 2 deformity (G2D) proportion was 22% (95% CI 15%, 30%). Among age groups, the pooled children proportion was 11% (95% CI 8%, 13%), and the pooled adult proportion was 89% (95% CI 87%, 92%). The subgroup analysis indicated that epidemiological indicators varied from country to country. This study suggested that disparities existed between sex, type, grade 2 deformity (G2D) and age group characteristics of leprosy from country to country.

Renaissance of Hansen's Disease in Post-Elimination Era in North India: A Retrospective Clinico-Bacteriological Study

Introduction Hansen's disease is a chronic infectious disease caused by Mycobacterium leprae. India declared the elimination of leprosy in December 2005, but a slow resurgence of the disease still continues in several parts of India. The diagnosis of leprosy is primarily clinical but slit-skin smear microscopy aids in an accurate diagnosis. There are very few studies on clinico-bacteriological patterns of leprosy at this post-elimination phase. Aim This study aimed to analyze the clinical and bacteriological findings of newly diagnosed cases of Hansen's disease in the post-elimination era. Materials and methods This is a descriptive, hospital-based, retrospective study of newly diagnosed cases of Hansen's disease, enrolled in the Hansen's disease clinic attached to the dermatology outpatient department (OPD) of a tertiary care hospital in North India. A retrospective chart review of newly diagnosed cases of leprosy for a period of one year was done. Information about demographics, clinical characteristics, spectrum of disease, and slit skin smear data of patients were collected. Statistical analysis was performed using SPSS Version 16.0 (Chicago, IL, SPSS Inc.). Result A total of 116 patients were included of which 68.1% (79) were males. The age of patients ranged from 7 to 72 years and children (<15 years) constituted 6% (7/116) of all cases. The most common clinical spectrum was borderline lepromatous leprosy 37.9% (44/116) followed by lepromatous leprosy 32.8% (38/116). Out of 116 cases, 39.6% of cases showed slit-skin smear positivity. Conclusion The study brings forth evidence on the slow re-emergence of leprosy in India. In this study, multibacillary cases outnumber the paucibacillary cases; also, childhood cases were encountered indicating active community spread of the disease in the "post-elimination era." There is an urgent need to step up the surveillance for Hansen's disease to curb the further spread of the bacilli in the community.

Leprosy in Elderly and Children among New Cases - A 3-Year Retrospective Study

Background:

Leprosy occurs in all age groups, with adults constituting the majority. However, leprosy in children always drew the attention of epidemiologists as a guide to transmission of leprosy. With increasing life expectancy and decreasing prevalence of leprosy, there is going to be a significant rise of leprosy among elderly in India. In elderly leprosy patients, clinical signs are often quiet, which makes it a hidden source of infection. The detection of leprosy in elderly is of epidemiological importance, hence it is critical that due attention be given to leprosy in elderly as a possible contributor to hidden leprosy in India.

Aim:

To analyze leprosy in elderly and in children from the records of new patients seen over the past 3-year period.

Methods:

Analysis of details of “leprosy in elderly” and “leprosy in children'” from the records of new leprosy patients seen at a dermatology OPD of a teaching hospital over a period of 3 years.

Results:

Out of 157 patients, 34 (21.6%) were above 45 years, while 18 (11.4%) were below 15 years, the difference being statistically significant (P > 0.05). Bacteriological Index (BI) values in elderly were higher compared to children. In addition, elderly had a higher percentage of multibacillary (MB) leprosy compared to children both clinically (35% vs 22%) and histopathologically (38% vs 22%).

Conclusion:

Leprosy in elderly is an important entity, and there is a need to study it as a distinct group. It will provide information on hidden leprosy load and apprise us on sources of infection in the community.

Leprosy patients with deformities at post-elimination stage: The Bangladesh experience

Background

Disability assessment in leprosy patients is a very important factor in the evaluation of the effectiveness of a leprosy elimination program. Little information exists on deformities in leprosy patients in Bangladesh.

Objectives

To describe the pattern and prevalence of deformities in leprosy patients after leprosy has been declared eliminated from Bangladesh in 1998.

Methods

A descriptive retrospective cross-sectional study was carried out in Chittagong Medical College Hospital using the registered records of patients for the period 2004-2013.

Results

Out of 670 leprosy patients, 213 (31.79%) had deformities. The prevalence of deformity was for grade 1: 92 (43.20%), for grade 2: 121 (56.80%). Among the patients with deformity, males 144 (67.60%) outnumbered females 69 (32.40%). Four age groups were considered. The calculated age-specific cumulative detection rates showed the highest case detection in >40 years group at 81 (38.02%). The rate of children (<14 years) was less at 7 (3.29%). Of the 213 patients with deformity, the borderline tuberculoid patients were totalled 79 (37.08%), which was higher than other forms of leprosy. Among the 121 patients with limb deformity, 57 (8.50%) had claw hand followed by wrist drop 31 (4.63%), foot drop 30 (4.48%). Three (0.45%) had a nerve abscess, 27 (4.02%) had a trophic ulcer and 7 (1.05%) patients had ocular complications.

Conclusion

The grade 2 deformities among newly detected leprosy patients were still high. Claw hand was the most common deformity in the upper limbs, whereas foot drop and trophic ulcer were the most common deformities in the lower limbs. Although leprosy according to the World Health Organization has been eliminated globally, the disease continues to be a significant cause of peripheral neuropathy, deformity, disability and disfigurement in some developing countries like Bangladesh.

Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil

Reorientation of the public health policies in Brazil over the last 20 years in association with a stable rate of new-case detection prompted the establishment of a decentralized leprosy control strategy. The aim was to move from a vertical model associated with general dermatological services to one in which the diagnosis and treatment of the disease would be integrated into the primary care level of the national health care facilities. Once patients demand for leprosy reference centers began to be affected by the process of integrating leprosy diagnosis into the basic health care services, it was necessary to determine the profile of all our referrals in light of the new decentralization policy.

Leprosy, a neglected disease, remains endemic in some developing countries despite the existence of a successful program to treat and cure patients. While has been a drastic decrease in the number of patients, but we still have a stable number of new cases that is still very high in countries like India and Brazil in which more than 30.000 new cases were observed in 2014. Over the past ten years, Brazil has changed the strategies regarding of public health so that leprosy diagnostic, treatment and surveillance functions would predominantly be performed in primary care health units. The decentralization of leprosy diagnosis and treatment was expected to impact early cases detection and contribute to decrease in the number of cases with nerve damage. We analyzed and compared the demand of patient referrals to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, Brazil, prior and subsequent to the implementation of the decentralization strategy. Our results indicated that the profile of patients treated at the Fiocruz Clinic changed after the diagnosis and treatment of leprosy was integrated into the primary health services. There was an increase in the proportion of patients with other skin diseases. At the same time, 40% of the patients with leprosy had a higher disability grade at diagnosis, indicating late diagnosis. The initial presentation of leprosy may be a discrete skin or neural lesion, representing a challenge even for trained dermatologists. These results are probably the consequence of difficulties encountered in diagnosing leprosy in the primary health units without specialized health professionals or adequate laboratory tests. Although decentralization strategies have several advantages integrating the diagnosis of leprosy into basic health care units, the support of referral centers in diagnosing complex cases, managing difficult reactional episodes, and treating of side effects is central to the control of the epidemic.