Functional biomarker signatures of circulating T-cells and its association with distinct clinical status of leprosy patients and their respective household contacts

BACKGROUND

Leprosy is a chronic infectious disease classified into two subgroups for therapeutic purposes: paucibacillary (PB) and multibacillary (MB), closely related to the host immune responses. In this context it is noteworthy looking for immunological biomarkers applicable as complementary diagnostic tools as well as a laboratorial strategy to follow-up leprosy household contacts.

METHODS

The cross-sectional study enrolled 49 participants, including 19 patients and 30 healthy controls. Peripheral blood mononuclear cells (PBMC) were isolated and incubated in the presence of Mycobacterium leprae bacilli. The cells were prepared for surface (CD4+ and CD8+) and intracytoplasmic cytokine staining (IFN-γ, IL-4 and IL-10). Multiple comparisons amongst groups were carried out by ANOVA, Kruskal-Wallis, Student T or Mann-Whitney test. Comparative analysis of categorical variables was performed by Chi-square. Functional biomarker signature analysis was conducted using the global median values for each biomarker index as the cut-off edge to identify the proportion of subjects with high biomarker levels.

RESULTS

The cytokine signature analysis demonstrated that leprosy patients presented a polyfunctional profile of T-cells subsets, with increased frequency of IFN-γ+ T-cell subsets along with IL-10+ and IL-4+ from CD4+ T-cells, as compared to health Controls (Venn diagram report). Moreover, statistical analysis was carried out using parametric or non-parametric variance analysis followed by pairwise multiple comparisons, according to the data normality distribution. L(PB) displayed a polyfunctional profile characterized by enhanced percentage of IFN-γ+, IL-10+ and IL-4+ produced by most T-cell subsets, as compared to L(MB) that presented a more restricted cytokine functional profile mediated by IL-10+ and IL-4+ T-cells with minor contribution of IFN-γ produced by CD4+ T-cells. Noteworthy was that HHC(MB) exhibited enhanced frequency of IFN-γ+ T-cells, contrasting with HHC(PB) that presented a cytokine profile limited to IL-10 and IL-4.

CONCLUSIONS

Our data demonstrated that L(PB) displayed enhanced percentage of IFN-γ+, IL-10+ and IL-4+ as compared to L(MB) that presented functional profile mediated by IL-10+ and IL-4+ T-cells and HHC(MB) exhibited enhanced frequency of IFN-γ+ T-cells, contrasting with HHC(PB). Together, our findings provide additional immunological features associated with leprosy and household contacts. These data provide evidence that biomarkers of immune response can be useful complementary diagnostic/prognostic tools as well as insights that household contacts should be monitored to access putative subclinical infection.

Evaluation of the cutaneous sensation of the face in patients with different clinical forms of leprosy

Background

Leprosy can be considered to be the most common peripheral neuropathy of infectious etiology and constitutes a public health problem. The standard routine examination for assessing sensory impairment in leprosy neuropathy basically evaluates hands, feet and eyes. However, evaluation of facial cutaneous sensation is not routinely performed.

Objectives

The aim of this study was to evaluate facial cutaneous sensation in patients with different clinical forms of leprosy and compare the findings with those from healthy individuals.

Methodology

19 healthy controls and 71 leprosy patients who were being treated at a national reference center for leprosy in Brazil underwent facial sensation assessment using the Semmes-Weinstein monofilament test. This test was applied over the facial areas corresponding to the ophthalmic, maxillary and mandibular distal branches of the trigeminal nerve.

Results

The predominant clinical form in terms of changes to facial cutaneous sensation was lepromatous leprosy (LL), followed by the borderline-borderline (BB), and borderline-lepromatous (BL) forms, in comparison with healthy individuals. The distal branches most affected were the zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was asymmetrical sensory impairment of the face in 62.5% (20/32) of the cases.

Conclusion

The face is just as impaired in leprosy as are the feet, hands and eyes, but facial impairment is underdiagnosed. Our evaluation on the different sensory branches and evidence of asymmetrical impairment of the face confirm the classically described pattern of leprosy neuropathy, i.e. consisting of asymmetrical and predominantly sensory peripheral neuropathy.

Relationship between bacilloscopy and operational classification of Hansen's disease in patients with reactions

Leprosy can be classified according to its operational form as paucibacillary or multibacillary. Bacilloscopy integrates its diagnostic armamentarium. Patients with the disease may present leprosy reactions. This study describes the association of bacilloscopy results and the type of operational classification of leprosy in patients with leprosy reactions. Medical records were analyzed at a reference center between 2010 and 2015. Reactions occurred in almost half of the patients, making their identification important. The bacilloscopic and operational characterization indicates a greater occurrence of leprosy reactions in patients with positive bacilloscopy and also in multibacillary.

[Retrospective Study of Leprosy in Togo (2000-2014): about 2,630 cases]

The aim of this retrospective study carried out from January 2000 to December 2014 was to determine and map the epidemiological evolutionary trends and the clinical forms of leprosy cases notified in Togo. All the 2,630 new leprosy cases notified by all districts to the National Leprosy/Buruli Ulcer Control Program (PNLLUB-Togo) were included. The mean annual incidence was 175 cases with extremes of 73 to 266 cases. The median age of patients was 40 years, and the sex-ratio was 1.13. Children aged 0 to 15 accounted for 5.5% of the cases. The plateau region in the center of the country had the highest annual incidence (around 800 cases). Multibacillary forms accounted for 74.2% of cases. All patients were treated with multidrug therapy (MDT). WHO grade 2 disease was found in 15% of patients and 9.5% were lost to follow-up. Our results confirm that leprosy is no longer a major public health problem in Togo. However, the high incidence of leprosy in some areas of the country, could permit a resurgence of the disease.

[Leprosy – an old infectious disease with unsolved matters]

Leprosy is a chronic disease with many clinical manifestations, which affect mainly the skin, the peripheral nerves, mucosa of the upper respiratory tract and the eyes. Although global elimination of leprosy was achieved globally in the year 2000 and the disease is actually rare in most parts of the world, a low but constant number of more than 200,000 new cases are still registered each year. Leprosy is caused by two acid-resistant, slow multiplying Gram-positive bacteria, i. e., Mycobacterium leprae and the recently discovered M. lepromatosis. The transmission routes of these pathogens are not completely understood. All forms of leprosy can be treated with long-lasting antibacterial combination therapy using dapsone and rifampicin and – in cases of multibacillar leprosy – clofazimin. Using this multi-drug approach, leprosy has been shown to be curable in most cases. However, immunological sequelae (leprosy reactions), which may appear during therapy or even several years later, are frequently difficult to treat. Although leprosy has been eliminated in most countries, its complete eradication is extremely unlikely.

Is the WHO disability grading system for leprosy related to the level of functional activity and social participation?

To investigate the relationship between the WHO disability grading system for leprosy with the limitations to perform daily functional activities and the decrease in social participation in participants with leprosy. Participants with a diagnosis of leprosy were recruited at the dermatology ambulatory clinic of the University Hospital of Sergipe. In order to investigate the association of WHO disability grading system for leprosy with activities of daily living measured with the Screening Activity Limitation and Safety Awareness (SALSA) scale and with the social participation (P-scale), we performed an analysis with the Kruskal-Wallis test and the Spearman coefficient. Thirty-six patients diagnosed with leprosy participated in the study. Most of participants had mild to moderate daily activity limitations and 58% of participants did not have any restriction participation. The findings demonstrated that the WHO grading is associated with the level of activity (P < 0·0001; p = 0·58), but not with the level of participation (P <0·05; p = 0·27). Although the WHO grading system is used in Brazil and worldwide as an epidemiological indicator to explain the burden of leprosy, the results of this study demonstrated that in our sample the WHO grading system was not associated with participation. Participation is a complex construct with the influence of different psychosocial factors. In order to determine social participation damage of infectious diseases such as leprosy, it is necessary to develop new index of classification based on a broader definition of disability. Health professionals should consider the international classification of function and health (ICF) to develop such index.

Leprosy type 1 reaction (formerly reversal reaction)

Nerve damage leading to impairment and permanent disability is the major problem in the course of a leprosy infection. Most of the damage occurs during two types of leprosy reactions, type 1 reaction (T1R) and type 2 reaction (T2R). Timely and adequate treatment may prevent this damage. Particular T1R reactions, however, are often diagnosed too late and are even missed. Clinical symptoms and warning signs are therefore covered, as are the immunology and pathophysiology of nerve damage. The differences between upgrading and downgrading, old terms but still relevant, are explained. Methods to detect reactions and to monitor their treatment are given. Triggering factors, the mechanisms of the reactions, including autoimmunity, and the presence of physical compression are discussed. Treatment over the years is placed in its context, and based on this information a treatment schedule is recommended.

Description of leprosy classification at baseline among patients enrolled at the uniform multidrug therapy clinical trial for leprosy patients in Brazil

The uniform multidrug therapy clinical trial, Brazil (U-MDT/CT-BR), database was used to describe and report the performance of available tools to classify 830 leprosy patients as paucibacillary (PB) and multibacillary (MB) at baseline. In a modified Ridley and Jopling (R&J) classification, considering clinical features, histopathological results of skin biopsies and the slit-skin smear bacterial load results were used as the gold standard method for classification. Anti-phenolic glycolipid-I (PGL-I) serology by ML Flow test, the slit skin smear bacterial load, and the number of skin lesions were evaluated. Considering the R&J classification system as gold standard, ML Flow tests correctly allocated 70% patients in the PB group and 87% in the MB group. The classification based on counting the number of skin lesions correctly allocated 46% PB patients and 99% MB leprosy cases. Slit skin smears properly classified 91% and 97% of PB and MB patients, respectively. Based on U-MDT/CT-BR results, classification of leprosy patients for treatment purposes is unnecessary because it does not impact clinical and laboratories outcomes. In this context, the identification of new biomarkers to detect patients at a higher risk to develop leprosy reactions or relapse remains an important research challenge.

Clinico-Histopathological Correlation of Skin and Nerve in Leprosy

The histopathological features of skin tissue sections in patients clinically diagnosed as leprosy were correlated with the histopathological features of nerve specimens obtained from the same patients. Fifty untreated leprosy patients attending the Outpatient Department of the Department of Dermatology and Sexually Transmitted Diseases of Smt. Sucheta Kriplani and Kalawati Saran Children's Hospitals, New Delhi, India were included in the study. On correlating the histological features of skin and nerve tissue sections, concordant findings were found in 24 out of the 50 patients (48%) but discordance between the histopathological features of skin and nerve tissue sections were found in 26 out of 50 cases (52%). Of these 26 cases, the nerve tissue histology when compared with the skin histology showed features lower down the disease spectrum in 17 (34%) cases. Seven of the 50 patients (14%) showed histological features of leprosy higher in the disease spectrum in the nerve tissue sections than in the skin biopsy sections. One patient clinically LL leprosy demonstrated histopathological features of Histoid leprosy in the skin sections and LL in the nerve sections. The remaining one patient had features of TT leprosy in the skin tissue sections while the nerve tissue histopathology showed non-specific changes. Histological features of the skin tissue sections were consistent with the clinical diagnosis in 33 out of 50 cases (66%). When the clinical groups were correlated with the histological features of the nerve tissue sections, concordance was found in 30 of the 50 cases (60%). On comparison of the histological features of skin and nerve tissue sections with the clinical diagnosis, concordance was still lower i.e., 19 out of 50 cases (38%). Thus the histological features of the skin tissue sections correlated more frequently with the clinical diagnosis than did those of the nerve sections. The importance of neural histology lies in the fact that it shows a higher BI and a lower histological grading in some cases and if not performed the lapse can result in inadequate treatment, drug resistance and even relapse.

Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease.

Correlation of clinical and histopathological classification of leprosy in post elimination era

Clinical and histopathological correlative study was carried out in 171 cases of leprosy using the criteria laid down by Ridley and Jopling. There was male preponderance in the study with majority of patients (35.7%) in the age goup of 21-30 years. The overall concordance between the clinical and histopathological diagnosis was 57.3%. Maximum concordance was seen in the polar ends of the spectrum with 76.9% in LL and 75.0% in TT. The concordance rate was lower in the borderline groups with 57.3% in BT, 40.0% in BL and least concordance of 16.7% in BB. However the concordance for IL was higher than the borderline groups with 66.7%. Cases in borderline group are in continuously changing immunological spectrum. Histological classification because of its definitive features gives a better indication than clinical classification for any recent shift of a case in the spectrum. Therefore skin biopsy should be done in all cases for correct classification of leprosy.

Clinico histopathological correlation in leprosy

INTRODUCTION

Leprosy is a chronic infectious disease caused by M. leprae, which presents in different clinico-pathological forms, depending upon the immune status of the host. Clinical classification gives recognition only to gross appearances of the lesions, whereas the parameters used for the histopathological classification are well defined, precise, and also take into account the immunological features.

RESULTS

Of the 182 suspected cases of leprosy which were biopsied, the clinical diagnosis was TT in 32 (17.5%), BT in 70 (38.4%), BB in 5(2.7%), BL in 24 (13.1%), LL in 23 (12.6%), and indeterminate in 28 (15.3%) cases. Of the 182 cases, which were biopsied, only 136 (74.7%) showed histological features consistent with any one type of leprosy. The overall clinicohistological correlation was 74.7 percent. A comparison of the histopathological pattern with that of clinical pattern revealed that the maximum correlation was seen with LL (84.2%), followed by BL (73.3%), BT (64.1%), TT (56%), BB, and IL (50%).

CONCLUSION

Because there is some degree of overlap in different types of leprosy, especially the unstable forms, the correlation can be made more accurate by combining clinical and histopathological features.

Clinicohistopathological concordance in leprosy - a clinical, histopathological and bacteriological study of 100 cases

Leprosy is a treatable chronic infectious disease, prevalent in South Asian countries, especially India. Before labeling a patient as a case of leprosy and starting multidrug treatment for particular type, the clinical findings should be correlated and confirmed with histopathological examination and bacteriological index of skin biopsy. Skin biopsy is an important tool in diagnosing leprosy and determining the type of leprosy. In the present study, one hundred untreated clinically diagnosed cases of leprosy were studied according to Ridley-Jopling scale for confirmation of diagnosis and classification of leprosy. The study was done by routine H & E (Haematoxylin & Eosin) staining and Fite-Faraco's staining for acid-fast bacillus. The data pertaining to age, sex, clinical and histopathological classification of the type of leprosy were collected and analyzed. In analyzing the histopathology of a lesion, special attention was given to the following features, viz., invasion of the epidermis with or without erosion, involvement of the sub-epidermal zone, character and extent of granuloma, density of lymphocytic infiltrate epithelioid cells and other cellular elements, nerve involvement and the presence of Mycobacterium leprae. Histological diagnosis of leprosy was established in 98% of clinically diagnosed cases. Clinicohistopathological concordance was maximum in LL(93.75%) followed by BL(87.5%), TT(78.5%), BT(73.8%) and least in IL(27.78%). Overall, it was 60.23%. Indeterminate type of leprosy was diagnosed more on histologythan on clinical evaluation.

Childhood leprosy in a tertiary-care hospital in Delhi, India: a reappraisal in the post-elimination era

OBJECTIVE

To assess the profile and describe the clinical presentations, clinico-histopathological profile, complications and treatment compliance of childhood leprosy at a tertiary care hospital in north-east district of Delhi during 2000-2009.

DESIGN

A retrospective institutional study of children less than 14 years of age diagnosed with leprosy and registered in a leprosy clinic during 2000-2009. Demographic, clinical, investigative and treatment data was extracted from a pre-designed proforma.

RESULTS

A total of 1790 cases of leprosy were registered during this period, of which 172 (9.6%) were children. The majority of patients (70.3%) were more than 11 years of age with a male preponderance. History of contact was present in 25 (14.5%) patients. Borderline tuberculoid (BT) was the commonest clinical type (70.3%) followed by tuberculoid (TT) seen in 5.8%, mid-borderline (BB) in 1.2%, borderline lepromatous (BL) in 9.9%, lepromatous (LL) in 4.1%, pure neural (PNL) in 4.6% and indeterminate in 4.1% cases. More than half (52.9%) patients had a single lesion. Nerve thickening was detected in 70% cases. Slit skin smears were positive in 34 (19.8%) patients. Eighty-nine (51.7%) children were classified as multibacillary (MB) and 83 (48.3%) as paucibacillary (PB) disease by NLEP criteria. Of the available biopsy records, clinico-histological correlation was observed in 130/151 (86.1%) patients. Lepra reactions were observed in 32 patients (18.6%), Type I in 29 cases and Type II in three cases. Neuritis occurred in 11 (6.4%) and deformities in 22 (12.8%) patients. Thirty-four (19-8%) children defaulted from treatment. Two patients relapsed.

CONCLUSIONS

Despite the statistical elimination of leprosy in this region, childhood leprosy cases continue to present in alarming numbers. Our study confirmed that multibacillary disease and the complications of lepra reactions and deformities remain common in children. Early detection, treatment and contact tracing may be important reducing the burden of leprosy in the community. There is a need to continue leprosy control activities with full vigour even in areas where, statistically, it has been eliminated.

A case of leprosy with multiple cranial neuropathy mimicking Melkerson Rosenthal syndrome

Involvement of cranial nerves is not uncommon in leprosy with trigeminal and facial nerves being commonly affected. Other cranial nerves can also be involved especially in longstanding cases of leprosy towards the lepromatous pole. Herein, we report a case of leprosy with multiple cranial neuropathy mimicking Melkerson Rosenthal syndrome.

[Clinical aspects of leprous neuropathy]

For the last 5 years, not a single new case of leprosy has been reported among native Japanese people, but several new cases of leprosy have been reported every year among foreigners in Japan. Because most leprosy patients consult doctors not for skin rashes but for the neurological symptoms of leprous neuropathy, every neurologist should be well aware of the clinical features of leprous neuropathy. The finding that the clinical pictures of leprous neuropathy differ greatly between patients from the main Japanese islands and those from Okinawa is of clinical importance the former comprise the lepromatous type while the latter are of the borderline group. The clinical features of leprous neuropathy among people from leprosy-prone areas in the world wide are usually of the tuberculoid type or of the borderline group. Further, the clinical pictures of each type of leprous neuropathy are so distinct that these conditions can be diagnosed with the simple classical neurological examination. One of the most important issues in managing leprosy patients with neurological deficits is protection of the areas of analgesia caused by leprous neuropathy from injuries or burns. Protection against entrapment neuropathies of thickened peripheral nerve trunks, which are quite likely to be compressed during various activities of daily living, is also important.

Nitric oxide metabolites in sera of patients across the spectrum of leprosy

Leprosy, a chronic infectious disease, caused by Mycobacterium leprae infection, manifests itself as a clinical spectrum depending on the patients' immunological response, finally leading to peripheral nerve damage and deformities in the patients. Nitric oxide (NO) which is known to contribute to pathogenesis of several neurological diseases has been detected in tissues and urine of leprosy patients. This is the first study assessing NO as its stable end products, nitrites and nitrates, in sera of patients across the spectrum of the disease as a possible parameter of prognostic value. Comparison of NO metabolites showed a significant increase in multibacillary patients and patients with type I reactions as compared to healthy control individuals. These levels reduced significantly after treatment. This study has further borne out the utility and reliability of the cadmium-reduction method of estimation of NO metabolites--a relatively inexpensive procedure that lends itself to large-scale screening and follow-up of patients.

Limitations of clinico-histopathological correlation of skin biopsies in leprosy

BACKGROUND

Skin biopsies play an important role in diagnosing and classifying different types of leprosy. The aim of this study was to analyse different histologic types of leprosy, to correlate histopathological diagnosis with clinical diagnosis, to study the uniformity of clinical and histological findings in the diagnosis of leprosy and to evaluate difficulties faced during clinicopathological correlation according to Ridley- Jopling classification due to inadequacy of data provided.

METHODS

This is a retrospective study of all skin biopsies reported from Department of Pathology of Tribhuvan University Teaching Hospital from 14 April 2007 to 13 April 2009, for which leprosy was the diagnosis or was strongly suspected on histopathology.

RESULTS

Out of 40 cases included, 33 were males and seven were females. Tuberculoid leprosy was the most common type comprising 23 /40 cases (57.5%). In 18/ 40 cases (45%), clinical diagnosis was leprosy. Only in three, leprosy was classified according to Ridley-Jopling criteria clinically. Thus clinicopathological correlation according to Ridley-Jopling criteria could not be done. Histopathological reporting lacked uniformity too. In 13/40 reports (32.5%), exact location of granuloma, presence or absence of Grenz zone and enroachment of epidermis by granuloma was not mentioned. None mentioned the number and distribution of lymphocytes or relative proportion of epithelioid cells and foamy histiocytes. Results: Out of 40 cases included, 33 were males and seven were females. Tuberculoid leprosy was the most common type comprising 23 /40 cases (57.5%). In 18/ 40 cases (45%), clinical diagnosis was leprosy. Only in three, leprosy was classified according to Ridley-Jopling criteria clinically. Thus clinicopathological correlation according to Ridley-Jopling criteria could not be done. Histopathological reporting lacked uniformity too. In 13/40 reports (32.5%), exact location of granuloma, presence or absence of Grenz zone and enroachment of epidermis by granuloma was not mentioned. None mentioned the number and distribution of lymphocytes or relative proportion of epithelioid cells and foamy histiocytes.

CONCLUSIONS

Histopathological diagnosis of leprosy did not correlated with clinical diagnosis significantly. Uniformity was not seen in the clinical or histopathological informations provided making it difficult to conduct retrospective clinico pathological correlation.

Study of leprosy in children

Leprosy, a disease as oId a mankind, has been a public health problem in many developing countries and among children, it reflects disease transmission in the community and efficiency of control programmes study on childhood leprosy was carried out Gandhi Hospital, spread over 4 years. There were 32 children among 280 diagnosed cases of leprosy. The study revealed an incidence of 11.43% among leprosy patients with more number of boy being affected than girls. Most of children presented with hypopigmented anaesthetic patches. Hansen's BT was the most common clinical type of leprosy with extremities being the common site of involvement. Slit-skin smear was positive in 25% of children. We could find significant positive clinico-pathological correlation among 12 children who were subjected to biopsy. Reactional states and deformites were less common in our study.

Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey

BACKGROUND

The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold.

OBJECTIVE

Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon.

METHODS

The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used.

RESULTS

A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991. From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland.

CONCLUSION

Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

Childhood leprosy in Essimbiland of Cameroon: results of chart review and school survey

BACKGROUND

The WHO targeted to eliminate leprosy from the world as a public health problem by reducing the prevalence to less than 1 case per 10000 population based on the use of multi-drug therapy (MDT). Despite the success of MDT, endemic pools still exist in some countries that have attained the national elimination threshold.

OBJECTIVE

Assess the burden of childhood leprosy and control efforts in Essimbiland of Cameroon.

METHODS

The records of children patients were reviewed in two main primary health care institutions and 4 primary schools in Essimbiland having 459 pupils were surveyed for leprosy. A purposive sampling of all available registers and pupils was used.

RESULTS

A total of 1129 case files were reviewed covering the periods before MDT (1961-1967) implementation in 1982 and post MDT (1982-1999); no records were available from 1968-1991.From chart review, 42 (23.3%) new leprosy cases from 1961-1967 and 35 (12.2%) from 1982-1998 were from the Mbingo leprosarium. 31 (39.7%) of 78 childhood leprosy cases from chart review [1961-1967 and 1982-1999] were from Essimbiland. Of the 35 incident childhood leprosy cases from 1982-1998, 24 (68.6%) were from Essimbiland compared to other divisions. Poor record - keeping on leprosy was common in the study area. Among 459 pupils surveyed in 4 primary schools, 6 (1.3%) new leprosy cases were identified giving a prevalence of 131 per 10,000 pupils. The common skin lesion was on the back but one pupil had both hands clawed. 16 (3.5%) pupils were placed on observation. All the new leprosy cases from the school survey were indigenes of Essimbiland.

CONCLUSION

Childhood leprosy is a public health problem in the Essimbiland requiring school surveys and a house-to-house search for new cases.

Impact of integration on the profile of newly diagnosed leprosy patients attending a referral hospital in South India

This article compares the clinical profile of new untreated leprosy patients attending a referral hospital (The Schieffelin Institute for Health Research & Leprosy Centre, formerly known as SLR&TC, Karigiri, South India, in post-integration period (2005-2007) with that during the pre-integration period (1995-1996). A total of 529 patients--259 in pre-integration and 270 in post-integration period--were seen at this hospital. The clinical data culled from records for the earlier period were compared with data gathered prospectively for the latter period and was analyzed using SPSS software. The results showed a significant increase in the mean age of registration, percent multibacillary (clinical criteria) and grade 2 diabilities in post-integration period. Increase in proportion of cases with grade 2 deformities is a matter of concern and suggests continued need for referral hospitals for their management and also population based overall assessment whether actual numbers with deformities have increased or it is peculiar to a tertiary care hospital where the cases with problems may be coming. As the proportion of bacteriological positive cases was not found to change, it is a positive sign of effective coverage in the post-integration scenario in this population.

Development and validation of a severity scale for leprosy type 1 reactions

Objectives

To develop a valid and reliable quantitative measure of leprosy Type 1 reactions.

Methods

A scale was developed from previous scales which had not been validated. The face and content validity were assessed following consultation with recognised experts in the field. The construct validity was determined by applying the scale to patients in Bangladesh and Brazil who had been diagnosed with leprosy Type 1 reaction. An expert categorized each patient's reaction as mild or moderate or severe. Another worker applied the scale. This was done independently. In a subsequent stage of the study the agreement between two observers was assessed.

Results

The scale had good internal consistency demonstrated by a Cronbach's alpha >0.8. Removal of three items from the original scale resulted in better discrimination between disease severity categories. Cut off points for Type 1 reaction severities were determined using Receiver Operating Characteristic curves. A mild Type 1 reaction is characterized using the final scale by a score of 4 or less. A moderate reaction is a score of between 4.5 and 8.5. A severe reaction is a score of 9 or more.

Conclusions

We have developed a valid and reliable tool for quantifying leprosy Type 1 reaction severity and believe this will be a useful tool in research of this condition, in observational and intervention studies, and in the comparison of clinical and laboratory parameters.

Leprosy is caused by a bacterium and is curable with a combination of antibiotics known as multi-drug therapy which patients take for six or 12 months. However, a significant proportion of leprosy patients experience inflammation in their skin and/or nerves which may occur even after successful completion of multi-drug therapy. These episodes of inflammation are called leprosy Type 1 reactions. Type 1 reactions are an important complication of leprosy because they may result in nerve damage which leads to disability and deformity. Type 1 reactions require treatment with immunosuppressive agents such as corticosteroids. The severity of Type 1 reactions varies with time, treatment and between individuals. We have developed a clinical severity scale to measure the severity of Type 1 reactions. The scale has three sections. The first measures the involvement of the skin using the number of affected skin lesions, the degree of inflammation of those lesions and the presence of swelling of the hands, feet or face. The second section is a measurement of the sensory function of the nerves supplying the eyes, hands and feet by assessing a patient's ability to feel graded nylon fibres. The third section uses a standard measure of muscle power to assess motor function of the nerves of the face, hands and feet. The clinical severity scale we have developed will facilitate the study of Type 1 reactions and enable direct comparison between different studies. This will improve the management of this disabling complication of leprosy.

Leprosy type 1 (reversal) reactions and their management

The type of leprosy that affects an individual depends on the immune response mounted against the organism. This leads to a spectrum of disease which may be complicated by immunological phenomena called reactions. Antimicrobial chemotherapy is effective in treating the Mycobacterium leprae infection but up to 30% of individuals with borderline disease experience Type 1 reactions (T1Rs). T1Rs are immunologically mediated episodes, localised in skin and nerves, which are a major cause of nerve function impairment. Nerve function impairment may result in disability and deformity. We review the frequency and features of Type 1 reactions. The data from the limited number of randomised controlled trials of treatment are discussed. These four randomised controlled trials were all conducted in south Asia. The accepted treatment of T1Rs is with oral corticosteroids but there is no consensus about the dose or duration of treatment due to the lack of data. One randomised controlled trial showed that patients treated with a 5 month course of prednisolone (total dose 2.31 g) were less likely to need additional prednisolone than those treated with a 3 month course of prednisolone (total dose 2.94 g). This study did not use nerve function as an outcome measure. The improvement in nerve function impairment with steroid treatment is highly variable, with 33-73% of nerves recovering fully. Optimal steroid regimes and alternative treatments need to be identified if the disability associated with leprosy is to be minimised. Search strategy Papers for this review were identified by repeated searches of the Cochrane Clinical Trials Register, PubMed and LILACS with various combinations of the following search terms 'leprosy', 'lepra', 'reaction', 'steroids', 'corticosteroids', 'reversal', 'Type 1', 'Hansen*'. Searches were complete to the end of November 2008.

Detection and classification of leprosy: future needs and strategies

This paper focuses on the obstacles and dilemmas in detection and classification of leprosy cases and suggested strategies for the same. This review attempts to raise some cardinal issues within leprosy diagnosis and the need for capacity building at clinical and field level in light of research conducted. It also recommends strategies to overcome these obstacles.

Methods for the Classification of Leprosy for Treatment Purposes

The World Health Organization advocates 2 leprosy treatment regimens on the basis of disease classification (as multibacillary or paucibacillary) by skin lesion count. This method, which, in the Philippines, results in a high prevalence (78%) of patients with multibacillary leprosy, was directly compared with classification using standard histopathological and microbiological criteria in 264 currently untreated patients with leprosy. Of those whose leprosy was classified as paucibacillary, 38%-51% of patients had multibacillary leprosy according to classic criteria and were thus at risk of undertreatment according to World Health Organization recommendations.

Observations on reactions of leprosy in the field

In order to assess the incidence of reaction in leprosy, it would be necessary to examine the data from a field control unit. In this study, it was found, at a fully monitored control unit, that Type I reaction occurred in 3.9% of borderline cases and Type II in 23.7% of LL and BL cases. Even so, the load of reaction is not high since reaction of Type I and Type II together are seen only in 3.7% of all types of cases. A majority of them are of mild or moderate degree and could be treated as out-patients. Of the borderline cases, the BB type showed maximum rate of reaction. The BL type can present with both Type I and Type II reactions with a total incidence of 12.8%. While the BT type constituted 74% of total cases, reaction of Type I occurred in 3.1% of cases. Reaction also occurred in 0.8% of RFT cases.

Fine needle aspiration cytology in reactional and non-reactional leprosy

BACKGROUND

Histopathological evaluation of skin lesions is not feasible in many leprosy endemic areas. Fine needle aspiration cytology (FNAC) is a simpler tool compared to histopathology for the evaluation of the cytomorphology of skin lesions.

AIMS

To study the cytomorphology of leprosy lesions in fine needle aspirates and correlate it with the histopathology.

METHODS

Seventy leprosy patients diagnosed and classified according to Ridley Jopling scale were included. Fine needle aspirates were taken from the lesion followed by a skin biopsy from the same site for histopathological examination after H/E staining.

RESULTS

Borderline leprosy patients with Type I reaction showed significantly large numbers of giant cells, collagen and elastin in their smears as compared to those without reaction. The smears were more heavily cellular with fragmented collagen and elastin along with significant increase in neutrophils in patients with Type II reaction while foamy macrophages with fatty background were common in non-reactional lepromatous leprosy patients. A complete correlation between histopathological and cytomorphological findings was observed in 77.3% of cases.

CONCLUSION

FNAC may be used as an alternative tool to assess leprosy lesions in areas where histopathological services are not readily available.

Evaluation of leprosy patients with 1 to 5 skin lesions with relevance to their grouping into paucibacillary or multibacillary disease

BACKGROUND

Patients with 1 to 5 skin lesions are arbitrarily categorized as belonging to the paucibacillary (PB) group for treatment purposes. With the decreasing prevalence of leprosy in India and modifications in leprosy program, the relevance of this grouping needs further study.

AIMS

To study a group of leprosy patients with 1 to 5 skin lesions and compare the clinical parameters with histopathological findings and bacteriological status of the skin and nerve to evaluate the relevance of this grouping.

METHODS

Seventy seven patients of leprosy with 1 to 5 skin lesions were included in the study. The number of skin lesions was recorded. Slit skin smears (SSS) and skin biopsies were taken in all patients and nerve biopsy was performed in 19 of them. The biopsies were evaluated for the type of pathology and AFB status.

RESULTS

In these 77 patients (single skin lesions, 42; two lesions, 18; three lesions, 10; four lesions, 5; and five lesions, 2 patients) the clinical classification was indeterminate leprosy (IL) in 4, tuberculoid leprosy (TT) in 4 patients and borderline tuberculoid leprosy (BT) in 69 patients. Skin smears were positive only in 1 patient. The histological diagnoses in the skin were IL in 13, TT in 3, BT in 48 and borderline lepromatous (BL) in 4 patients. Acid-fast bacilli (AFB) were found in 14 out of 77 skin biopsies. Of the 19 nerve biopsies, 17 showed histological features of BT leprosy; of these, 12 demonstrated AFB on Fite staining. The bacillary index of granuloma (BIG) ranged from 1+ to 2+. The clinico-histopathogical correlation was 63% in the BT group, with 4 patients of this group showing features of BL on histopathology. When the presence of AFB was assessed, the percentage of positivity was 1.3% in SSS, 18% in skin biopsies and 63% in nerve biopsies.

CONCLUSION

Our results point to the non-homogeneous nature of this group of leprosy patients with 1 to 5 skin lesions, with varied bacteriological and histopathological features. The significance of MB type findings on histopathology in patients grouped as PB leprosy should be resolved so that these patients may be given the drug therapy and the duration of therapy they warrant.

Use of protein microarrays to define the humoral immune response in leprosy patients and identification of disease-state-specific antigenic profiles

Although the global prevalence of leprosy has decreased over the last few decades due to an effective multidrug regimen, large numbers of new cases are still being reported, raising questions as to the ability to identify patients likely to spread disease and the effects of chemotherapy on the overall incidence of leprosy. This can partially be attributed to the lack of diagnostic markers for different clinical states of the disease and the consequent implementation of differential, optimal drug therapeutic strategies. Accordingly, comparative bioinformatics and Mycobacterium leprae protein microarrays were applied to investigate whether leprosy patients with different clinical forms of the disease can be categorized based on differential humoral immune response patterns. Evaluation of sera from 20 clinically diagnosed leprosy patients using native protein and recombinant protein microarrays revealed unique disease-specific, humoral reactivity patterns. Statistical analysis of the serological patterns yielded distinct groups that correlated with phenolic glycolipid I reactivity and clinical diagnosis, thus demonstrating that leprosy patients, including those diagnosed with the paucibacillary, tuberculoid form of disease, can be classified based on humoral reactivity to a subset of M. leprae protein antigens produced in recombinant form.

Leprosy situation in Brazil

We present the situation of leprosy in Brazil, reporting about epidemiology, clinical criteria for classification, multidrugtherapy and special situations, as co-infection. This material was presented in the 79th Annual Meeting of Japanese Hansen's Disease Association in May 2006, during a discussion about the Japanese Guidelines for leprosy treatment.

[Guideline for the treatment of Hansen's disease in Japan (Second edition)]

ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 1997). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > or = 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI become negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > or = 3, 1 year treatment by MDT/MB is necessary. When BI become negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. This is a simplification of first version in 2000. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.

Comparative profile of new leprosy cases coming to a referral institute in pre- and post-integration periods

This article presents findings from a retrospective analysis of 3031 new leprosy cases attending the Out-patient Department of the Regional Leprosy Training and Research Institute, Raipur, Chhattisgarh, during the period January 2000-December 2005. The analysis was carried out in order to compare the profiles of new leprosy cases between pre- and post-integration periods. The cut-off date, in order to distinguish between the two groups, was determined as 31st December 2002. A comparison was made between the two groups on identified host- and disease-related variables and its significance was tested using suitable statistical tests. The results showed that there was more than 50% increase in the number of new leprosy cases coming to the OPD of the RLTRI during the post-integration period. The mean age at registration showed an increase of 0.9 years, while the proportion of child and female cases showed a decrease of 7.7% and 4.3% respectively during the same period. Significant decline was also recorded in the proportion of grade II deformity cases (11.8%) and cases with type I lepra reaction (11.4%) during the post-integration period. The study emphasizes the need for developing an effective referral mechanism and proper screening of cases at the PHC level for better utilization of referral institutions in a need-based manner.

Self-care programme to prevent leprosy-related problems in a leprosy colony in Champa, Chattisgarh

A self-care programme aimed at preventing leprosy-related physical disabilities in a leprosy colony in Champa, Chattisgarh, India, is described. Once the initial resistance was overcome through persistent and caring attitudes, the residents accepted the challenges for self-care. The outcome at the end of one year showed significant decline (41%) in ulcer rates, significant use of MCR footwear (43%), and significant proportion (over 90%) of patients and their families practising and helping in self-care activities.

[Recent condition of new leprosy patients in Japan]

Most of 148 newly registered leprosy patients in the past 10 years from 1995 to 2004 in Japan had received some examinations, such as histopathology test (85%), skin smear test (84%), estimation of PGL-I antibody titer (55%) or detection M. leprae with PCR method (41%). 17% of newly patients should receive wrong therapy, if they had not had aforesaid clinical examinations in addition to count skin lesions. Improvement of technical level at skin smear test should be required for accurate treatment program in Japan. In Japanese patients, the number has been decreasing year by year; epidemiological condition was different between in Okinawa prefecture and in others, about ratio of sex, kind of type and age group.

Cyclooxygenase 2 expression in vessels and nerves in reversal reaction leprosy

Tissue expression of cyclooxygenase (COX)2, an inducible enzyme synthesizing eicosanoids in inflammation, was studied in reversal reaction (RR) leprosy in comparison with nonreactionary leprosy. COX2 was consistently expressed in cells of the mononuclear-macrophage lineage across the leprosy spectrum. Only in RR, the following two additional sites showed COX2 expression in the dermis and subcutis: 1) microvessels and 2) nerve bundles and isolated nerve fibers. The same sites also express vascular endothelial growth factor (VEGF). This is in keeping with experimental models relating VEGF to COX2 expression, with VEGF enhancing prostaglandin production through COX2 stimulation and prostaglandin synthase expression. We postulate that selective COX2 inhibitors, which are currently used in several inflammatory conditions, could be considered for RR treatment to reduce acute symptoms caused by tissue edema and possibly prevent long-term nerve damage, the main complication of RR.

[Conjugal leprosy]

OBJECTIVES

Determining the occurrence of leprosy amongst couples and establishing the type of leprosy in index and secondary cases.

METHODS

The characteristics of leprosy were studied between 1980 and 2000 in Atlántico Department located on the Colombian Caribbean Coast. Clinical histories of patients registered in the Leprosy Control Programme were reviewed. Clinical exams were performed and personal interviews carried out with couples suffering from leprosy.

RESULTS

Twenty-six married couples were found to be suffering from leprosy, representing 5.4% of leprosy cases detected during the study period. They were aged from 20 to 89. 65.4% of the index cases were men and 22 (84.6%) were multibacillary, lepromatous cases; two had indeterminate leprosy and two were suffering from tuberculoid leprosy. Sixty-one percent of the secondary cases were paucibacillary patients, 42% of them being tuberculoid. No paucibacillary cases were associated with multibacillary leprosy in the couples. Only two couples had consanguinity. None of the couples had had leprosy at the time of being married. The time between leprosy being detected in index cases and the disease being detected in secondary patients varied from 5 to 40 years. Disabilities were more common in the feet and to a higher degree in lepromatous index cases who had had the disease for a longer time than the secondary cases because these were more frequently paucibacillary patients who had a disease having shorter evolution.

CONCLUSIONS

In spite of ongoing, prolonged contact, conjugal leprosy is not frequent and requires several years to develop in the second person. Lepromatous leprosy in index cases was more frequently associated with leprosy in the couple. When the primary case was paucibacillary, no multibacillary leprosy occurred in the secondary case.

MDT-MB therapy in paucibacillary leprosy: a clinicopathological assessment

BACKGROUND

The World Health Organization recommends treatment regimens for paucibacillary (PB) and multibacillary (MB) leprosy, which differ in their duration and components. Hence accurate classification of the disease is required. To overcome difficulties in classification Uniform Multi Drug Therapy (U-MDT) has been recommended.

AIM

To evaluate the benefit of adding clofazimine to paucibacillary regimens in leprosy patients by measuring clinical and histological resolution.

METHODS

Forty-four paucibacillary patients were included in the study. Twenty-two patients were given MDT-PB regimen and the remaining MDT-MB regimen for six months . Skin biopsies were done before the commencement and at the end of treatment. Clinical and histological resolutions were measured according to the standard criteria a laid down. The results were analyzed using Fishers' test and Crammers' V test.

RESULTS

Clinical improvement was observed in 90.9% in the MB group as compared to 27.3% in the PB group. Regression in the nerve swelling was observed in 70% in the MB group and in 37.5% in the PB group while histological resolution was observed in 72.8% and 54.5% respectively.

CONCLUSIONS

Addition of clofazimine helps to resolve leprosy lesions both clinically and histologically, thus justifying the concept of Uniform MDT regimen for all patients.

Is increasing MB ratio a positive indicator of declining leprosy?

In recent years, an increasing MB ratio-trend has been seen in most state reported leprosy data in India and elsewhere. The programme of leprosy all over the world has been integrated with general health system (GHS). This has given rise to gross under reporting of leprosy cases and increasing MB ratio. This paper examines this critical issue and attempt to find out the causes of this trend. The findings suggest clearly that increasing MB ratio is the result of early cases of leprosy being missed out. This can be to the extent of 73% when MB ratio is reached to 47.5%.

Physical Distance, Genetic Relationship, Age, and Leprosy Classification Are Independent Risk Factors for Leprosy in Contacts of Patients with Leprosy

BACKGROUND

Close contacts of patients with leprosy have a higher risk of developing leprosy. Several risk factors have been identified, including genetic relationship and physical distance. Their independent contributions to the risk of developing leprosy, however, have never been sufficiently quantified.

METHODS

Logistic-regression analysis was performed on intake data from a prospective cohort study of 1037 patients newly diagnosed as having leprosy and their 21,870 contacts.

RESULTS

Higher age showed an increased risk, with a bimodal distribution. Contacts of patients with paucibacillary (PB) leprosy with 2-5 lesions (PB2-5) and those with multibacillary (MB) leprosy had a higher risk than did contacts of patients with single-lesion PB leprosy. The core household group had a higher risk than other contacts living under the same roof and next-door neighbors, who again had a higher risk than neighbors of neighbors. A close genetic relationship indicated an increased risk when blood-related children, parents, and siblings were pooled together.

CONCLUSIONS

Age of the contact, the disease classification of the index patient, and physical and genetic distance were independently associated with the risk of a contact acquiring leprosy. Contact surveys in leprosy should be not only focused on household contacts but also extended to neighbors and consanguineous relatives, especially when the patient has PB2-5 or MB leprosy.

Comparison of two systems of classification of leprosy based on number of skin lesions and number of body areas involved--a clinicopathological concordance study

BACKGROUND AND AIMS

WHO guidelines classify leprosy patients for therapeutic purposes into paucibacillary (PB) and multibacillary (MB) leprosy based on the number of skin lesions. An alternative system of classification has been in practice in Nepal from 1985 onwards, based on the number of body areas involved in patients of leprosy. We attempted a clinicopathological approach for comparison of these two systems of classification in leprosy patients for their ability to demarcate patients into groups of PB and MB leprosy.

MATERIALS AND METHODS

The study included 108 leprosy patients (80 males and 28 females). Complete clinical examination and body charting was carried out in each patient noting the count of skin lesions and the number of body areas involved. Slit skin smears and skin biopsies were taken from an active skin lesion in all patients.

RESULTS

On analysis, it was observed that there was good clinicopathological correlation between patients with 5 or < 5 skin lesions and 2 or < 2 body areas involved. (Clinical 95% and histological 96%) A similar correlation was also observed in the other group of patients with > 5 skin lesions and > 2 body areas involved, (Clinical 94% and histological 96%). There were almost identical numbers of patients represented in these two groups of classification.

CONCLUSIONS

Our findings suggest that patients with involvement of 2 or less body areas can be classified as PB leprosy and those with more than 2 body areas involved can be classified as MB leprosy for the purposes of therapy. The study of areas of involvement in leprosy patients not only provides additional patient information but also adds another parameter as a basis for the study of leprosy patients.

Leprosy in the Department of Dermatology, Chang Gung Memorial Hospital at Kaohsiung from 1988 to 2004: a clinical and histopathologic study of 13 cases

BACKGROUND

Leprosy has long been in Taiwan, but it has never been eradicated. Incidental cases are easily overlooked nowadays because most younger dermatologists are unfamiliar with this disease.

METHODS

We review and analyze 13 cases diagnosed as leprosy at the Department of Dermatology, Chang Gung Memorial Hospital at Kaohsiung from 1988 to 2004, all of which were histopathologically proven.

RESULTS

The ages of the 13 recruited patients ranged from 31 to 73 (mean, 58.6) years, without a gender preference (male: female, 7:6). Two male patients were under 40 years old; one was a foreign worker from Thailand and the other was a local person in Penghu working as the chief officer on a fishing boat. The most-common clinical subtype was lepromatous leprosy (5/13), followed by borderline lepromatous leprosy, borderline tuberculoid leprosy, and tuberculoid leprosy (each 2/13), and then borderline leprosy and indeterminate leprosy (each 1/13). The initial clinical impression before the histopathological diagnosis included granuloma annulare, generalized eczema, lymphoma, syphilis, papular urticaria, cutaneous tuberculous infection, Sweet's syndrome, erythema annulare centrifugum, and hematoma. Most of these patients only received irregular treatment after the diagnosis was made and were soon lost to follow-up.

CONCLUSIONS

With increasing numbers of foreign workers and immigrants living in Taiwan in recent years, leprosy seems to have become a challenging diagnosis for younger dermatologists. Dermatologists should keep this ancient disease in mind and not overlook it. Because of the necessity of prolonged medication, complete treatment and long-term follow-up of leprosy cases will remain a major problem in public health.

Clinico-pathological study of 12 cases of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000

BACKGROUND

Leprosy is considered a chronic disabling condition. Many clinical and immunological aspects of the disease remain ill defined.

AIM

The study of clinico-pathological and laboratory findings of patients with leprosy admitted to Sina Hospital, Hamadan, Iran, from 1991 to 2000.

METHODS AND PATIENTS

This is a descriptive retrospective cross-sectional study. The statistical community comprised all patients diagnosed leprosy. This diagnosis was clinical and confirmed through pathology (skin-biopsy) and laboratory (peripheral smear) measures.

RESULTS

In this study, the disease was more common in males than females with a mean age of 48.5 +/- 16.2 years. Most of the patients were more than 40 years old. Among 12 patients in this study, six cases were urban and six cases were rural. Six cases were living in Hamadan province and two cases migrated to Hamadan province (one of them from Afghanistan and the other from Kurdestan). Clinical diagnosis was confirmed by pathology in 11 cases, but in one case the clinical diagnosis did not match the pathology. In four cases the clinical diagnosis did not match the peripheral smear. Eight cases were admitted just once. Four cases had a history of recurrence and readmission (two patients had one time recurrence and the other two patients had two recurrences). There was no difference in the clinical findings between first presentation and recurrence. From the point of complication and disability, extremity disability was more common than eye disability. Increased severity of complications was found in patients with a delayed diagnosis and incomplete treatment.

CONCLUSION

This study showed that a rapid and correct diagnosis and complete treatment was necessary for prevention of complication and disability in patients with leprosy. Also the accuracy of pathology (skin biopsy) in the diagnosis exceeded the peripheral smear. Skin biopsy is recommended to confirm the diagnosis in all cases of leprosy. In the absence of pathology, patients must be considered as multibacillary patients and treated as such.