A clinical study of eye complications in leprosy

A study was conducted to find out the incidence of ocular complications in leprosy. The ocular lesions were found in 6.6% of lepromatous leprosy and 1.6% in nonlepromatous leprosy. Out of 150 patients with eye lesions 74% were males and 80% belonged to lepromatous leprosy. The age group in all the patients varied from 3rd to 6th decade. Mean duration of leprosy ln lepromatous leprosy was 6.2 years. The important eye complication observed were lagophthalmos (8.1%), corneal ulcers (10%) and iridocyclitis (24%). The loss of eye-brows (76%) was found to be most frequent in this study followed by corneal lesion (62%). It is concluded that examination of eyes are essential in all types of leprosy.     

Recent advances in ocular leprosy

Proper MDT soon after detection of leprosy and anti-reaction measures with newer steroids, regular supervision and monitoring of those released from treatment (RFT) reduce the incidence of ocular leprosy to a remarkable extent. Today, most eye complications are because of normal ageing process or of other phenomena in normal healthy population. Cataract and lagophthalmos are the main causes of blindness. However, in India, though the rate of cataract surgical coverage is up to the mark, the same for lagophthalmos is lagging far behind. Integration of management of ocular leprosy into community eye health care service is the talk of the day along with other health care facilities delivered to people affected with leprosy (PAL). Routine eye examinations are necessary for all PB and MB patients, as well as for the RFT persons in order to detect and treat eyes that are at high risk. All eye surgeries can be performed when needed, irrespective of deformities and bacteriological status, by latest microsurgical techniques with good outcome, and better rehabilitation measures. Reorientation training in ocular leprosy is the immediate special need for ophthalmologists, paramedical ophthalmic assistants and eye health care managers working in general hospitals in those areas that were previously "leprosy endemic zones".     

A study of leprosy affected beggars in Aska

A study conducted among beggars in and around Aska, Orissa revealed 41 of them to be leprosy patients. Almost all had taken treatment and had been released from control. Only 2 of them were mildly positive in their skin smears for AFB. All of them had disabilities and deformities. It is evident that at least in this area beggar leprosy patients cannot be contributing to the transmission of the disease. Their treatment regularity record was also very good.     

A study of dermatological conditions in leprosy in-patients

Three hundred and sixty six in-patients in a leprosy hospital were examined for other dermatological conditions. Eighty eight of them displayed ichthyosiform changes. A peculiar condition of a verrucous hyperkeratotic growth on the anterior aspect of ankle, not described previously, was observed in four patients. It was noted that 11 out of 12 patients with scabies did not have the classical lesions in web spaces of the hands.     

A study of leprosy in relation with HBsAg

In the present study presence of HBsAg in the serum of 130 leprosy patients (LL 50; ENL 30; TT 50) and its relationship with various complications has been studied. The HBsAg positivity in controls and various types of leprosy did not show any significant difference. Similarly complication also had no relation with HBsAg positivity. So we conclude that leprosy has no relation with HBsAg.     

A study of palmar ridge malformation in leprosy

Palmar ridge malformation of 150 male leprosy patients (50 multibacillary and 100 paucibacillary) were compared with matched controls. Significantly high incidence of ridge malformation was found on the palms of multibacillary leprosy patients. The acquired ridge atrophy was found in 32% multibacillary leprosy, 4.5% paucibacillary leprosy and 0% controls. The congenital ridge dissociation was found in 46% multibacillary leprosy, 20% paucibacillary leprosy and 22% controls. The difference is statistically significant.     

A clinico-pathological study of multidrug regimen in paucibacillary leprosy

Preliminary results of a clinical trial in one hundred untreated paucibacillary leprosy cases with multidrug therapy (MDT) as per WHO recommendation are presented. Out of 100 fresh cases studied 18 had indeterminate, 35 tuberculoid and 47 cases had borderline tuberculoid leprosy. All were given MDT consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for six months. At the end of six months all the cases were evaluated clinically and histopathological examination of lesions were studied. The lesions were still active in 35% of patient clinically and 47% histologically. Complete histological resolution have come across only in 4 cases suffering from indeterminate leprosy. Altogether 65% cases receiving MDT have shown marked improvement to total inactivation. Histologically, lymphocytic infiltration still persisted in 90% of slides examined and nerve infiltration were still present in 64% of cases at the end of six months receiving MDT.     

Management of complications following leprosy: an evolving scenario

Reaction in leprosy, nerve damage/deformities, drug resistance/relapses, may come as yet another challenge. Their management too is intriguing and has been dealt with carefully. In addition, special situations such as pregnancy and concomitant HIV/tuberculosis also need care for their effective management. To facilitate a comprehensive appraisal, the subject has been bifurcated into management of leprosy per se were multidrug therapy (MDT) is widely the accepted and acclaimed treatment option. The former has been dealt with in depth in an adjoining article, while the latter forms the contents of the current paper. The salient contents of the text are illustrated by exemplary literature, which should provide an adequate and comprehensive source of information for the academic work force, under- and post-graduate students of dermatology, health workers and treating physicians involved in the care of leprosy patients, and facilitate decision making or options for treatment in a given case.     

A preliminary study of locognosia in people affected by leprosy

Locognosia is the ability to localize a sensory stimulus on the body's surface and can be tested by graded filaments (Semmes-Weinstein monofilaments). This point localization of sensation (locognosia) wastested by SW filaments over four quadrants of the pulp of the fingers in ulnar/median and ulnar paralysis in 38 new patients affected by leprosy. The results were compared with standard testing of sensation at selected sites by Semmes Weinstein monofilament. Both pulp quadrant testing and standard site testing were done in leprosy patients and also in a group of controls. Sensation was tested in 73 hands in leprosy patients and 34 hands in controls. Results indicate a positive correlation between locognosia and standard SW filament testing. When locognosia and standard SW filament tests were compared, there was significant difference between the two tests to pick up abnormal sensation in leprosy patients both over the entire hand and over individual fingers. This preliminary study suggests that locognosia may be a useful tool to diagnose sensory impairment in leprosy. Further studies are required to corroborate this.     

A study of behavioural changes and clinical evaluation of leprosy in school going children of leprosy parents

Seventy-seven school going children in age group 5-15 years having one or both parents affected with leprosy and staying away from their parents in charitable ashram cum school for the last 6 months to 6 years time were examined for any behavioural changes and signs and symptoms of leprosy. None of these children showed any behavioural changes or signs and symptoms of leprosy.     

Bone changes in leprosy. A study of 50 cases

The radiological bone changes have been studied in 50 patients comprising of lepromatous, tuberculoid, mixed (borderline lepromatous, borderline tuberculoid, dimorphous) and polyneuritic (neural) types of leprosy of which the former formed the largest group. The overall incidence of non-specific bone changes is higher as compared to specific bone changes. These were found to have highest incidence in the lepromatous type of leprosy, in the occupational group of manual workers and from 3rd to 6th decade of life. With the longer duration of the disease, the incidence of non-specific bone changes is also more.