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

Recent Articles

Original Papers
Pages 207 - 217
  • Sonographic characteristics of median nerve neuropathy in Hansen’s disease: a case-control study

    • Y. Muralidhar Reddy
    • Jagarlapudi M. K. Murthy
    • Lalitha Pidaparthi
    • Shyam K. Jaiswal
    • E. S. S. Kiran
    • Anusha Penneru
    • Ravi Nukala
    • Sudhir Kumar
    Volume 92, Issue 3

    | Published on September 2021

    Background and objectives

    High-resolution ultrasonography (HRUS) has become a vital imaging tool in the management of leprosy. This case-control study analyzed the sonographic data on median nerves in leprosy and healthy controls to identify the features characteristic of leprosy.

    Methods

    Newly diagnosed and treatment naïve Hansen’s patients of both sexes and aged >16 years were included in the study. The control group included prospectively enrolled healthy subjects. Nerve conduction studies were performed in all. HRUS of the median nerve was performed using a Philips HD15 machine. HRUS parameters studied included cross-sectional area (CSA) of the nerve, fascicular architecture and abnormal blood flow (by colour Doppler). CSA was measured at the wrist (S1), 5 cm above the wrist (S2), 10 cm above the wrist (S3), mid-forearm (S4) and at the elbow (S5).

    Results

    30 median nerves from 22 cases of leprosy and 30 nerves from 15 healthy subjects were compared. Among cases, 8 were borderline tuberculoid, 9 borderline lepromatous, 3 lepromatous leprosy, and 2 indeterminate leprosy. Abnormal motor (76.7%) and sensory conduction (96.7%) was noted in the patient group. The mean CSA was 18.5 mm2 at S1, 20.3 mm2 at S2, 14.1 mm2 at S3, 9.1 mm2 at S4, and 8.1 mm2 at S5. The CSA at S1 and S2 were significantly higher compared to other sites. CSA values were significantly higher in patients compared to controls. The fascicular architecture was distorted in patients - grade II (33.3%), III (40.0%) and IV (20%), and hypervascularity was noted in 26.6%.

    Conclusion

    HRUS depicted characteristic features of the median nerve in leprosy - maximum enlargement in the distal forearm with distorted fascicular architecture.

Original Papers
Pages 218 - 224
  • The carpal tunnel syndrome in leprosy: a long term follow up of steroids versus surgical decompression for median nerve neuritis in leprosy

    • Imran Sajid
    • Mamta Arora
    • Etisha Nawani
    • Kameshwar Nath Mishra
    Volume 92, Issue 3

    | Published on September 2021

    Leprosy is a stigmatizing and neglected tropical disease still prevalent in various countries of the world. According to WHO reports from 159 countries, 208,619 new leprosy cases were reported globally in 2018, of which Brazil, India, and Indonesia accounted for 79.6%. With the preference of M. leprae for cooler areas, peripheral nephropathy of the hand and feet are commonly seen in leprosy patients. Peripheral nerve involvement may result in the development of deformities. The ulnar nerve is commonly involved followed by median nerve, common peroneal nerve, facial nerve and the radial nerve in descending order. High doses of steroids are commonly given in peripheral neuropathies, but 70–75% cases still develop deformity with this treatment. Surgical decompression of involved nerves, though not so common, is another modality attempted for nerve damage prevention. In the present study, we compared steroid therapy alone with steroids plus surgical decompression, for carpal tunnel syndrome in leprosy cases.

    Methods

    52 patients with involvement of 70 median nerves (18 bilateral) were enrolled. They had palpable median nerves, along with sensory and motor loss. 16 patients were lost to follow up by 2 years, so that 36 patients with 50 median nerves (14 bilateral) remained for review. These cases were randomly divided into two groups: one group was given steroids while the second group was given steroids along with surgical nerve decompression. The results were evaluated for improvement or deterioration of the sensory and motor symptoms, along with pain.

    Conclusion

    The results support the proposition that surgical decompression of the nerve together with steroid treatment, is a better option to prevent the progression of deformities due to median nerve involvement, than steroids alone. 

Original Papers
Pages 225 - 235
  • A clinicopathological and electrophysiological study of nerve involvement in leprosy in a tertiary care centre in South India

    • M. I. Celine
    • Ameena Jaleel
    • Seena Palakkal
    • Beena Vasanthi
    • K. Sobhanakumari
    • M. S. Sadeep
    Volume 92, Issue 3

    | Published on September 2021

    Objectives and Methods

    To correlate the clinical spectrum of Hansen’s disease with the histopathological spectrum in skin and nerve and to study the electrophysiological changes in peripheral nerves in Hansen’s disease. Thirty-five consecutive attendees with leprosy were recruited for the study from a tertiary dermatology clinic.

    Results

    Clinically, borderline tuberculoid (BT) classification was the commonest subtype with 34% cases, followed by borderline lepromatous (BL) and lepromatous (LL). The incidence of multibacillary (MB) cases was high (83%) and grade 2 disability was seen in 23% cases. Concordance between clinical diagnosis and skin histopathology was 75.8%, while between clinical diagnosis and nerve histopathology was 68%. Skin and nerve histopathology were in concordance in 60% of cases. Electrophysiological assessment revealed derangement in 88.5% of cases with sensory nerve conduction parameters being the commonest and earliest to be affected. Analysis revealed a significant association between deranged parameters and thickness of the superficial peroneal nerve, sural and common peroneal nerves. Subclinical involvement was high in most nerves studied. Cases at the tuberculoid end of the spectrum showed more of segmental demyelination, whereas lepromatous cases showed a mixture of axonal and demyelinating changes.

    Conclusion

    A high degree of concordance was seen between dermal and nerve histopathologies, especially towards the poles of the leprosy spectrum. With an increasing trend towards MB cases and grade 2 disability, our study validates nerve conduction study to be a very sensitive screening tool to detect Hansen’s disease in its early stages and also to identify the type of nerve degeneration. Nerve histopathology may be considered as the gold standard for confirmation of the diagnosis of leprosy.