Keywords

contacts of leprosy cases erythema nodosum leprosum Hansen Disease Hansen’s disease HbsAg HBV HCV Histopathology India leprosy Leprosy Leprosy-related disabilities Mycobacterium leprae nasal secretion nerve biopsy NLEP Oral cavity panniculitis Postural Balance pure neural leprosy Rating scores Risk Groups RLEP PCR sensory painful mononeuritis Soft palate Somatosensory Disorders suppurative ENL Testicular dysfunction Transmission vasculitic neuropathy vasculitis

Volume - 88, Issue - 2

editorial
Page 161
Original Papers
Pages 162 - 173
  • The decline of autochthonous leprosy in the Valencia Region of Spain: patterns and trends 1940–2015

    • Inés Suárez-García
    • José Ramón Gómez Echevarría
    • Fátima Moll Cervera
    • Diana Gómez-Barroso
    • Paul E.M. Fine
    Volume 88, Issue 2

    | Published on June 2017

    Objectives:

    The aim of this study was to describe the patterns and trends of autochthonous leprosy in the Valencia Region (Spain).

    Methods:

    We included all new leprosy cases originating from the Valencia Region between the years 1940 and 2015. Patients originating from other countries or other Spanish regions were excluded. New cases were analysed by age, sex, clinical type, occupation, and geographic distribution.

    Results:

    A total of 442 patients with presumably autochthonous leprosy were included. Incidence rates consistently declined over the study period. Mean age at onset gradually increased from 34.2 years during the period 1940–1949 to 59.5 years during 2000–2015. There were no cases with clinical onset after 2006 and no cases born after 1973. Patients were predominantly males (57.7%) and 85.4% had multibacillary leprosy. The proportion of multibacillary cases increased gradually after 1970. The majority of male patients (67.9%) worked in agriculture. Most of the cases, especially during the later periods, were concentrated in the coastal regions.

    Conclusions:

    Our findings are consistent with trends described in other regions with declining leprosy incidence rates and suggest that the transmission of M. leprae infection in this area may well have now stopped. Autochthonous leprosy in this region has had a male predominance and a high proportion of multibacillary cases. The geographic distribution and the high incidence in agricultural workers suggest that environmental factors should be further explored.

Original Papers
Pages 174 - 183
  • Serodiagnosis of leprosy and follow-up of household contacts using a commercial rapid test containing ND-O/LID-1 antigens

    • Eliane Aparecida Silva
    • Patricia Sammarco Rosa
    • Andrea Faria Fernandes Belone
    • Neusa Maria Broch Coelho
    • Somei Ura
    • Jane Tomimori
    Volume 88, Issue 2

    | Published on June 2017

    Introduction:

    Early diagnosis of leprosy, including the diagnosis of sub-clinical disease in contacts of known cases, would be a major advance. The signs of early leprosy are often difficult to assess and a reliable diagnostic test could play an important role in identifying cases and thus reducing transmission.

    Methods:

    Subjects were recruited at Centro de Saúde Jardim Guanabara, Rondonópolis, Mato Grosso State, Brazil. Sera were obtained from 174 recently diagnosed leprosy patients, 409 household contacts, 53 endemic controls and 12 patients with active TB. 186 of the household contacts were re-tested on subsequent visits. Both the NDO-LID® rapid test (Orange Life®, Rio de Janeiro, Brazil) and an anti-PGL-1 ELISA test were used on all samples for comparison.

    Results:

    LID-1 was positive in 25 of 125 PB cases (20%), but in 41 of 49 MB cases (83.7%), while the anti-PGL-1 ELISA was positive in 8 (6.4%) and 35 (71.4%) cases, respectively. Specificity for LID-1 was 85% and for the anti-PGL-1 ELISA, 97%. Amongst household contacts, 9 of 409 (2.2%) were positive on the LID-1 test, and a further 51 (12.5%) were weakly positive; although 9 cases of leprosy were subsequently identified amongst these contacts, 6 had tested negative, 2 were weakly positive and only 1 had been positive.

    Conclusion:

    The ND-O-LID-1 assay can be easily performed by the addition of serum to the assay device, and thus can be applied in resource-poor settings. The test was found to be useful for the detection of multibacillary cases, which in the long term will help to reduce transmission of the disease. This is a specific test, but it is not very sensitive for early detection of leprosy in household contacts and paucibacillary forms.

Original Papers
Pages 184 - 196
  • Detection of subclinical Mycobacterium leprae infection in children, contacts of leprosy cases, Fortaleza – Ceará, Brazil

    • Delaide Sampaio Dias Lourenço
    • Thales Alves Campelo
    • Gizele Almada Cruz
    • Paulo César De Almeida
    • Heitor De Sá Gonçalves
    • Maria Araci De Andrade Pontes
    • Luana Nepomuceno Gondim Costa Lima
    • Cristiane Cunha Frota
    Volume 88, Issue 2

    | Published on June 2017

    Objectives:

    To investigate the subclinical infection of leprosy in contacts younger than 15 years old of new leprosy cases diagnosed at the Dona Libânia Dermatology Center in Fortaleza, Ceará.

    Methods:

    This was a cross-sectional study involving 69 leprosy cases and 101 household contacts under 15 years old. Nasal secretion samples were collected in order to investigate the Bacilloscopic Index (BI) for M. leprae and to detect the DNA of the bacilli; we also investigated the seropositivity of the IgM antibody to the PGL-1 antigen through the ML-Flow technique.

    Results:

    Evaluating the positivity of all three techniques used in the study, we obtained a frequency of 33.7% for ML-Flow, 16.1% for PCR of DNA and 1.98% for BI in nasal secretion. The positivity for RLEP PCR and in the anti-PGL-1 indicates stimulation of the immune response and consequent subclinical infection. In our study, all positive BI cases were also RLEP PCR positive, which confirms the presence of the bacillus in the nasal mucosa of the studied contacts. The seropositivity to anti-PGL-1 was higher among the female sex, the ones between 11 and 15 years old and among the contacts of paucibacillary (PB) cases.

    Conclusions:

    Such techniques when used together help the monitoring of contacts with greater risk of developing the disease, especially in childhood.

Original Papers
Pages 197 - 207
  • Adverse Drug Reactions (ADR) necessitating modification of multi-drug therapy (MDT) in Hansens disease: a retrospective study from Kerala, India

    • Betsy Ambooken
    • Sandhya George
    • Neema Azeez
    • N Asokan
    • TD Xavier
    Volume 88, Issue 2

    | Published on June 2017

    Objective:

    To assess the frequency and type of adverse drug reactions (ADR) that necessitated modification of multi-drug therapy (MDT) in Hansen’s disease, with emphasis to find out the interval between initiation of MDT and the occurrence of ADR.

    Design:

    A retrospective analysis of case records of patients diagnosed with Hansen’s disease (HD) and registered for MDT in a tertiary care institution between 2010 and 2015. Clinical details and laboratory data were collected using a proforma.

    Results:

    One hundred and ninety-six patients were registered for treatment during the study period. We analysed 150 records that met the inclusion criteria. Thirty-six among them (24%) had ADR that needed modification of MDT. The most common ADR was haemolytic anemia (19 patients; 12.7%) followed by hepatitis (14 patients; 9.3%). The most serious ADR was agranulocytosis (three patients; 2%). Adverse effects were more common (72%) during the initial 2 months of MDT compared to later months. (P = 0.004).

    Conclusion:

    Nearly a quarter of the patients started on MDT for Hansen’s disease needed its stoppage and subsequent modification due to ADR. Haemolytic anemia and hepatitis were the most frequent adverse events. 72% of the ADR events occurred during the initial two months of MDT which points to the need for more frequent monitoring of the haemogram and liver function tests during the initial months of treatment.

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