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Li X, Jin G, Yang J, Li Y, Wei P, Zhang L. Epidemiological characteristics of leprosy during the period 2005-2020: A retrospective study based on the Chinese surveillance system. Front Public Health 2023; 10:991828. [PMID: 36711406 PMCID: PMC9874668 DOI: 10.3389/fpubh.2022.991828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Background Jiangsu Province is located in the Yangtze River Delta region, with a total area of 107,200 square kilometers. Since 1949, over 55,000 cases have been registered, with Taixing accounting for the highest number of patients. The proportion of new cases with MB and G2D was higher compared to other regions. As a result, Jiangsu has been considered a priority area for public health interventions in China. Methods This paper mainly described the population, time, and spatial distribution of the newly detected leprosy cases in Jiangsu Province between 2005 and 2020. In this study, all the data were entered into Microsoft Excel and SPSS for the descriptive analysis. ArcGIS was applied to create statistical maps, and Geoda was used to conduct spatial autocorrelation analysis with local Moran's I statistics (LISA). The epidemiological data were obtained from LEPMIS. In addition, population data were obtained from the Statistical Yearbook of Jiangsu Province. Results During the study period, 363 new cases were reported. Of these, 232 were men and 131 were women (1.77:1). The mean age at diagnosis was 60.56 years, and no adolescent cases were identified. Three hundred and twenty-seven (90.08%) were diagnosed with MB and 36 (9.92%) with PB. 31.68% (115/363) of the patients presented with G2D. Farmers accounted for 74.9%, and most cases were identified in skin clinics (248, 68.32%). We observed a decreasing trend in detection rate, with a higher concentration of new cases diagnosed between July and October. Spatial analysis showed that the new cases were primarily distributed in the northwest of Jiangsu province, and Suqian has the highest incidence of leprosy. Special attention should be paid to Wuzhong, a county with a potential risk of inter-provincial transmission. Furthermore, 55 new cases came from other Chinese provinces but lived in Jiangsu. Conclusion The NCDR of leprosy decreased, but the new cases showed disabilities, a sign of the late diagnosis. The results indicated that some regions were still suffering from the burden of leprosy. Thus, we recommend that the government should adopt effective strategies to promote leprosy control. The main priorities for eliminating new cases were to provide sustainable financial support, improve the quality of clinical services, strengthen preventive intervention and rehabilitation services for disabilities, provide health education among high-risk populations, and explore new approaches.
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Affiliation(s)
- Xiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Guangjie Jin
- Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jing Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yunhui Li
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Pingmin Wei
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China,*Correspondence: Pingmin Wei ✉
| | - Lianhua Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China,Department of Chronic Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China,Lianhua Zhang ✉
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Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study. PLoS Negl Trop Dis 2021; 15:e0009923. [PMID: 34758025 PMCID: PMC8580233 DOI: 10.1371/journal.pntd.0009923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. METHODOLOGY/PRINCIPAL FINDINGS We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516-7.073, 3.714-5.212, and 2.063-2.509; for ≥ 10, 5-10 y, and 2-5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843-4.244, and 1.959-3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341-2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052-2.079, 1.075-1.923, 1.261-1.838, and 1.072-1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106-1.960 and 1.498-2.814; for 15-59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522-2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195-1.952), rural occupation (OR: 1.364; 95% CI: 1.128-1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159-1.386), and male sex (OR: 1.128; 95% CI: 1.024-1.243). CONCLUSIONS Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.
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Meghashyam K, Prakash M, Narang T, Sinha A, Sandhu MS. Role of shear wave elastography in treatment follow-up of leprosy neuropathy. J Ultrasound 2021; 25:265-272. [PMID: 33959898 DOI: 10.1007/s40477-021-00583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Grayscale ultrasonography when complemented with shear wave elastography helps in better evaluation of treatment response of leprosy neuropathy and in guiding appropriate management of the patient. There is limited literature regarding the use of shear wave elastography in ulnar nerve neuropathy. Our purpose was to evaluate the role of shear wave elastography in assessing stiffness changes within the ulnar nerve during treatment of leprosy. METHODS This was a prospective study which included 30 patients diagnosed with leprosy neuropathy. Recruited patients were followed up, during the course of treatment, i.e. for 1 year. Serial ultrasonography of these patients was done at 0, 3, 6 and 12 months interval. RESULTS Significant (P < 0.05) decrease in elastography parameters was seen in transverse imaging plane between first and third, as well as first and fourth visits (mean stiffness and velocity pretreatment ~ 25.78 ± 18 kPa and 2.74 ± 0.98 m/s, mean stiffness and velocity post-treatment 15.67 ± 5.89 kPa and 2.24 ± 0.428 m/s). Although elastography parameters decreased during these visits in the long-axis imaging plane, they were not found to be statistically significant. However, gross morphology and cross-sectional area of the nerve did not change significantly across visits. Interestingly, elastography values were higher in patients with neuritis, though not statistically significant. CONCLUSION Shear wave elastography is a novel, upcoming modality in musculoskeletal imaging especially in the evaluation of peripheral neuropathy. It can act as an adjunct to grey-scale imaging, which can help in early diagnosis and in guiding treatment of leprosy neuropathy.
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Affiliation(s)
- Kesha Meghashyam
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mahesh Prakash
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Tarun Narang
- Department of Dermatology, Venerology and Leprology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - M S Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Assis BPN, Lyon S, Grossi MADF, Rocha MODC. Risk factors for physical disability upon release from multidrug therapy in new cases of leprosy at a referral center in Brazil. Rev Inst Med Trop Sao Paulo 2019; 61:e13. [PMID: 30785567 PMCID: PMC6376927 DOI: 10.1590/s1678-9946201961013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/03/2019] [Indexed: 11/24/2022] Open
Abstract
The present study sought to investigate the risk factors for physical disability
upon release from multidrug therapy (MDT) in new cases of leprosy, registered at
a referral center in Brazil. This is a longitudinal and retrospective study that
evaluated 260 patients. Multivariate analyses, using both the ordinal logistic
regression, as well as the classification and regression tree (CART) algorithm
were performed to determine the factors associated with physical disability upon
release from treatment. The prevalence of disability did not differ
significantly between diagnosis and release from treatment. Number of affected
nerves and sensory impairment upon diagnosis were risk factors for disability at
the end of MDT. The analysis using the CART algorithm resulted in the
development of a clinical score to predict the risk of disability upon release
from MDT. The decision tree may have a direct applicability in clinical practice
for professionals dealing with leprosy, as it allows them to identify patients
with a higher risk of physical disability through the use of simple and widely
available clinical tests. This study also shows that the disability grade upon
admission is the main risk factor for disability upon release from MDT. This
result draws attention to the importance of early diagnosis in disability
prevention.
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Affiliation(s)
- Bárbara Proença Nardi Assis
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais, Brazil.,Centro Universitário de Belo Horizonte, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
| | - Sandra Lyon
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Eduardo de Menezes, Belo Horizonte, Minas Gerais, Brazil.,Faculdade da Saúde e Ecologia Humana, Vespasiano, Minas Gerais, Brazil
| | - Maria Aparecida de Faria Grossi
- Faculdade da Saúde e Ecologia Humana, Vespasiano, Minas Gerais, Brazil.,Secretaria de Estado de Saúde de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Manoel Otávio da Costa Rocha
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Belo Horizonte, Minas Gerais, Brazil
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Van Veen NHJ, Nicholls PG, Smith WCS, Richardus JH. Corticosteroids for treating nerve damage in leprosy. Cochrane Database Syst Rev 2016; 2016:CD005491. [PMID: 27210895 PMCID: PMC8520738 DOI: 10.1002/14651858.cd005491.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leprosy causes nerve damage that can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although their long-term effect is uncertain. This is an update of a review first published in 2007, and previously updated in 2009 and 2011. OBJECTIVES To assess the effects of corticosteroids on nerve damage in leprosy. SEARCH METHODS On 16 June 2015, we searched the Cochrane Neuromuscular Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL Plus, and LILACS. We also checked clinical trials registers and contacted trial authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of corticosteroids for nerve damage in leprosy. The comparators were no treatment, placebo treatment, or a different corticosteroid regimen. DATA COLLECTION AND ANALYSIS The primary outcome was improvement in nerve function after one year. Secondary outcomes were change in nerve pain, limitations in activities of daily living, limitations in participation, and adverse events. Two review authors independently extracted data and assessed trial quality. When data were lacking, we contacted trial authors for additional information. MAIN RESULTS We included five RCTs involving 576 people. The trials were largely at low risk of bias, but we considered the quality of the evidence from these trials as moderate to low, largely due to imprecision from small sample sizes. Two out of the five trials reported on improvement in nerve function at one year. These two trials compared prednisolone with placebo. One trial, with 84 participants, treated mild sensory impairment of less than six months' duration, and the other, with 95 participants, treated nerve function impairment of 6 to 24 months' duration. There was no significant difference in nerve function improvement after 12 months between people treated with prednisolone and those treated with placebo. Adverse events were not reported significantly more often with corticosteroids than with placebo. The other three trials did not report on the primary outcome measure. One (334 participants) compared three corticosteroid regimens for severe type 1 reactions. No serious side effects of steroids were reported in any participant during the follow-up period. Another trial (21 participants) compared low-dose prednisone with high-dose prednisone for ulnar neuropathy. Two participants on the higher dose of prednisone reported adverse effects. The last (42 participants) compared intravenous methylprednisolone and oral prednisolone with intravenous normal saline and oral prednisolone. The trial found no significant differences between the groups in the occurrence of adverse events. AUTHORS' CONCLUSIONS Corticosteroids are used for treating acute nerve damage in leprosy, but moderate-quality evidence from two RCTs treating either longstanding or mild nerve function impairment did not show corticosteroids to have a superior effect to placebo on nerve function improvement. A third trial showed significant benefit from a five-month steroid regimen over a three-month regimen in terms of response to treatment (need for additional corticosteroids). Further RCTs are needed to establish optimal corticosteroid regimens and to examine the efficacy and safety of adjuvant or new therapies for treating nerve damage in leprosy. Future trials should address non-clinical aspects, such as costs and impact on quality of life, which are highly relevant indicators for both policymakers and participants.
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Affiliation(s)
- Natasja HJ Van Veen
- Erasmus Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Peter G Nicholls
- University of SouthamptonSchool of Health SciencesUniversity RoadHighfieldSouthamptonUKSO17 1BJ
| | - W Cairns S Smith
- University of AberdeenPublic HealthPolwarth BuildingForesterhillAberdeenUKAB25 2ZD
| | - Jan Hendrik Richardus
- Erasmus Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
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Cabalar M, Yayla V, Ulutas S, Senadim S, Oktar AC. The clinical & neurophysiological study of leprosy. Pak J Med Sci 2014; 30:501-6. [PMID: 24948967 PMCID: PMC4048494 DOI: 10.12669/pjms.303.5354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/23/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate neurological and neurophysiological features of leprosy. METHODS Seventy seven hospitalized leprosy patients (52 male, 25 female) were examined neurological and neurophysiologically between 2010 and 2012. Standard procedures were performed for evaluating sensory and motor conduction studies to all patients. Motor studies were carried out on median, ulnar, tibial and common peroneal nerves. Sensory studies were carried out on median, ulnar and sural nerves. Sympathetic skin response (SSR) recordings on both hands and feet, and the heart rate (R-R) interval variation (RRIV) recordings on precordial region were done in order to evaluate the autonomic dysfunction. RESULTS The mean age was 59.11±14.95 years ranging between 17 and 80 years. The mean duration of disease was 35.58±18.30 years. Clinically, the patients had severe deformity and disability. In neurophysiological examinations, sensory, motor conduction studies of the lower extremities were found to be more severely affected than upper, and sensory impairment predominated over motor. Abnormal SSRs were recorded in 63 (81.8%) cases of leprosy. Abnormal RRIVs were recorded in 41 (53.2%) cases and abnormal RRIVs with hyperventilation were recorded in 55 (71.4%) cases of leprosy. Significant differences were found between SSR and sensory conduction parameters of median, ulnar nerves as well as motor conduction parameters of median, ulnar and peroneal nerves (p<0.05). CONCLUSION Peripheral nervous system dysfunction is accompanied by autonomic nervous system dysfunction in leprosy patients. Sympathetic involvement may predominate over parasympathetic involvement.
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Affiliation(s)
- Murat Cabalar
- Dr. Murat Cabalar, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Vildan Yayla
- Dr. Vildan Yayla, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Samiye Ulutas
- Dr. Samiye Ulutas, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Songul Senadim
- Dr. Songul Senadim, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
| | - Ayla Culha Oktar
- Dr. Ayla Culha Oktar, Department of Neurology, Bakirkoy Dr. Sadi Konuk Research & Training Hospital, Istanbul, Turkey
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Van Veen NHJ, Schreuders TAR, Theuvenet WJ, Agrawal A, Richardus JH. Decompressive surgery for treating nerve damage in leprosy. Cochrane Database Syst Rev 2012; 12:CD006983. [PMID: 23235638 DOI: 10.1002/14651858.cd006983.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. This is an update of a review first published in 2009 and previously updated in 2010. OBJECTIVES To assess the effects of decompressive surgery on nerve damage in leprosy. SEARCH METHODS We searched the Cochrane Neuromuscular Disease Group Specialized Register (15 October 2012), CENTRAL (2012, Issue 9 in The Cochrane Library), MEDLINE (January 1966 to October 2012), EMBASE (January 1980 to October 2012), AMED (January 1985 to October 2012), CINAHL Plus (January 1937 to October 2012) and LILACS (from January 1982 to October 2012). We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com) (1 November 2012), conference proceedings and contacted trial authors. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs of decompressive surgery for nerve damage in leprosy. DATA COLLECTION AND ANALYSIS The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects information from the trials and non-randomised studies. MAIN RESULTS We included two RCTs involving 88 participants. The trials were at high risk of bias. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. After two years' follow-up there was only very low quality evidence of no significant difference in nerve function improvement between participants treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. AUTHORS' CONCLUSIONS Decompressive surgery is used for treating nerve damage in leprosy but the available evidence from RCTs is of very low quality and does not show a significant added benefit of surgery over steroid treatment alone. Well-designed RCTs are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.
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Idema WJ, Majer IM, Pahan D, Oskam L, Polinder S, Richardus JH. Cost-effectiveness of a chemoprophylactic intervention with single dose rifampicin in contacts of new leprosy patients. PLoS Negl Trop Dis 2010; 4:e874. [PMID: 21072235 PMCID: PMC2970532 DOI: 10.1371/journal.pntd.0000874] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 10/06/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND With 249,007 new leprosy patients detected globally in 2008, it remains necessary to develop new and effective interventions to interrupt the transmission of M. leprae. We assessed the economic benefits of single dose rifampicin (SDR) for contacts as chemoprophylactic intervention in the control of leprosy. METHODS We conducted a single centre, double blind, cluster randomised, placebo controlled trial in northwest Bangladesh between 2002 and 2007, including 21,711 close contacts of 1,037 patients with newly diagnosed leprosy. We gave a single dose of rifampicin or placebo to close contacts, with follow-up for four years. The main outcome measure was the development of clinical leprosy. We assessed the cost effectiveness by calculating the incremental cost effectiveness ratio (ICER) between the standard multidrug therapy (MDT) program with the additional chemoprophylaxis intervention versus the standard MDT program only. The ICER was expressed in US dollars per prevented leprosy case. FINDINGS Chemoprophylaxis with SDR for preventing leprosy among contacts of leprosy patients is cost-effective at all contact levels and thereby a cost-effective prevention strategy. In total, $6,009 incremental cost was invested and 38 incremental leprosy cases were prevented, resulting in an ICER of $158 per one additional prevented leprosy case. It was the most cost-effective in neighbours of neighbours and social contacts (ICER $214), slightly less cost-effective in next door neighbours (ICER $497) and least cost-effective among household contacts (ICER $856). CONCLUSION Chemoprophylaxis with single dose rifampicin given to contacts of newly diagnosed leprosy patients is a cost-effective intervention strategy. Implementation studies are necessary to establish whether this intervention is acceptable and feasible in other leprosy endemic areas of the world.
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Affiliation(s)
- Willemijn J. Idema
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Istvan M. Majer
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David Pahan
- Rural Health Program, The Leprosy Mission Bangladesh (formerly DBLM), Nilphamari, Bangladesh
| | - Linda Oskam
- KIT (Royal Tropical Institute), KIT Biomedical Research, Amsterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Moschioni C, Antunes CMDF, Grossi MAF, Lambertucci JR. Risk factors for physical disability at diagnosis of 19,283 new cases of leprosy. Rev Soc Bras Med Trop 2010; 43:19-22. [PMID: 20305962 DOI: 10.1590/s0037-86822010000100005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 01/06/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The purpose of this study was to evaluate risk factors for physical disability at the moment of leprosy diagnosis. METHODS This is a retrospective, descriptive and exploratory investigation of 19,283 patients with leprosy, registered in the State of Minas Gerais, Brazil, between 2000 and 2005. RESULTS The risk of Grade 2 disability was 16.5-fold higher in patients with lepromatous leprosy, and 12.8-fold higher in patients presenting the borderline form, compared to patients presenting indeterminate leprosy. The occurrence of more than one thickened nerve increased the odds of a patient developing Grade 2 disability, 8.4-fold. Age <15 years, multibacillary leprosy and no formal education presented 7.0, 5.7 and 5.6 odds of developing physical disability, respectively. CONCLUSIONS These factors should be considered as strong prognostic indicators in the development of physical disability at diagnosis.
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Affiliation(s)
- Cristiane Moschioni
- Infectious Diseases Branch, School of Medicine, Federal University of Minas Gerais, Brazil
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Gonçalves SD, Sampaio RF, Antunes CMDF. [Occurrence of neuritis among leprosy patients: survival analysis and predictive factors]. Rev Soc Bras Med Trop 2009; 41:464-9. [PMID: 19009187 DOI: 10.1590/s0037-86822008000500006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 09/01/2008] [Indexed: 11/21/2022] Open
Abstract
Neuritis in leprosy cases is responsible for deformities and disability. The objective of this historical cohort study was to investigate the risk factors associated with the time taken for neuritis to occur. This study followed up 595 patients from 1993 to 2003. The life table technique and the Kaplan-Meier method for survival curves were used. The log-rank test was used to test differences between groups regarding the time take for neuritis to occur, and the Cox regression model was used to estimate the hazard ratios. Just over half (54%) of the sample had neuritis, which had mostly taken 0 to 11.9 months to appear. The degree of disability at admission and the bacillary index were strongly associated with the occurrence of neuritis, thus confirming the need for early diagnosis of leprosy, as well as regular neurological follow-up and appropriate interventions.
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Van Veen NHJ, Schreuders TAR, Theuvenet WJ, Agrawal A, Richardus JH. Decompressive surgery for treating nerve damage in leprosy. Cochrane Database Syst Rev 2009:CD006983. [PMID: 19160310 DOI: 10.1002/14651858.cd006983.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leprosy causes nerve damage which may result in nerve function impairment and disability. Decompressive surgery is used for treating nerve damage, although the effect is uncertain. OBJECTIVES To assess the effects of decompressive surgery on nerve damage in leprosy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Trials Register (November 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (from January 1950 to November 2007), EMBASE (from January 1980 to November 2007), AMED (from January 1985 to November 2007), CINAHL (from January 1982 to November 2007) and LILACS (from January 1982 to November 2007) in November 2007. We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com), conference proceedings and contacted trial authors. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of decompressive surgery for nerve damage in leprosy. DATA COLLECTION AND ANALYSIS The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects information from the trials and non-randomised studies. MAIN RESULTS We included two randomised controlled trials involving 88 people. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than six months duration. After two years follow-up there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompressive surgery were not adequately described. AUTHORS' CONCLUSIONS Decompressive surgery is used for treating nerve damage in leprosy but evidence from randomised controlled trials does not show a significant added benefit of surgery over steroid treatment alone. Well-designed randomised controlled trials are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone.
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Affiliation(s)
- Natasja H J Van Veen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
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Nashed SG, Rageh TA, Attallah-Wasif ES, Abd-Elsayed AA. Intraneural injection of corticosteroids to treat nerve damage in leprosy: a case report and review of literature. J Med Case Rep 2008; 2:381. [PMID: 19068123 PMCID: PMC2615035 DOI: 10.1186/1752-1947-2-381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 12/09/2008] [Indexed: 11/10/2022] Open
Abstract
Introduction Nerve damage in leprosy patients leads to deformities and disabilities. Oral corticosteroids are given early to prevent permanent injury. We present a new approach to treat well-established nerve damage with local injection of corticosteroids. Case presentation A 60-year-old leprosy patient presented with right claw hand deformity secondary to right ulnar and median neuropathy. Monthly intraneural injection of corticosteroids resulted in improvement in sensory and motor function of his right hand over a 6-month period. Nerve conduction velocity testing documented the success of our therapy. Conclusion We report the first case of successful nerve regeneration in neglected neuropathy secondary to leprosy after local injection of corticosteroids. Intraneural extra-fascicular injection of corticosteroids improved the sensory and motor nerve function in our patient with borderline leprosy regardless of the duration of nerve function loss.
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Affiliation(s)
- Sherine G Nashed
- Public Health and Community Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
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van Brakel WH, Nicholls PG, Wilder-Smith EP, Das L, Barkataki P, Lockwood DNJ. Early diagnosis of neuropathy in leprosy--comparing diagnostic tests in a large prospective study (the INFIR cohort study). PLoS Negl Trop Dis 2008; 2:e212. [PMID: 18382604 PMCID: PMC2270341 DOI: 10.1371/journal.pntd.0000212] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 02/12/2008] [Indexed: 12/03/2022] Open
Abstract
Background Leprosy is the most frequent treatable neuromuscular disease. Yet, every year, thousands of patients develop permanent peripheral nerve damage as a result of leprosy. Since early detection and treatment of neuropathy in leprosy has strong preventive potential, we conducted a cohort study to determine which test detects this neuropathy earliest. Methods and Findings One hundred and eighty-eight multibacillary (MB) leprosy patients were selected from a cohort of 303 and followed for 2 years after diagnosis. Nerve function was evaluated at each visit using nerve conduction (NC), quantitative thermal sensory testing and vibrometry, dynamometry, monofilament testing (MFT), and voluntary muscle testing (VMT). Study outcomes were sensory and motor impairment detected by MFT or VMT. Seventy-four of 188 patients (39%) had a reaction, neuritis, or new nerve function impairment (NFI) event during a 2-year follow-up. Sub-clinical neuropathy was extensive (20%–50%), even in patients who did not develop an outcome event. Sensory nerve action potential (SNAP) amplitudes, compound motor action potential (CMAP) velocities, and warm detection thresholds (WDT) were most frequently affected, with SNAP impairment frequencies ranging from 30% (median) to 69% (sural). Velocity was impaired in up to 43% of motor nerves. WDTs were more frequently affected than cold detection thresholds (29% versus 13%, ulnar nerve). Impairment of SNC and warm perception often preceded deterioration in MF or VMT scores by 12 weeks or more. Conclusions A large proportion of leprosy patients have subclinical neuropathy that was not evident when only MFT and VMT were used. SNC was the most frequently and earliest affected test, closely followed by WDT. They are promising tests for improving early detection of neuropathy, as they often became abnormal 12 weeks or more before an abnormal monofilament test. Changes in MFT and VMT score mirrored changes in neurophysiology, confirming their validity as screening tests. Leprosy is the most frequent treatable disease of the peripheral nerves. Yet, every year, thousands of patients develop nerve damage as a result of leprosy. If this is detected and treated early, the prognosis is good. We conducted the largest prospective study on this topic to date to determine which test would detect nerve damage earliest. One hundred and eighty-eight leprosy patients were selected from centres in North India and followed for 2 years after diagnosis. Nerve function was tested at each visit using a battery of nerve function tests. A large proportion of the patients had or developed subclinical nerve damage that was not detected with the standard clinical tests (monofilaments and voluntary muscle testing). Sensory nerve conduction was the most frequently and earliest affected test, closely followed by the warm temperature perception test. They are promising tests for improving early detection of nerve damage, as they often became abnormal 12 weeks or more before the monofilament test became abnormal. Changes measured with the monofilament and voluntary muscle tests mirrored changes in more advanced electronic measures, confirming their validity as screening tests. These findings open the door to future improvement of the prognosis of nerve damage in leprosy.
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Meima A, Van Veen NHJ, Richardus JH. Future prevalence of WHO grade 2 impairment in relation to incidence trends in leprosy: an exploration. Trop Med Int Health 2008; 13:241-6. [DOI: 10.1111/j.1365-3156.2007.01996.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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van Veen NHJ, Schreuders TAR, Theuvenet WJ, Agrawal A, Richardus JH. Decompression surgery for treating nerve damage in leprosy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd006983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND Leprosy causes nerve damage which can result in nerve function impairment and disability. Corticosteroids are commonly used for treating nerve damage, although the long-term effect is uncertain. OBJECTIVES To assess the effects of corticosteroids on nerve damage in leprosy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Register, the Cochrane Central Register of Controlled Trials (Issue 4), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1980), LILACS (from 1982) in January 2006. We checked reference lists of the studies identified, the Current Controlled Trials Register (www.controlled-trials.com), conference proceedings and contacted trial authors. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of corticosteroids for nerve damage in leprosy. DATA COLLECTION AND ANALYSIS The primary outcome was improvement in sensory and motor nerve function after one year. Secondary outcomes were improvement in nerve function after two years, change in nerve pain and tenderness, and adverse events. Two authors independently extracted data and assessed trial quality. We contacted trial authors for additional information. We collected adverse effects and cost effectiveness information from the trials and non-randomised studies. MAIN RESULTS We included three randomised controlled trials involving 513 people. Two trials compared prednisolone with placebo. One trial treated mild sensory impairment of less than six months duration and the other trial treated nerve function impairment of 6 to 24 months duration. Both trials examined an effect twelve months from the start of treatment. There was no significant difference in nerve function improvement between people treated with prednisolone or with placebo. The third trial compared three corticosteroid regimens for severe type 1 reactions. This trial did not report the prespecified outcomes. However, after 12 months, a significantly higher proportion of individuals on a 3-month course of prednisolone required extra corticosteroids compared to the groups with a high-dose and low-dose regimen of five months duration. Diabetes and peptic or infected ulcer were sometimes reported as serious adverse events in the placebo-controlled trials, but not significantly more often in the corticosteroid than placebo groups. AUTHORS' CONCLUSIONS Corticosteroids are used for treating acute nerve damage in leprosy, but evidence from randomised controlled trials does not show a significant long-term effect. Randomised controlled trials are needed to establish their effectiveness, the optimal regimens and to examine new therapies.
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Affiliation(s)
- N H J Van Veen
- Erasmus MC, University Medical Center, Department of Public Health, PO Box 2040, Rotterdam, Netherlands, 3000 CA.
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Van Veen NHJ, Meima A, Nicholls PG, Smith WCS, Richardus JH. Corticosteroid interventions for treating nerve damage in leprosy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd005491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Penna GO, Martelli CMT, Stefani MMA, Macedo VO, Maroja MDF, Chaul A. Talidomida no tratamento do eritema nodoso hansênico: revisão sistemática dos ensaios clínicos e perspectivas de novas investigações. An Bras Dermatol 2005. [DOI: 10.1590/s0365-05962005000600010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: A hanseníase persiste como problema de saúde pública, e episódios de ENH são eventos agudos que ocorrem antes, durante e após PQT. Na última década, o uso da talidomida como agente imunomodulador foi expandido a outras doenças. OBJETIVOS: realizar revisão sistemática dos ensaios clínicos publicados sobre a eficácia e efeitos colaterais da talidomida no ENH. Descrever metodologia e resultados da triagem para recrutamento de ensaio clínico visando avaliar dose-resposta da talidomida seguida de desmame no ENH moderado e grave, realizado no Brasil. MÉTODOS: Analisaram-se ensaios publicados sobre talidomida no ENH. Foi delineado um ensaio clínico duplo-cego randomizado para avaliar dose de 100 thalid 300mg/dia de talidomida durante fase aguda de ENH, seguida de desmame da talidomida, thalid placebo. Para este ensaio clínico descreve-se metodologia e dados de recrutamento de pacientes, com ênfase na gravidade dos episódios de ENH. RESULTADOS: Os seis ensaios clínicos publicados nas décadas de 1960 e 1970 apontam para o benefício da talidomida no ENH, embora diferenças metodológicas dificultem a comparação. Na fase de recrutamento do ensaio brasileiro, dos 143 pacientes de ENH triados, 65% eram potencialmente elegíveis. A associação com neurite em 56,4% dos ENH moderados e graves exigiu co-intervenção com corticosteróide. CONCLUSÃO: O padrão de recrutamento dos pacientes evidenciou alta freqüência de neurite nos episódios de ENH. O esquema de talidomida isolada no ENH foi avaliado como infreqüente na prática clínica brasileira. O desafio atual é acumular evidências sobre a eficácia e efeitos colaterais da talidomida em associação com corticosteróides.
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Pimentel MIF, Nery JADC, Borges E, Rolo R, Sarno EN. Neurite silenciosa na hanseníase multibacilar avaliada através da evolução das incapacidades antes, durante e após a poliquimioterapia. An Bras Dermatol 2004. [DOI: 10.1590/s0365-05962004000200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
FUNDAMENTOS: A neurite silenciosa é definida como deterioração da função nervosa na ausência de dor neural, diferenciando-se da neurite franca, em que ocorre dor no nervo periférico, com ou sem prejuízo da função nervosa. Sua detecção precoce é importante para tentar impedir o estabelecimento de seqüelas decorrentes da hanseníase. OBJETIVOS: Conhecer a freqüência das neurites silenciosas em portadores de formas multibacilares de hanseníase. MÉTODOS: Cento e três pacientes (18,4% BB, 47,6% BL e 34% LL) foram acompanhados durante o período médio de 64,6 meses a partir do momento do diagnóstico, durante e após a poliquimioterapia, por meio da avaliação do grau de incapacidade. RESULTADOS: Foram analisados doentes que tiveram piora do grau de incapacidade no término de tratamento, ou ao fim do seguimento, em relação ao grau manifestado antes do tratamento ou no término do tratamento medicamentoso. Ao todo, pelo menos cinco pacientes (4,9% do total) evoluíram com neurite silenciosa, durante ou após a poliquimioterapia. CONCLUSÃO: Preconiza-se exame neurológico seqüencial cuidadoso dos pacientes multibacilares, de modo a detectar e tratar precocemente a neurite silenciosa.
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Vishwanath G, Sadhotra LP, Singh M, Bhandari PS, Chari K. ISOLATED RADIAL NERVE INVOLVEMENT IN LEPROSY. Med J Armed Forces India 2001; 57:237-8. [PMID: 27365607 PMCID: PMC4925063 DOI: 10.1016/s0377-1237(01)80052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- G Vishwanath
- Classified Specialist (Surgery), Command Hospital (Southern Command), Pune-411 040
| | - L P Sadhotra
- Senior Advisor (Surgery & Reconstructive Surgery), Command Hospital (Southern Command), Pune-411 040
| | - M Singh
- Classified Specialist (Surgery & Reconstructive Surgery), Command Hospital (Southern Command), Pune-411 040
| | - P S Bhandari
- Classified Specialist (Surgery), Command Hospital (Southern Command), Pune-411 040
| | - K Chari
- Senior Advisor (Dermatology & Venereology), Command Hospital (Southern Command), Pune-411 040
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