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PubMed1981

[Ocular findings in leprosy: results of a survey in the Green Pastures Leprosy Hospital, Nepal (author's transl)].

One hundred and seventy leprous patients underwent ophthalmic examination; of those with tuberculoid leprosy, 49.3% had ocular pathology; in patients with lepromatous leprosy the corresponding figure was 61.4%. 4.7 percent of all eyes examined were blind. Early chemotherapy prevents further complications in tuberculoid leprosy, but not in ;the lepromatous type. The results are compared with those of other authors.

Adult↗

PubMed1983

Lepromatous leprosy in man; depth of the cellular infiltrate and bacillary mass in relation to the possibility of transmission of leprosy by biting arthropods.

In order to further define the possible role of arthropods in the transmission of leprosy, the depth of the cellular infiltrate and bacillary mass in the skin of patients with untreated lepromatous leprosy was measured, and this was related to the depth of penetration of the mouthparts of some species of arthropods of medical importance. The results confirmed that large numbers of bacilli are readily available to the biting apparatus of several species of arthropods, but not to that of the scabies mite, which has only a superficial attachment and depth of penetration. The data do not indicate that leprosy transmission in man (or animals) occurs through biting arthropods, but they do lend support to this possibility, if only in a mechanical sense.

Animals↗

PubMed2003

Simple and fast lateral flow test for classification of leprosy patients and identification of contacts with high risk of developing leprosy.

The interruption of leprosy transmission is one of the main challenges for leprosy control programs since no consistent evidence exists that transmission has been reduced after the introduction of multidrug therapy. Sources of infection are primarily people with high loads of bacteria with or without clinical signs of leprosy. The availability of a simple test system for the detection of antibodies to phenolic glycolipid-I (PGL-I) of Mycobacterium leprae to identify these individuals may be important in the prevention of transmission. We have developed a lateral flow assay, the ML Flow test, for the detection of antibodies to PGL-I which takes only 10 min to perform. An agreement of 91% was observed between enzyme-linked immunosorbent assay and our test; the agreement beyond chance (kappa value) was 0.77. We evaluated the use of whole blood by comparing 539 blood and serum samples from an area of high endemicity. The observed agreement was 85.9% (kappa = 0.70). Storage of the lateral flow test and the running buffer at 28 degrees C for up to 1 year did not influence the results of the assay. The sensitivity of the ML Flow test in correctly classifying MB patients was 97.4%. The specificity of the ML Flow test, based on the results of the control group, was 90.2%. The ML Flow test is a fast and easy-to-perform method for the detection of immunoglobulin M antibodies to PGL-I of M. leprae. It does not require any special equipment, and the highly stable reagents make the test robust and suitable for use in tropical countries.

Antibodies, Bacterial↗

PubMed1987

Experimental leprosy in African green monkeys (Cercopithecus aethiops): a model for polyneuritic leprosy.

Three African green monkeys (Cercopithecus aethiops) were inoculated intravenously and intracutaneously with Mycobacterium leprae derived from a naturally infected mangabey monkey. All developed cutaneous lesions at inoculation sites. One developed disseminated cutaneous lesions, while the cutaneous lesions in the other two regressed and eventually disappeared. The animals were examined at necropsy five years after inoculation. All three had active leprosy infection in peripheral nerves with extensive inflammation and fibrosis. The disease histologically resembled borderline-lepromatous leprosy. These findings add a new dimension to animal models of leprosy.

Animals↗

PubMed1990

The anatomical distribution of single leprosy lesions in an African population, and its implications for the pathogenesis of leprosy.

Data on the anatomical sites of single leprosy lesions found in 635 newly diagnosed and biopsy-confirmed leprosy patients are presented. These patients were found during total population surveys carried out by the Lepra Evaluation Project, a prospective longitudinal study of the epidemiology of leprosy in Karonga District, Northern Malaŵi. There was a striking excess of single lesions on the face and the back of the arms, compared to the distribution of skin surface area, and a deficit on the legs, regardless of age. There is some evidence for a sex difference in lesion distribution among adults, with facial and arm lesions being relatively more common in females and back lesions being more common in males. The excess of lesions on the face compared to the lower limbs is similar to data from Uganda, but very unlike data from Burma and elsewhere in Asia. Overall, the distribution of lesions does not suggest a pattern reflecting entry of Mycobacterium leprae, nor does it suggest an association with anatomical distribution of the nervous or vascular system. It is argued that the distribution reflects the influence of some 'local' environmental or behavioural factors.

Age Factors↗

PubMed1994

Social problems of women leprosy patients--a study conducted at 2 urban leprosy centres in Delhi.

Leprosy seems to afflict women less commonly than men, but for cultural reasons this difference may be more apparent than real. Unfortunately, the effects are as equally devastating, if not more so, in women than in men. This study, carried out at the Urban Leprosy Centres of Safdarjung Hospital and Dr Ram Manohar Lohia Hospital in Delhi, showed that the impact of stigmata attached to leprosy had more effect on educated women belonging to a higher socioeconomic group than on less fortunate women. Discriminative attitudes were more common in joint than nuclear families. Although many got support from their families, the disease had definite psychological effects. Because of the fear of infecting the family members, women sufferers kept themselves aloof and were constantly worried about divorce. Fear of social ostracism prevented the disclosure of disease to the community. Deformities and disabilities led to a deterioration in their functional capabilities and their psychological state of mind. Pregnancy did not affect regularity of treatment. Many women needed an escort to attend the clinic. Solutions to minimize some problems have been suggested.

Adolescent↗

PubMed1998

Leprosy and disability control in the Guéra prefecture of Chad, Africa: do women have access to leprosy control services?

In a retrospective study, data from the Guéra Leprosy and Disability Control Project in Chad, covering the years from 1992 to 1996, were analysed in order to determine whether there was any indication that the quality of care provided to female leprosy sufferers is inferior to the care provided for male patients. Data from a total of 741 patient registered for MDT, of whom 351 were newly diagnosed cases, are presented and discussed. The data indicate that women have access to diagnosis and treatment and health education. They do not present for treatment later than men, disability rates are lower and they have slightly higher treatment completion rates. Both women and men benefit from footwear and loan programs. More women than men are involved in patient self-help groups. The study shows that in this part of central Chad, there is no evidence of disadvantage for women with leprosy in either diagnosis, treatment or follow-up, but more qualitative data is needed to confirm these findings.

Adolescent↗

PubMed1999

Guidelines for carrying out leprosy elimination campaigns 1996. WHO, Action Programme for the Elimination of Leprosy.

A Leprosy Elimination Campaign (LEC) is an initiative which aims to detect leprosy cases, particularly the more serious ones referred to as 'cases of consequence', that remain undetected in the community, and to treat them with MDT. This will subsequently reduce the delay in managing such cases in the community and ensure that the existing health services are able to treat them. It is a time-bound, one-time activity. Leprosy of consequence is defined as cases with more than five skin lesions and skin smear positive cases. Such cases are regarded as being of consequence because they act as a major source of infection in the community and are either already disabled or at high risk of becoming disabled. LEC is a focused combination of activities which includes: orientation courses for local health workers and volunteers; community awareness creation activities; case-finding and treating every detected case immediately with MDT. These campaigns are to be carried out primarily in endemic regions where the prevalence and new case detections are high and where the gap between estimated and registered cases is large. It is a national activity, implemented by the national staff with technical cooperation from WHO and other agencies.

Drug Therapy, Combination↗

PubMed2000

Computerization of leprosy records: national leprosy recording and reporting system in China.

This paper describes the national system of leprosy recording and reporting in China and the computerization of records. The system was designed for data collection at local level and data entry by optically scanned or manual mode as well as for sophisticated data analysis. The major functions include data entry, data check, sum-up, maintenance, communication, inquiry, statistics, graph and print. A total of 17 options for epidemiological and clinical data analysis are available. Through the implementation for about 10 years, the system has gained widespread acceptance. This acceptance would facilitate introduction of computer analysis to other leprosy projects and other disease control programs in China. Up to 1998, a database of more than 740,000 records covering all the leprosy patients detected since 1949 had been established by this system.

Adolescent↗

PubMedDate not supplied

Prediction of elimination of leprosy in leprosy endemic areas of China.

A study was carried out based upon the data from the National System for Leprosy Surveillance and using appropriate mathematical models. The results showed that of 337 counties where the national goal of basic eradication of leprosy had not been reached and in 40 counties where the WHO goal of leprosy elimination had not been achieved in 1996, the detection rates in calendar years followed exponential models with significant goodness-of-fit. In the 67 counties with downward trends of detection rates, the national goal can be met in terms of detection rate in 6% of counties before the year 2000 or 34.4% before the year 2010, or, in terms of prevalence rate in 31.3% before the year 2010. In the 11 counties with downward trends of the detection rates, the WHO target can be met in eight to ten counties within this century when the duration of disease was determined with the WHO definition. If the MB proportion among new cases increased by 10%, the target would be met one year later. However, at the same MB proportion, the change of fixed treatment schedules from PB six months and MB two years to PB nine months and MB three years will cause achievement of the goal to be postponed by two to ten years.

Analysis of Variance↗

PubMed1999

HLA linked with leprosy in southern China: HLA-linked resistance alleles to leprosy.

According to the World Health Organization recommended multidrug therapy (WHO/MDT), we have carried out this study to investigate the presence of HLA-linked susceptibility or resistance to leprosy in a southern Chinese population. Sixty-nine leprosy patients and 112 healthy controls participated in the study. HLA-DR2 subtypes, HLA-B and MHC Class I chain-related A (MICA) alleles were typed at the DNA level using the polymerase chain reaction-single strand conformation polymorphism method. The frequencies of HLA-DR2-DRB1 alleles did not show any significant differences between the patient and the control groups, suggesting that the disease susceptibility was not associated with the DR2 subtypes in this southern Chinese population. On the other hand, in the multibacillary (MB) patients significantly decreased allele frequencies of HLA-B46 (0.040 in MB patients vs 0.129 in controls) and MICA-A5 (0.200 vs 0.380) were observed compared with the healthy controls. The calculated relative risk (RR) for B46 was 0.28; for MICA-A5, 0.52. In addition, on haplotype analysis the frequency of the HLA-B46/MICA-A5 haplotype was significantly decreased in the MB patients compared to controls (0.060 vs 0.233, RR = 0.22, p < 0.01). These results suggest that an HLA-linked disease-resistant gene to MB leprosy in southern China is in strong linkage disequilibrium with the HLA-B46/MICA-A5 haplotype. In other words, the resistant gene may be located near the HLA-B/MICA region and not in the HLA-DR locus.

China↗

PubMed1998

Underutilization of the available services by the needy disabled leprosy patients in Government Leprosy Control Unit Puttoor, Chittoor district, Andhra Pradesh, South India.

This study was undertaken to find out the deformity profile, utilization of disability care services, factors associated with underutilization and the impact of educating leprosy patients with visible disabilities in self-care practices in the area covered by the LCU Chittoor. The disability prevalence rate in the area was 15 per 10,000 population. Training of the staff and teaching leprosy patients in self-care practices has shown a remarkable improvement in skin texture and ulcer situation of disabled leprosy patients.

Adolescent↗

PubMed1975

Biochemical, immunological and genetic studies in leprosy. III. Genetic polymorphism of C3 and immunoglobulin profile in leprosy patients, healthy family members and controls.

148 members from 30 families (64 children) from Ethiopia, where one of more persons were affected with leprosy, were investigated for genetic polymorphism of C3, serum concentration of ss1C/ss1A-globulin and immunoglobulins A, G and M using high voltage agarose electrophoresis, immunoelectroassay and single radial immunodiffusion techniques respectively. The results are compared with related healthy controls. No association between C3 phenotypes and leprosy could be established through family studies. C3 concentration was, however, lower in leprosy patients. Difficulties and drawbacks of such studies with small families are discussed.

Adult↗

PubMedDate not supplied

Induction of lepromin positivity by a candidate anti-leprosy vaccine Mycobacterium w in lepromin negative healthy contacts of multibacillary leprosy patients.

In a hospital based study, 362 household contacts of multibacillary leprosy patients were screened for evidence of leprosy and 54 (14.9%) were found to be having leprosy. The remaining 308 apparently healthy contacts were lepromin tested and 109 (35.4%) were observed to be negative to Mitsuda lepromin. M.w vaccine was administered intradermally to 95 of these 109 lepromin negative contacts. Sixty eight of them could be retested for lepromin A reactivity. Fifty six (82.35%) manifested lepromin conversion. The twelve subjects who did not show lepromin conversion, received a second dose of the vaccine, and eleven subsequently became lepromin positive. The overall lepromin conversion rate was thus 98.5% (67 out of 68). Follow-up of these contacts upto a period of 30 months did not demonstrate reversion of lepromin positivity back to negativity status. No untoward effects of vaccination were observed except for local ulceration at the site of vaccine administration.

Adolescent↗

PubMed1975

Depressive effect of serum from patients with leprosy on mixed lymphocyte reactions. Influence of anti-leprosy treatment.

Mixed leucocyte cultures, from two normal donors, were set up in media containing human serum from one of the following sources: (a) a pool of normal group AB donors; (b) Chinese, Malay or Indian patients with untreated leprosy; (c) the same patients after effective anti-leprosy treatment; (d) control Chinese, Malay or Indian subjects. Transformation was estimated by measuring the incorporation of tritiated thymidine in the last 24 hr of a 7-day culture period. Transformation was impaired in sera from treated lepromatous patients, but was less impaired or not impaired at all in sera from treated lepromatous patients. The loss of depressive activity after treatment was more marked in Chinese and Indian than in Malay patients. Transformation was also impaired, though to a lesser extent, in sera from patients with untreated tuberculoid leprosy; it was still impaired in sera from treated tuberculoid patients. There was no evidence of specificity in impairment of mixed lymphocyte reactivity and lymphocytotoxic antibodies appeared to play no role. The incidences of hepatitis B antigen and antibody and of anti-nuclear factor were not notably high.

Adolescent↗

PubMed2004

An exploration of the views of people with leprosy in Nepal concerning the quality of leprosy services and their impact on adherence behaviour.

Based on a qualitative interview study conducted in eastern Nepal, this paper explores the quality of services received by people with leprosy and the impact of quality of services received on adherence behaviour. The study found that a person's status within the family and community influenced the quality of care, which in turn affected adherence to treatment. Five major types of deficiency in the quality of care experienced were identified, particularly by the poor people and by women. These were the attitude and behaviour of the health worker, the practitioner-centeredness of the care and lack of information sharing, the organization of the health services, barriers in accessibility of the leprosy services, and lack of, or carelessness in, patient referral. This paper explores these types of deficiencies and the way people affected by leprosy cope with them. People of a higher status had access to enabling factors which allowed them to continue treatment, people of a lower status had to endure many disadvantages which had a great influence on their adherence behaviour.

Adaptation, Psychological↗

PubMed2004

National Leprosy Eradication Programme and progress towards elimination of leprosy in India.

The World Health Assembly in May 1991 made the declaration to eliminate leprosy at global level by the year 2000. Complete coverage of all the districts with MDT was possible in the year 1996. Very good results were obtained and the case lead came down to 0.51 million by December 2000. A new goal has been set to reach leprosy elimination at national level in India by December 2005. The challenges to eliminate leprosy and to bring prevalence rate 0.9/10,000 by December 2005 are to be taken at epidemiological, operational and at administrative levels.

Adult↗

PubMed2005

The INFIR Cohort Study: investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India.

The aim of this study was to find predictors of neuropathy and reactions, determine the most sensitive methods for detecting peripheral neuropathy, study the pathogenesis of neuropathy and reactions and create a bank of specimen, backed up by detailed clinical documentation. A multi-centre cohort study of 303 multibacillary leprosy patients in Northern India was followed for 2 years. All newly registered MB patients requiring a full course of MDT, who were smear positive and/or had six or more skin lesions and/or had two or more nerve trunks involved, were eligible. A detailed history was taken and physical and neurological examinations were performed. Nerve function was assessed at each visit with nerve conduction testing, warm and cold detection thresholds, vibrometry, dynamometry, monofilaments and voluntary muscle testing. Because the latter two are widely used in leprosy clinics, they were used as 'gold standard' for sensory and motor impairment. Other outcome events were type 1 and 2 reactions and neuritis. All subjects had a skin biopsy at registration, repeated at the time of an outcome event, along with a nerve biopsy. These were examined using a variety of immunohistological techniques. Blood sampling for serological testing was done at every 4-weekly clinic visit. At diagnosis, 115 patients had an outcome event of recent onset. Many people had skin lesions overlying a major nerve trunk, which were shown to be significantly associated with an increased of sensory or motor impairment. The most important adjusted odds ratios for motor impairment were, facial 4.5 (1.3-16) and ulnar 3.5 (1.0-8.5); for sensory impairment they were, ulnar 2.9 (1.3-6.5), median 3.6 (1.1-12) and posterior tibial 4.0 (1.8-8.7). Nerve enlargement was found in 94% of patients, while only 24% and 3% had paraesthesia and nerve tenderness on palpation, respectively. These increased the risk of reactions only marginally. Seven subjects had abnormal tendon reflexes and seven abnormal joint position sense. In all but one case, these impairments were accompanied by abnormalities in two or more other nerve function tests and thus seemed to indicate more severe neuropathy. At diagnosis, 38% of a cohort of newly diagnosed MB leprosy patients had recent or new reactions or nerve damage at the time of intake into the study. The main risk factor for neuropathy found in this baseline analysis was the presence of skin lesions overlying nerve trunks. They increased the risk of sensory or motor impairment in the concerned nerve by 3-4 times. For some nerves, reactional signs in the lesions further increased this risk to 6-8 times the risk of those without such lesions. Patients with skin lesions overlying peripheral nerve trunks should be carefully monitored for development of sensory or motor impairment.

Adolescent↗