An epidemiological study of leprosy disability in a leprosy endemic rural population of Pondicherry (south India)

The disability rate in this study was 16.23%. The highest disability rate of 30.76% was found in those aged 45 years and above. Disabilities were found to be more common among male leprosy patients with a disability rate of 21.05% compared to that of 11.45% found among female leprosy patients. None of the indeterminate leprosy patients showed any disabilities, whereas all the neuritic and lepromatous leprosy cases showed disabilities. The disability rate among tuberculoid leprosy patients and borderline leprosy patients were found to be 3.25% and 35% respectively. Persons whose monthly per capita income was less than Rs. 200/- constituted 93.50% of the cases with disabilities. Anaesthesia of the hand was seen in 67.4% of the cases. The mean disability index (DI-2 type) was 0.927.     

麻风畸残程度影响因素的逐步回归分析

目的：探讨麻风病畸残程度的影响因素。方法：资料来自现场调查登记完整的辽宁省麻风畸残病历，根据畸残程度计算算数指数(ADI)和加权指数(WDI)，分别作为因变量进行逐步回归分析。结果：两种指数进行的逐步回归分析所选入的麻风畸残影响因素是一致的，为年龄、麻风反应、麻风型别、生活水平。多元回归方程分别为：ADI=0．439 0．829(年龄) 0．260(麻风反应) 0．200(麻风型别)-0．001(生活水平)；WDI=0．781 1．497(年龄) 0．518(麻风反应) 0．421(麻风型别)-0．031(生活水平)。复相关系数分别为0．605和0．572。结论：年龄、麻风反应、麻风型别、生活水平为影响麻风畸残程度的显著性因素，及时发现和治疗病人、有效控制麻风反应、提高生活水平改善经济状况是减轻麻风病人畸残的有效措施。     

云南勐腊县391例麻风新发病人畸残影响因素分析

目的：分析勐腊县近70年麻风新发患者畸残情况及影响因素。方法：收集勐腊县历年麻风患者资料,采用二元logistic回归分析方法分析麻风畸残的影响因素。结果：共分析勐腊县麻风患者391例,麻风新发病例畸残率46.04%（180/391）,其中2 级畸残率44.50%（174/391）。延迟期2～5年、5～10年、≥10年的麻风患者发生畸残风险分别是延迟期＜2年的2.49倍（P=0.018）、4.8倍（P＜0.001）和14.56倍（P＜0.001）;家外传染的麻风畸残风险是家内传染的1.93倍（P=0.030）;有麻风反应的麻风畸残风险是没有反应的2.36倍（P=0.010）;神经损害数2～4条和＞4条的麻风畸残风险分别是神经损害1条的3.37倍（P=0.029）和5.09倍（P=0.009）。结论：勐腊县麻风畸残的危险因素主要有延迟期、家外传染、麻风反应、神经损害数。     

1990-2018年云南省新发麻风患者畸残情况分析

目的：分析云南省1990-2018年新发麻风患者2级畸残情况。方法：对1990-2018年11010例新发麻风患者资料进行分析。结果：新发病例中2级畸残2647例,2级畸残率24.04%。4006例少菌型患者中2级畸残者1294例（32.3%）, 7004例多菌型患者中畸残者1353例(19.3%)。对其中的2202例畸残者进一步分析,单侧和双侧眼部畸残分别为138例和184例,手部单双侧畸残分别为742例和430例,足部单双侧畸残分别为384例和144例。结论：少菌型（PB）比多菌型（MB）麻风患者畸残比例更高,手部畸残明显高于眼部和足部,手部和足部畸残常呈不对称性。     

贵州省新发麻风病患者特征分析

目的了解贵州省低流行状态下新发麻风患者特征,为今后发现更多早期麻风患者,有效降低2级残疾比提供科学的依据。方法采用统一问卷进行现场一对一的调查,并将患者调查问卷和病案信息录入EXCEL表格建立数据库,用SPSS18.0软件进行分析。结果贵州省2012-2018新发的387例麻风患者中,男281例,女106例,男∶女=2.65∶1,14岁及以下患者占4.13%,平均延迟期为43.80个月。周围神经受损主要有尺神经311例(80.36%)、腓总神经176例(45.48%)、耳大神经125例(32.30%),皮损主要有麻木98例(25.32%)、红斑95例(24.55%)、脱眉85例(21.96%)。MB型占75.50%,MB∶PB=3.07∶1,通过比较,麻风的不同型别在性别、年龄和延迟期之间无差异,但少数民族患者的MB型显著性高于汉族(P<0.05),有明确传染源的MB型患者高于不明传染源的(P<0.05),差异均有统计学意义。病期在2年内且无疾残的早期患者为220例(56.85%),以文化程度较高(初中以上)的早期患者为主(70.59%)。不明传染源的患者2级残疾比明显高于有明确传染源的患者,差异有统计学意义(P<0.001),延迟期越长,残疾情况越严重。94.44%的14岁及以下患者均有明确的传染源接触史。结论近年来贵州省新发麻风以多菌型为主,且每年都有儿童患者被发现,仍有局部流行风险,患者延迟诊断情况较严重,急待提升医务人员识别早期麻风能力和患者接触检查质量,实现麻风患者的早期发现。     

Should nutritional status evaluation be included in the initial needs assessment of leprosy patients with disability prior to socio-economic

Because of the large numbers of leprosy patients with disability and the limited resources available, it is important that socio-economic rehabilitation (SER) is targeted towards those who are most in need. Towards this purpose, current assessments of leprosy patients prior to initiating SER include the evaluation of income, assets and household possessions. Conspicuously absent is the nutritional assessment of the patient. In the absence of weight loss associated with illness, population studies indicate that undernutrition reflects poor socio-economic conditions. In this study of 151 cured leprosy patients with disability, 57% of the patients were found to be undernourished using body mass index (kg/m2) derived from body weight and height, and 10% of the patients were severely undernourished (grade III). Undernutrition in the patients was poorly though significantly correlated with personal income (r = 0.18, P < 0.05). Total household income, reported amount of money spent on food and estimated cereal intakes were not correlated with the BMI of the patient, possibly due to reporting bias and other methodological issues. We propose the inclusion of nutritional status evaluation by anthropometry as part of the initial screening of leprosy patients prior to instituting SER. We believe that this simple and objective evaluation can add to the assessment of 'threat' of economic deprivation or actual economic 'dislocation', and thus help in the prioritization of leprosy patients for SER.     

重复开展消除麻风运动对当地新发现病人情况的影响

目的:观察贵州省兴义市重复开展消除麻风运动对当地新发现麻风病人的影响.方法:收集1996～2004年新发现麻风病人的有关资料进行比较分析.结果:9年共发现麻风病人166例,平均每年发现18.4例,年均发现率为2.65/10万.1999年首次开展消除麻风运动后3年,新病人中的2级畸残率和延迟期呈明显下降趋势,低于开展前3年的水平.两次开展消除麻风运动时的畸残率和平均延迟期均达较高水平,提示该地区虽两次开展消除麻风运动但麻风流行程度仍处于较高水平.结论:重复实施消除麻风运动可促进某些流行病学指标的好转,应反复多次开展.     

Quality of life in patients with lepromatous leprosy in China

Background Leprosy has an impact on patients’ quality of life (QoL). However, there has been no study specifically on the impact of the severest type of leprosy‐lepromatous leprosy on QoL. Objective To describe the use of Dermatology Life Quality Index (DLQI) among patients with lepromatous leprosy in China. Methods Sixty‐four inpatients with lepromatous leprosy of Shangluo hospital and Hanzhong hospital and sixty‐four controls (healthy volunteers or patients with other dermatoses) matched for age and gender were asked to complete DLQI questionnaires from 2 September 2008 to 20 December 2008. Extensive data were collected besides DLQI, including demographic data and disease‐related characteristics. Absence or presence of disability among patients with lepromatous leprosy was evaluated at the same time. Results The overall mean DLQI score for lepromatous leprosy (18.78) was higher than that for control (9.00) (P < 0.001). Patients with lepromatous leprosy scored significantly higher for all items (P < 0.001) except Q4 (clothes choice). Controls scored significantly lower for all domains of DLQI. Scores of LL increased markedly with increasing clinical severity, but were not associated with educational level, gender, age and disease duration. The inter‐item correlation averaged 0.240 and Cronbach’s alpha was 0.759, indicating high internal consistency. Conclusions This is the first exclusive study to attempt to measure the impact of lepromatous leprosy on QoL. Lepromatous leprosy has a severe impact on QoL.     

Lymphocyte adenosine deaminase activity (L-ADA) in leprosy, during and after treatment of reactions

Twenty-five patients with type 1 (lepra) and type 2 (E.N.L.) leprosy reactions were studied for lymphocyte adenosine deaminase activity (L-ADA), during and after treatment of the reactions, using a standard technique, in order to establish its pattern and if possible, its value in assessing the course of reactions. The results were compared with those from 30 control subjects, comprising 10 normal healthy adults, 10 patients with borderline tuberculoid (BT) leprosy, four patients with borderline lepromatous (BL) leprosy and six patients with lepromatous (LL) leprosy. The level of L-ADA in the leprosy controls was higher than that of normal healthy subjects. The L-ADA values in patients with different types of reactions were about 10-fold higher than those obtained from leprosy controls, emphasizing a possible role in assessing reactions in leprosy. However, there was no significant variation in L-ADA levels, either between the various leprosy controls or reaction groups, before and after treatment.     

Cytokines in leprosy, I. Serum cytokine profile in leprosy

Background Leprosy is a chronic infectious disease characterized by a broad spectrum of clinical forms depending on the patient's immune response, in particular cell-mediated immune response. Methods Cytokines can play a role in the cell-mediated immune response. Serum levels of interferon-gamma (IFN-γ), interleukin-2 (IL-2), interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), tumor necrosis factor-alpha (TNF-α), and interleukin-1beta (IL-1β) were measured by enzyme-linked immunosorbent assay (ELISA) in 55 untreated leprosy patients and 35 reactional leprosy patients, in addition to 20 age- and sex-matched healthy controls. Results Leprosy patients showed significantly higher serum levels of the studied cytokines (except IL-2) compared with healthy controls. When the two poles were compared, tuberculoid leprosy (TT) patients showed significantly higher levels of IFN-γ and TNF-α with significant negative correlations with the bacterial index (BI), whereas lepromatous leprosy (LL) patients showed significantly higher serum levels of IL-2R, IL-10, and IL-1β with significant positive correlations with the BI. Both type I and type II reactional patients showed significantly higher serum IFN-γ, IL-2R, and IL-1β, in addition to IL-10 in type II reactional patients, compared with nonreactional leprosy patients. When compared with each other, type I reactional patients showed increased levels of IFN-γ, whereas type II reactional patients showed increased levels of IL-10. Conclusions In leprosy patients, both IFN-γ and TNF-α are immunoprotective, whereas IL-2R, IL-10, and IL-1β are immunosuppressive. Our results indicate that type I reaction, with increased levels of IFN-γ, is a cell-mediated immune response, whereas type II reaction, with increased levels of IL-10, is essentially an immune complex disease.     

陕西省麻风新发病例基本情况分析

通过全国麻风防治管理信息系统（LEPMIS）收集陕西省2004-2020年麻风病例资料,对新发麻风患者的基本情况进行回顾性分析。研究纳入了305个麻风新发病例,其中男212例,女93例,MB型麻风272例(89.2%),PB型麻风33例(10.82%)。60岁以上患者49例,20～59岁247例,20以下患者9例。100例（32.8%）有家庭内接触史。42例（13.8%）出现麻风反应,247例（81%）出现神经损害,男性神经损伤率高于女性（86.3% vs 68.8%）。218例（71.5%）出现畸残,其中II级畸残122例,I级畸残96例。     

Cytokines in leprosy, II. Effect of treatment on serum cytokines in leprosy

Background Multidrug therapy (MDT) causes a decrease in the bacterial burden in leprosy patients. Does the decrease in the antigenic stimulation of the immune system have an effect on cytokine production? Methods The effect of treatment on serum cytokines was evaluated in 36 leprosy patients and 35 reactional leprosy patients and compared with that in 20 age- and sex-matched healthy individuals. The enzyme-linked immunosorbent assay (ELISA) technique was used to measure serum levels of interleukin-2 receptor (IL-2R), interleukin-10 (IL-10), and interleukin-1beta (IL-1β) before and after treatment. These cytokines represent T-helper 1 (TH1), T-helper 2 (TH2), and macrophage cytokines, respectively. Results The studied serum cytokines were significantly reduced after 1 year of treatment in leprosy patients. The degrees of reduction were significantly positively correlated with a reduction in the bacterial index (BI) and morphologic index (MI). After 1 year of MDT (but not 6 months), paucibacillary (PB) patients showed a significant reduction in all the studied serum cytokines to levels comparable with those of healthy controls. Multibacillary (MB) patients also showed a significant reduction in all the studied serum cytokines, but the levels were still significantly higher than those of healthy controls. Leprosy patients with high levels of serum IL-1β were more susceptible to the development of reactions after the initiation of treatment. Corticosteroid therapy of reactional patients resulted in a significant reduction in the studied serum cytokines to levels similar or lower than those of nonreactional leprosy patients. The dose of steroids showed a significant positive correlation with the amount of decrease in IL-1β. Conclusions MDT caused a reduction in serum cytokines correlated with a reduction in the bacterial burden. It is advisable to continue MDT for PB patients for 1 year. Serum IL-1β levels may have a prognostic value for the susceptibility of leprosy patients to the development of reactions.     

甘肃省麻风患者诊断延迟期与2级畸残发生的相关性

目的：明确诊断延迟期与发生2级畸残的相关性。方法：通过“全国麻风病防治管理信息系统”（LEPMIS）收集2000年1月至2019年12月确诊的麻风患者,分析诊断延迟与畸残的相关性。结果：共收集麻风患者130例,2级畸残组37例,非2级畸残组93例,麻风患者诊断延迟期和2级畸残发生率呈明显正相关（r=0.70,P＜0.05）。诊断延迟期≥6个月的患者发生2级畸残的风险是诊断延迟期＜6个月患者的6.64倍。结论：诊断延迟是麻风患者发生2级畸残的重要风险因素。     

2005-2020年贵阳市麻风流行病学特征分析

目的:了解贵阳市2005-2020年麻风的流行病学特征.方法:通过全国麻风防治管理信息系统(LEPMIS)收集整理贵阳市2005-2020年新、复发麻风患者的详细资料,采用SPSS 18.0软件对麻风病例的一般情况和就诊次数、麻风反应、残疾情况、传染源、发现方式和型别等相关因素进行χ2检验和非条件logistic多因素...     

An epidemiological study of leprosy in a rural community of Pondicherry

In a rural area, endemic for Leprosy a total population survey had been undertaken in 6 villages covering a population of 5667. Out of the 5281 persons examined, 191 were found to be suffering from leprosy giving a prevalence rate of 36.16/1000. The prevalence was highest in children aged between 5 and 14 years., i.e., 41.61/1000. Among adults the highest prevalence was seen among those aged above 45 years, i.e., 45.66/1000. Both the sexes were found to be equally affected in this area. Tuberculoid leprosy was the most common type found with a prevalence rate of 23.29/1000, followed by Indeterminate type with a prevalence rate of 5.3/1000. Lepromatous rate was 3.69%. The disability rate was found to be 16.23%, with a mean disability index of 0.927.     

120例住院麻风患者心理状况的研究

目的了解我院留院麻风治愈者的心理健康状况。方法采用SCL—90症状自评量表对我院120例住院麻风患者进行研究,并将调查结果与全国常模进行比较分析。结果发现住院麻风患者其躯体化因子分明显高于全国常模,有高度显著差异(P<0.001);总分、阳性痛苦水平、强迫、人际关系、焦虑、敌意、恐怖、偏执因子分均明显低于常模,有高度显著差异(P<0.001);精神病性因子分也低于常模,有统计学差异P<0.05);阳性项目数、抑郁虽低于常模,但统计学处理无差异P>0.05)。结论住院麻风治愈者心理异常以躯体症状为主,其它心理异常较常人为少,这表明麻风病院作为重症残疾麻风患者心理康复基地作用效果明显,有其重要独特地位。应注意加强对麻风患者残疾与老年疾病防治,以减轻麻风患者躯体不适,提高其整体健康水平。     

2235例麻风垂足的分析

目的：了解麻风垂足的患病情况，为制定预防措施提供科学依据。方法：选择江苏11个县市存活的麻风治愈者及现症患者为调查对象，资料输入计算机统计分析。结果：麻风垂足的患病率为15．7％，单足（13．62％）高于双足（2．07％），男性（16．36％）高于女性（13．84％）,现症及复发病人（31．28％）高于治愈者（15．07％），BT、BB型麻风占23．56％及20．96％。麻风病期在5年以内发生垂足的少菌型麻风（72．41％）高于多菌型（50．47％）；发生过麻风反应的患者垂足占33．75％。垂足有足底溃疡（21．21％）、足骨破坏（19．17％）及足畸形（27．43％）多于无垂足的溃疡（15％）、骨破坏（15．09％）及足畸形（20．19％）。989只垂足可通过手术矫治，要求治疗者只占30％。结论：麻风垂足以男性、现症及复发病人多见且以单足为主，垂足发生的足底溃疡及足畸形明显增多，三分之二的垂足失去了手术矫治的机会，70％的患者对垂足的治疗没有信心。麻风垂足的发生与麻风诊断和治疗的延迟、麻风反应及麻风型别的不同有明显的关系。     

Assessing socio-economic factors in relation to stigmatization,impairment status,and selection for socio-economic rehabilitation: a 1-year cohort of new leprosy cases in north Bangladesh

The current leprosy elimination strategy focuses almost exclusively on delivery of leprosy diagnostic services and multi-drug treatment (MDT). However, the specific problems of people newly diagnosed with leprosy or cured with MDT primarily relate to impairment of nerve function and social and economic consequences of the diagnosis of leprosy. This study was carried out to investigate the relation between socio-economic factors and the development of nerve impairments and stigma. In addition the relation between socio-economic factors and selection for socio-economic assistance was studied. The study population was a cohort of 2364 newly diagnosed people with leprosy in rural Bangladesh in 1996, including 42.5% women, with an overall mean age of 31.4 years. Three hundred and sixty people (15.2%) had WHO grade 1 or 2 disability identified at diagnosis, and 50 (2.1%) had stigma identified on interview at home visit conducted within one month of diagnosis. One hundred and eighty-eight people (8%) were selected for specific assistance for rehabilitation, primarily interest-free loans for income generating activities or vocational training. Factors independently associated with WHO grade 1 or 2 disability at diagnosis were multibacillary (MB) classification, adult status, and manual occupations. Smear positivity, female sex, and the presence of dependents were associated with an increase in the experience of stigma. The presence of nerve impairments and stigma, as well as several indices of poverty were clearly associated with selection for inclusion in an integrated program for socio-economic assistance. An increased focus by leprosy services on the socio-economic factors associated with poorer physical and social outcomes is recommended. Where adequate finances and trained staff are available, efforts could be made to identify those at higher risk of poor outcomes, and to provide or to mobilize appropriately targeted socio-economic interventions.     

Status of histoid leprosy--a clinical, bacteriological, histopathological and immunological appraisal

The study of different aspects, namely clinical, bacteriological, histopathological and immunological, of 23 cases of histoid leprosy were quite revealing. The salient features included the occurrence of histoid lesions in a proportion of untreated leprosy patients in addition to those on dapsone treatment for a variable periods of time, a high bacteriological index in spite of infrequent formation of globi, high morphological indices and the immunological status of these patients. Cell-mediated immunity, which was deficient in relation to healthy controls, appeared to be augmented when compared with active lepromatous (LL) patients. A few contributory factors to the development of such a situation are discussed.     

Bone changes in leprosy patients with disabilities/deformities (a clinico-radiological correlation).

One hundred and ten leprosy patients (96 males and 14 females, mean age 45.3 years) with disabilities/deformities were examined radiologically to evaluate bone changes and correlating them with clinical parameters. Most patients (98) had paucibacillary leprosy. The mean duration of leprosy was 7.4 years and that of deformity was 4.1 years. Ten patients presented with reaction. Seventy-five (68.2%) patients had received a full course of antileprosy treatment. The overall prevalence of bone changes was 87.3% (96 patients); specific, non-specific, osteoporotic and facial changes were seen in 44.5%, 75.5%, 38.2% and 9.1% of the patients respectively. Among the specific bone changes, primary periosteitis (28.2%) and "bone cysts" (22.7%) were the more common findings. Among the non-specific bone changes, terminal phalangeal absorption (48.2%), soft tissue changes (44.5%) and concentric absorption (32.7%) were more common. Specific bone changes showed a significant (P < 0.05) increase with lack of or incomplete antileprosy treatment. Non-specific bone changes showed significant correlation (P < 0.05) with increasing duration of disease, lack of or partial treatment and rising disability index. Osteoporotic changes showed a significant relationship with rising disability index.