Keywords

16s r-RNA 16S rRNA gene target Absentees acid fast bacilli active case detection active case finding activities of daily living Activity adamawa Adherent leucoma adolescent adrenal gland adverse effects AFB Ag85 age at onset Aged alopecia Alopecia Anaesthetic foot anesthetic foot anti-leprosy therapy Antibodies antibody Antigen anxiety attitude attitudes Awareness Bacillary index bacterial index bacteriological index Bacteriological index ballpoint pen Bangladesh Beijing beliefs BI negative biofilm biopsy blindness bone mineral density Borderline borderline leprosy borderline tuberculoid leprosy Brazil Buddhism bullous Bullous lesions Burkholderia pseudomallei carriage Case detection case detection cataract in leprosy cause of death chemokines chemoprophylaxis Chemoprophylaxis Chemotherapy Chhattisgarh child Childhood Childhood leprosy children Christianity chromoblastomycosis Chronic inflammatory demyelinating polyneuropathy chronic neuritis chronic pain classificaion classification claw hand clinical demonstration CLTRI Co-infection co-infection Co-prevalent cases cold water Colombia colony Common Mental Disorders community community participation Community stigma community stigma community-based programs comorbidities comorbidity Construct Validity contact screening Contact screening contact tracing contacts contacts of leprosy contacts of leprosy cases Coping Corneal grafts corneal opacity Corticosteroids Cosmetic Cosmetic camouflage cotton wool COVID 19 and leprosy COVID-19 COVID-19 and leprosy Criterion Validity customized insole customized insoles Cutaneous nerve biopsy cutaneous nerve biopsy cyclophosphamide Cytokine cytokines Dapsone dapsone Dapsone hypersensitivity syndrome dapsone hypersensitivity syndrome de novo histoid leprosy decompression delay delay in diagnosis Delays denovo histoid leprosy Dental infections depression Detection Dhanusha diabetes Diabetes Diagnosis diagnosis diagnostic delay diagnostic test direct and indirect health information technology disabilities Disability disability disappearance Discrimination distorted fascicular architecture DLQI Dressing drug induced adverse effects Drug Resistance Drug resistance Eastern-Southern United States Effectiveness electromyography electrophysiological assessment Electrophysiological study of nerves in leprosy elephantiasis-like elimination employment empowerment Enhanced risk of transmission ENL ENLIST entitlements environment epidemiological tendency Epidemiology epidemiology Epididymo-orchitis epithelioid cell granulomas Erectile dysfunction erythema nodosum leprosum Erythema nodosum leprosum Europe evaluation facial granuloma familial leprosy Fedis Finger prosthesis Fixed duration treatment Florida foam cells Focussed Leprosy Campaign folliculotropic mycosis fungoides folP1 Gene footwear force sensitive resistors fracture risk FRAP fulani functional evaluation functioning Fungal Gender gender Generalized atrophoderma genotype Geographical distribution global Leprosy situation global leprosy situation Glutathione S-transferase Grade 1 Grade 2 grade 2 deformities Grade 2 Disability (G2D) grade-2 disability granuloma granulomatous hepatitis GSH gynaecomastia Hansen Hansen Disease Hansen disease Hansen; Nerve abscesses; Borderline tuberculoid leprosy; Downgrading Type 1 reaction Hansen’s disease Hansen’s diseases hansens Hansens disease Hansens diseases Hansens’ disease HbsAg HBV HCV health education health related quality of life Health Services hepatitis C Hinduism Histoid Hansen’s Histoid Hansens Histoid leprosy Histology histopathology Histopathology HIV HLA-B*13:01 household household contact Household contact examinations Household contacts Hyper-endemic leprosy hypervascularity hypocalcemia hypogonadism ICF identical twins Igbo iliopsoas abscess Immunohistochemistry Impairment in situ RT-PCR incidence Incident cases Incomers index case India indigenous Indonesia infection Infectious Diseases innovation interferon interleukin-10 Internalised stigma Intervention Islam isolation Jainism Jinchuang Ointment Kiribati knowledge Knowledge Kolkata lactation Latex Leavers lepromatous leprosy Lepromatous leprosy leprosy Leprosy leprosy delays Leprosy diagnosis delay Leprosy disability leprosy in Nepal leprosy reactio leprosy reaction Leprosy reactions leprosy reactions leprosy wounds Leprosy-related disabilities Leprosy; Lobomycosis; keloidal blastomycosis; Paracoccidioides loboi; Jorge Lobos disease linkages localized lepromatous leprosy lockdown and leprosy logMAR low dose adrenocorticotrophin stimulation test low-cost LPEP Lucio phenomenon lupus vulgaris lymphatic filariasis M. leprae M. leprae M. leprae infection Malaysia malondialdehyde matrix metalloproteinases MB leprosy MDT mechanical rupture median nerve medical interns medical students mental health mental wellbeing methotrexate MFP micro-cellular rubber mimick minocycline misdiagnosis MMP-9 Mortality rate most significant change motor mouse foot pad Mouse Foot Pad multi drug resistance Multi Drug Therapy Multibacillary multibacillary leprosy Myanmar mycobacteria mycobacterium leprae Mycobacterium leprae Mycobacterium lepromatosis nasal carriage nasal cavity nasal secretion Necrotic ENL Neglected Tropical Diseases Nepal Nerve nerve biopsy nerve conduction study nerve decompression nerve enlargement Nerve function impairment nerve function impairment neural compression neural leprosy neuritis neurolysis Neuropathic foot neuropathic pain neuropathy New case detection Nigeria nitric oxides NLEP nociceptive pain nomadic pastoralists non-healing wounds NTD ocular conditions offloading ophthalmology optic atrophy Oral cavity Oral health Orientation Orofacial granulomatosis oxidative stress pain pancytopenia panniculitis Parents attitude Participation Participation Scale Participation scale passive and active case finding passive and active leprosy case finding patient compliance patient’s perception paucibacillary Paucibacillary Paucibacillary leprosy paucibacillary Leprosy PB leprosy cases PCR peak plantar pressure Peek Acuity penans perception Periodontal medicine peripheral nerves Peripheral neuropathy peripheral neuropathy Persistent serpentine supravenous hyperpigmented eruption (PSSHE) Person affected by leprosy Person Health with disabilities physical activity physical disability Physical disability physiotherapy plantar pressure plantar ulcer Planter ulcer Platelet rich fibrin polymorphism Portugal post-partum Postural Balance poverty practice practice–theory prednisolone prednisolone and methotrexate pregnancy pressure ulcers prevention Prevention of disability Primary Care Nursing Primary Health Care prophylaxis protective footwear Psychological Assessment Psychological treatment Psychometric psychometric Psychometric properties and Hansen’s disease public private partnership pure neural leprosy Pure Neural leprosy diagnosis Pure neural leprosy suspects Pure neuritic leprosy pure neuritic leprosy Purulia qualitative study Quality of health care quality of life Rating scores Reaction reaction reactions Reactive Oxygen Species ready-made footwear Real Time PCR relapse Relapse Religion renal impairment reporting delay research priorities Resilience resistant rifampicin rifampicin-resistance Risk Risk factor Risk Groups RLEP PCR Routine surveillance RRDR SALSA SARI Sat Scan Scale Scale development scalp sclerotic bodies seasons second-line treatment self help group Semmes Weinstein nylon monofilament Senegal sensory sensory impairment Sensory neuropathy sensory neuropathy sensory painful mononeuritis serology serum SF-36 Sikhism single-dose skin biopsy skin lesions Skin overlying Nerve Snellen chart social aspects social determinants Social distance social distance social participation Social Participation Social participation social protection Soft palate soluble toll like receptor 2 Somatosensory Disorders Sonography southeast Nigeria Spain spatial analysis spatial clustering Spatial-temporal analysis Split Skin Smear states sterile needle steroid therapy steroids Stigma stigma Sudan suicide suppurative ENL surgery sustainable development goals systemic antifungals testicular atrophy Testicular dysfunction testosterone Th17 cells thalidomide therapeutic footwear Time Series Studies Toliara-Madagascar toolkit Total Contact Cast (TCC) Training Transcription factor Transmission transplacental transmission treatment Tregs trends tribal population Trophic ulcers tuberculoid Tuberculoid Leprosy tuberculoid leprosy tuberculosis Type 1 lepra reaction Type 1 reaction type 2 lepra reaction Type 2 lepra reaction U-MDT ulcer recurrence ulcerative ulcers ultrasonography ultrasound uniform multidrug therapy Uninvolved nerves in leprosy Urban Validation study vasculitic neuropathy vasculitis Viable M. leprae visual acuity visual impairment VNTR loci Walking iron warm water WHO grade WHODAS 2.0 Women work performance Z-N staining Ziehl-Neelsen Stain
Original Papers
Pages 56 - 62
  • A study of household contacts of persons affected by leprosy with a high bacterial index

    • Senthilkumar Ramasamy
    • Archana Kumar
    • Pitchaimani Govindharaj
    Volume 91, Issue 1

    | Published on March 2020

    Objective:

    The study aimed to screen household contacts of persons diagnosed with leprosy having a high bacterial index, at a tertiary referral centre.

    Methods:

    This hospital based study involved 334 persons who were newly diagnosed as leprosy with a high bacterial index, attending a tertiary referral hospital, Champa, Chhattisgarh, India. We enumerated all the household contacts of registered cases and invited them to be screened for leprosy.

    Results:

    Of 334 high BI cases, 252 (75%) were male and 82 (25%) were female, with ages ranging from 12 to 75 years. Sixty two (18%) had Grade 2 disability and 32% had a bacterial index of above 5+ at the time of diagnosis. A total of 1,397 household members were enrolled for screening and 678 (49%) were examined for leprosy. One hundred and sixteen household members were found to have signs of leprosy, and among these, 57 (49%) were identified as new cases, 11 (10%) were known cases on treatment and 48 (41%) had been previously treated for leprosy.

    Conclusion:

    This study showed that screening of household contacts of high BI cases is an effective method of leprosy case detection and emphasizes the continuing need to screen and follow up. Continued health education and motivation of household contacts will enhance voluntary reporting for periodical screening.

Original Papers
Pages 25 - 40
  • Is Myanmar on the right track after declaring leprosy elimination? Trends in new leprosy cases (2004–2018) and reasons for delay in diagnosis

    • Myo Ko Ko Zaw
    • Srinath Satyanarayana
    • Kyaw Ko Ko Htet
    • Kyu Kyu Than
    • Chan Tun Aung
    Volume 91, Issue 1

    | Published on March 2020

    Background:

    Myanmar declared leprosy elimination in 2003. In 2018, the country reported 2,214 new leprosy cases of whom 263 had Grade-2 disability (G2D). The country aims to reduce new cases with G2D to <53 cases by 2023 through early diagnosis and treatment.

    Objectives:

    To describe the trends (actual and projected) in new leprosy cases from 2004 to 2023 and to explore the reasons for delay in diagnosis.

    Methods:

    Mixed-methods study. The quantitative part—ecological study using numbers of new leprosy cases from 2004–2018. For qualitative part, new cases with G2D and health care providers were interviewed.

    Results:

    The annual total new cases, new multibacillary cases, new cases with G2D, new child cases are showing a declining trend. Total new cases and new cases with G2D, between 2004 and 2018 have declined by 40% and 28% respectively. If the current trends continue there will be 1,785 (95% CI: 1546-2024) new cases and <53 new cases with G2D in 2023. The interviews of patients and providers yielded the following reasons for delay in diagnosis: incorrect knowledge about leprosy, delay in recognition of symptoms, inappropriate care seeking, and fear of stigma and discrimination. Reduction in health system efforts, lack of local leadership, human resource constraints and decreased funding also contributed to delay in diagnosis.

    Conclusions:

    The declining trends and the possibility of achieving the target for new cases with G2D by 2023 is encouraging. The country must address the challenges mentioned by patients and health care providers as a priority, to accelerate the decline in new cases.

Original Papers
Pages 41 - 55
  • Magnitude of social determinants in high risk areas of leprosy in a hyperendemic city of northeastern Brazil: An ecological study

    • Antônio Carlos Vieira Ramos
    • Marcelino Santos Neto
    • Luiz Henrique Arroyo
    • Mellina Yamamura
    • Ivaneliza Simionato Assis
    • Josilene Dália Alves
    • Marcos Augusto Moraes Arcoverde
    • Luana Seles Alves
    • Thaís Zamboni Berra
    • José Francisco Martoreli Júnior
    • Flávia Meneguetti Pieri
    • Ricardo Alexandre Arcêncio
    Volume 91, Issue 1

    | Published on March 2020

    Objective:

    To investigate the association of certain social determinants with areas at high-risk for leprosy in a hyperendemic city in northeastern Brazil.

    Methods:

    An ecological study was carried out in Imperatriz, a hyperendemic municipality of northeastern Brazil. The units of analysis were urban census tracts, in which variables related to the number of dwellers per domicile, literacy and per capita monthly income were selected for the construction of the social determinants dimensions, by means of the Principal Components Analysis (PCA) technique. Spatial scan statistics were applied to identify areas of elevated leprosy risk and binary logistic regression was performed, considering the high-risk areas as the dependent variable and the social determinants dimensions as the independent variable. The Odds Ratios (ORs) were calculated with its 95% Confidence Intervals (CIs). The Receiver Operating Characteristic (ROC) Curve was applied to verify the discriminative power of the model. Type I error was set at 5% (p < 0.05).

    Results:

    2,552 leprosy cases were georeferenced and the scan statistic identified high-risk areas. The logistic model showed that social determinants were associated with high-risk areas (OR = 1.25, 95% CI = 1.07–1.49, p = 0.006). The area under the ROC curve value confirmed the discriminatory capacity for the model at 65%, which was considered sufficient.

    Conclusions:

    The high-risk areas for leprosy are associated with social determinants of low household per capita income, low educational levels and high numbers of residents per household.

Original Papers
Pages 14 - 24
  • Documenting the decline of leprosy in Europe: The example of Northern Portugal

    • Guilherme Gonçalves
    • Isabel Andrade
    • Carlos Pinheiro
    • Paul E.M. Fine
    Volume 91, Issue 1

    | Published on March 2020

    Background:

    There is continued uncertainty over trends of leprosy, including in areas with low incidence, where it may be possible to identify areas where M leprae is no longer transmitted or where it no longer causes disease. WHO has reported data on leprosy in the European Region only since 2015.

    Methods:

    Data reported to WHO and published in the Weekly Epidemiological Record were reviewed, Data from five districts in northern Portugal were collected from the National General Directorate of Health and Municipal Health Authorities.

    Results:

    Basic information on 133 leprosy cases has been reported to WHO by thirteen of the 54 states in the European Union since 2015. Data on place of birth of the cases were reported by ten states since 2016, implying eleven cases possibly attributable to transmission within Europe. Detailed but incomplete data on 38 leprosy cases notified in northern Portugal 1990–2018 are described and discussed. Of those cases which appear to have been autochthonous, none were born after 1966, none were notified after 2007, and the only three notifications after 2005 were for relapses.

    Conclusions:

    Data on leprosy in the European Region are obviously incomplete. The large majority of cases now detected are attributable to infections contracted abroad, but a small number of cases possibly attributable to local transmission are still being identified. Analysis of data from five districts in northern Portugal indicate that this region is no longer endemic for the disease, and that transmission in the area is likely to have ceased at least 40 years ago. The methods illustrated in this paper could be applied to data on leprosy in other regions of Europe, to better define the geographic limits of leprosy today.

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