Keywords

acid fast bacilli active case detection borderline leprosy Brazil bullous cyclophosphamide Detection disabilities Drug resistance ENLIST environment epidemiology erythema nodosum leprosum foam cells granuloma Hansen’s disease hansens hepatitis C indigenous interferon leprosy Leprosy Malaysia MFP neuritis penans Peripheral neuropathy prevention psychometric pure neuritic leprosy quality of life reaction SARI seasons SF-36 stigma ulcerative

Volume - 88, Issue - 4

editorial
Page 451
Original Papers
Pages 452 - 462
  • Enhanced active case-finding, identifying leprosy cases missed by recent detection campaigns in Munger District, Bihar, India

    • Jennifer Mangeard-Lourme
    • Amar Singh
    • Rajni Kant Singh
    • Jayaram Parasa
    • Guillermo Robert De Arquer
    Volume 88, Issue 4

    | Published on December 2017

    In India, some indicators of leprosy transmission are on the rise and suggest that many cases of leprosy currently go undetected. The lack of active casefinding outreach activities, aiming to find hidden cases in communities, are possible reasons for this. Lepra, an international non-governmental organisation, ran an active case-finding project in Munger District, Bihar, from 15th June to 15th December 2016, screening 85,560 people. A combined approach using Contact Surveys, Focal Surveys and Special Searches was implemented. A total of 321 new leprosy cases were found (28% Multibacillary, 47% women, 37% child cases, 59% belonging to scheduled castes, 10% to scheduled tribes, and 3% with disability and complications). The research supports evidence generated by other non-governmental organisations of a high transmission of the disease in India. Finding 303% more cases than traditional government-led detection campaigns, it shows that many cases in affected communities remain undetected in Bihar. This method was also found to be more efficient at finding vulnerable groups, child and female cases, as well as cases within scheduled castes and tribes.

Original Papers
Pages 463 - 477
  • Drug resistance pattern of Mycobacterium leprae from mouse footpad cultivation between 1997 to 2013 in Malaysia

    • Izzaty Dalawi
    • Min Moon Tang
    • Amrish Shah Osman
    • Muhamad Ismail
    • Rehan Shuhada Abu Bakar
    • Jiloris F. Dony
    • Johari Zainol
    • Asmah Johar
    Volume 88, Issue 4

    | Published on December 2017

    Background:

    After three decades of implementing multidrug therapy (MDT) consisting of rifampicin, dapsone and clofazimine in Malaysia, the drug resistance pattern of Mycobacterium leprae is a growing concern as it may lead to failure of treatment and relapse of disease.

    Objective:

    To determine the drug resistance patterns of M. leprae in Malaysia.

    Methods:

    Mouse footpad (MFP) culture of all skin biopsy samples from patients with borderline lepromatous and lepromatous leprosy sent to the Leprosy Unit, National Public Health Laboratory, Sungai Buloh, Malaysia between 1997–2013 were retrospectively studied.

    Results:

    There were 651 MFP cultures performed. The mean age of patients was 41 years old (range: 6–88). The male:female ratio was 3.8:1. Four hundred and fortyfour patients (69.1%) were Malaysian. The rate of positive M. leprae culture was 66.6% (433 of 651). The mean Bacteriological Index (BI) and median Morphological Index (MI) for those with positive culture were 3.7 and 2.8 respectively. The mean BI and MI of those which failed to grow in the MFP were significantly lower than those with positive cultures (P < 0.001). Dapsone has the highest resistance rate of 55% (238 of 433). Nevertheless, high degree dapsone resistance (0.01%) was 6.24%. There were 407 MFP tests using rifampicin 0.003% and 12 (2.9%) were resistant to it. Clofazimine has the lowest intermediate degree (0.001%) resistance rate of 0.2% (1 of 429). There were no significant differences between the drug resistance pattern and the gender or the nationality of the patients.

    Conclusion:

    More than half of our positive MFP cultures showed low-level resistance to dapsone; less than 3% were resistant to rifampicin, and clofazimine resistance remained very low.

Original Papers
Pages 478 - 487
  • Histological spectrum of pure neuritic leprosy with atypical clinical presentation at a tertiary care centre

    • Debajyoti Chatterjee
    • Gargi Kapatia
    • Uma Nahar Saikia
    • Tarun Narang
    • Sunil Dogra
    • Manoj Goyal
    • Bishan Dass Radotra
    Volume 88, Issue 4

    | Published on December 2017

    Introduction:

    Pure neuritic leprosy (PNL) is a rare disease and is characterised by isolated involvement of one or more peripheral nerves by Hansen’s disease (HD) in the absence of skin involvement. The aim of this study was to assess the histological spectrum of PNL cases with atypical clinical presentation.

    Material and Methods:

    A retrospective analysis of all biopsy proven PNL cases (total 23) over the past 16 years was done. Detailed histopathological examination of the nerve was performed. Myelin and axonal status were evaluated using luxol fast blue/ Periodic acid Schiff (LFB/PAS) stain and immunohistochemistry (IHC) for neurofilament protein (NFP) respectively.

    Results:

    Clinically a diagnosis of HD was suspected in 70%, mononeuritis multiplex in 12%, vasculitis and demyelination in 9% cases each. Moderate to severe epineurial and endoneurial inflammation were seen in 91% and 96% of cases respectively. Granulomatous inflammation was seen both in the endoneurial (70%) and epineurial (17%) location. Foam cell infiltration was more common in the endoneurial (60%) than the epineurial (22%) location. Occasional cases showed necrosis (4%) and vasculitis (13%). Severe myelin and axonal loss was seen in 74%. Leprosy bacilli were identified in 12 (52%) cases. One case showed normal morphology although leprosy bacilli were present.

    Conclusion:

    Although PNL is known to cause endoneurial inflammation, epineurial inflammation or even granulomas can be seen. Necrosis and vasculitis are rarely seen in PNL. Myelin and axonal loss are almost universal. Even if morphologically the biopsy is normal, staining for leprosy bacilli should be performed on all suspected PNL cases.

Original Papers
Pages 488 - 498
  • Health-Related Quality of Life amongst people affected by Erythema Nodosum Leprosum in Bangladesh: a Cross Sectional Study

    • Bob Bowers
    • C. Ruth Butlin
    • Khorshed Alam
    • Diana N.J. Lockwood
    • Stephen L. Walker
    Volume 88, Issue 4

    | Published on December 2017

    Erythema nodosum leprosum (ENL) is a multisystem reaction which affects some people with multibacillary (MB) leprosy, but more specifically those with BL or LL type leprosy. The symptoms of ENL can lead to long term physical, social and economic losses, although very little is known about the effect ofENLon quality of life.

    Methods:

    A cross-sectional study was conducted in northwest Bangladesh. A Bengali version of the RAND 36-Item Health Survey 1.0 (SF-36) was administered to people under treatment for ENL (n = 29) and controls affected by MB leprosy (n = 46) matched for: sex, treatment status, age, Disability grade at diagnosis, education level and housing type. Chi Square and Wilcoxon RST were used to analyse the data using the R statistical package.

    Results:

    Patients with ENL had significantly (P < .001) worse Health Related Quality of life (HRQoL) scores on all eight SF-36 health concepts: physical functioning, pain, role limitations due to physical and emotional limitations, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Cohen’s d indicated a large effect (d = .96 to 1.67). The results are compared with results of other published works which examined similar populations

    Conclusion:

    HRQoL is significantly impaired in Bangladeshi people suffering from ENL compared with people with MB leprosy and no ENL. ENL affects all areas of a person’s HRQoL measured by the SF-36. Health care providers need to spend time addressing other aspects of a person’s life and not just the physical symptoms.

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