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.     

Diagnosing leprosy: revisiting the role of the slit-skin smear with critical analysis of the applicability of polymerase chain reaction in diagnosis

Background Diagnosing leprosy is challenging, especially in early‐stage cases, and the need for a sensitive diagnostic tool is urgent. Polymerase chain reaction (PCR) holds promise as a simple and sensitive diagnostic tool, but its usefulness in the Indian context requires further evaluation. Slit‐skin smear (SSS) remains the conventional method of leprosy detection. Hence, this study was undertaken to evaluate and compare the diagnostic efficacy of PCR versus that of SSS. Methods Punch biopsy of skin and SSS were obtained from the active margins of lesions. Cases were clinically grouped according to whether they were multibacillary (MB) or paucibacillary (PB) and classified into tuberculoid (TT), borderline tuberculoid (BT), borderline lepromatous (BL), lepromatous (LL), histoid, and indeterminate groups after clinicopathological correlation. DNA was extracted from biopsy specimens, and multiplex PCR was carried out incorporating primers intended for the amplification of a specific 372‐bp fragment of a repetitive sequence of Mycobacterium leprae DNA. Results Among 164 patients, PCR was positive in 82.3%. The sensitivity of PCR was significantly greater (P < 0.0001) than that of SSS in both the MB (85.9% vs. 59.8%) and PB (75.4% vs. 1.8%) subgroups; the difference in sensitivity in the PB subgroup is remarkable. Positivity by PCR and SSS was found in 100% of LL and histoid leprosy, but PCR had significantly greater (P < 0.0001) positivity in BT leprosy and was of definite increased value in indeterminate and TT leprosy. Conclusions Polymerase chain reaction had higher sensitivity compared with SSS, especially in diagnostically challenging and PB cases. Thus, the use of this costly but sensitive tool should be restricted to this subgroup, because SSS is sufficiently sensitive in the diagnosis of LL and histoid leprosy.     

S-100 as a useful auxiliary diagnostic aid in tuberculoid leprosy

BACKGROUND: The diagnosis of tuberculoid leprosy is often difficult on hematoxylin and eosin (H&E) due to the absence of demonstrable nerve destruction. This study evaluates the utility of S-100 staining in identifying nerve fragmentation and differentiation of tuberculoid leprosy from other cutaneous granulomatous diseases. METHODS: Fifty cases of leprosy including 38 borderline tuberculoid (BT), two tuberculoid (TT), and 10 indeterminate leprosy (IL) were studied. Eleven controls of non-lepromatous cutaneous granulomatous lesions were included. S-100 was used for identifying the following dermal nerve patterns: infiltrated (A), fragmented (B), absent (C), and intact (D) nerves. RESULTS: On H&E, only 18/38 (47.4%) BT cases and 1/2 (50%) TT cases revealed neural inflammation. On S-100 staining of BT cases, 28/38 (73.7%) showed pattern B followed by patterns C and A in 8/38 (21.1%) and 2/38 (5.3%) cases, respectively. Both the TT cases showed pattern B. Only intact nerves (D) were seen in all the control cases. S-100 identified nerve damage in 4/10 (40%) IL cases. The patterns A, B, and C had sensitivity, specificity, and positive and negative predictive values of 100% in diagnosing tuberculoid (BT + TT) leprosy. CONCLUSIONS: S-100 is superior to H&E in identifying nerve fragmentation (p < 0.01). It also aids the differential diagnosis of tuberculoid leprosy.     

The leprosy agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico

Background Mycobacterium leprae was the only known cause of leprosy until 2008, when a new species, named Mycobacterium lepromatosis, was found to cause diffuse lepromatous leprosy (DLL), a unique form of leprosy endemic in Mexico. Methods We sought to differentiate the leprosy agents among 120 Mexican patients with various clinical forms of leprosy and to compare their relative prevalences and disease features. Archived skin biopsy specimens from these patients were tested for both M. leprae and M. lepromatosis using polymerase chain reaction‐based species‐specific assays. Results Etiologic species were confirmed in 87 (72.5%) patients, of whom 55 were infected with M. lepromatosis, 18 with M. leprae, and 14 with both organisms. The endemic regions of each agent differed but overlapped. Patients with M. lepromatosis were younger and were distributed across more states; their clinical diagnoses included DLL (n = 13), lepromatous leprosy (LL) (n = 34), and eight other forms of leprosy. By contrast, the diagnoses of patients with M. leprae did not include DLL but did include LL (n = 15) and three other forms of leprosy. Thus, M. lepromatosis caused DLL specifically (P = 0.023). Patients with M. lepromatosis also showed more variable skin lesions; the extremities were the most common sites of biopsy in these patients. Finally, patients with dual infections manifested all clinical forms and accounted for 16.1% of all species‐confirmed cases. Conclusions Mycobacterium lepromatosis is another cause of leprosy and is probably more prevalent than M. leprae in Mexico. It mainly causes LL and also specifically DLL. Dual infections caused by both species may occur in endemic areas.     

Circulating CD4+ CD25 high FoxP3+ T cells vary in different clinical forms of leprosy

Background CD4⁺ CD25^highFoxP3⁺ regulatory T cells (T‐regs) were reported to increase in chronic infections. We aimed at studying their frequency in leprosy to investigate their role during Mycobacterium leprae infection. Methods Using flow cytometry, the frequency and FoxP3 expression of circulating T‐regs was assessed in 38 leprosy patients and 38 healthy controls. Patients were divided into; group I tuberculoid (TT), group II borderline cases [borderline tuberculoid (BT), borderline (BB), and borderline lepromatous (BL)], group III lepromatous (LL), and group IV erythema nodosum leprosum (ENL). Results Mean T‐regs% and FoxP3 expression were significantly elevated in patients (particularly TT) compared to controls (3.8 ± 2.5% vs. 2.5 ± 0.8% and 78.8 ± 56.2% vs. 55.8 ± 15.7%, respectively) (P < 0.05). Comparing the four disease groups, T‐regs% was significantly different (median 5.3% in group I, 3.4% in group II, 2.8% in group III, and 1.2% in group IV; P = 0.005). FoxP3% on T‐regs was not significantly different between them [median 71.5% in TT, 62.3% in borderline categories, 67.75% in LL, and 85.75% in ENL; P = 0.149). Notably FoxP3 expression was significantly higher in ENL than controls (P = 0.011). Conclusion The frequency and suppressive marker of circulating T‐regs are elevated in TT patients. Patients with LL and ENL express significantly lower frequency of T‐regs and higher FoxP3 expression (in ENL), consistent with disease progression and immune hyper‐activation in these disease categories. Thus, rather than being detrimental to immunity, intact T‐regs activity may be beneficial to leprosy patients.     

Leprosy Scenario at a Tertiary Level Hospital in Delhi: A 5-year Retrospective Study

Background:

Leprosy has been officially eliminated from India since December, 2005; still, there are districts and blocks reporting high prevalence indicating ongoing transmission. The present study aimed at determining the current clinical profile of leprosy from a tertiary level hospital in Delhi.

Materials and Methods:

A retrospective, record-based study was carried out on patients diagnosed and registered in the leprosy clinic of a tertiary level teaching hospital in East district of Delhi (April 2007 to March 2012). Data regarding demographic details, clinical features, treatment started and complications was analyzed.

Results:

A total of 849 patients were registered over a 5-year period, with M: F ratio of 2.3:1. 9.3% were children (≤14 years). 54.3% patients were immigrants from adjoining states. Multibacillary leprosy was the most common clinical type (86.9%). Borderline tuberculoid leprosy was the most frequent morphologic type, seen in 56.3% followed by borderline-borderline (1.5%), borderline lepromatous (24.9%), lepromatous leprosy (8.1%), pure neuritic (8.1%), histoid and indeterminate leprosy (0.5% each). 37.4% patients presented in reaction (Type I in 30.4% cases and Type II in 7% cases). WHO grade II deformities were diagnosed in 37.9% with claw hand being the most common paralytic deformity (23.3% cases).

Conclusion:

Our study offers insight into the current status of the disease in an area of otherwise low prevalence. It is seen that despite statistical elimination, multibacillary disease, leprosy reactions and deformities are commonly seen as presenting manifestations, in contrast to national projected trends. Delhi''s unique demography with a high degree of migrant workers, presenting to our center (near border location) could be a possible contributing factor towards these aberrations. It highlights the need for continuation of targeted leprosy control activities and active case detection.     

2016—2020年中国麻风病流行病学特征分析

目的分析2016—2020年中国麻风病的流行病学特征, 为进一步消除麻风危害提供科学依据。方法对2016—2020年全国(未包括香港、澳门和台湾地区)麻风病疫情监测年度报表进行数据整理和统计分析。结果 2016—2020年, 全国共累计报告新发麻风病患者2 697例, 其中儿童46例(1.71%)、女性894例(33.15%)、流动人口374例(13.87%)、多菌型2 443例(90.58%)和2级畸残患者546例(20.24%);发现复发患者203例。到2020年底, 全国登记现症麻风病患者1 893例, 较2010年(6 032例)减少68.62%;36(1.2%)个县(市)患病率大于1/10万, 新发麻风病患者中2级畸残患者72例(17.73%)。结论 2016—2020年我国麻风病报告发病率和患病率逐年稳步下降, 麻风病继续保持整体低流行状态。     

Leprosy type 1 reaction as the first manifestation of borderline lepromatous leprosy in a young native German

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. Leprosy rarely presents with a reaction. We describe a German patient who presented in this unusual way in order to demonstrate the various tools used to confirm the diagnosis. A young German woman suddenly developed progressive functional loss of the left hand and within a few weeks an increasing number of erythematous macules and nodules appeared. Histological examination of a skin biopsy revealed tuberculoid granulomas, some located around small nerves: acid-fast bacilli were detected microscopically and DNA from Mycobacterium leprae was identified by polymerase chain reaction in the biopsy and a nasal swab: serological tests were positive. The disease was classified as borderline lepromatous leprosy. The acute neuritis followed by skin lesions represented a leprosy type 1 reaction in which the immune system reacts to bacilli previously unrecognized in nerve tissue, both in nerve and skin.     

Immunophenotype of skin lymphocytic infiltrate in patients co-infected with Mycobacterium leprae and human immunodeficiency virus: a scenario dependent on CD8+ and/or CD20+ cells

Background Leprosy occurs rarely in human immunodeficiency virus (HIV)‐positive patients. In contrast to tuberculosis, there has been no report to date of an increase in HIV prevalence among patients with leprosy or of differences in leprosy’s clinical spectrum. While several studies describe the systemic immune response profile in patients co‐infected with HIV and leprosy, the local immune skin response has been evaluated in only a small number of case reports and limited series of patients. Objective To investigate the interaction between Mycobacterium leprae and HIV infection in the skin. Methods We investigated the presence and frequency of cells positive for CD4, CD8, CD20, TIA‐1, FOXP3 and CD123 in lymphocytic infiltrates from 16 skin biopsies taken from 15 patients with HIV–leprosy co‐infection. Results CD4+ cells were absent in infiltrates from 6 (38%) skin biopsies and present in 10 (62%) cases at low levels (< 1·16%) of the lymphocytic infiltrate. CD8+ was the predominant phenotype in the infiltrate (99·4%), followed by TIA‐1, expressed by > 75% of CD8+ cells. FOXP3+ cells were also present, representing 3·4% of the lymphocytic infiltrate. CD20+ cells were detected in 75% of the cases; however, in two cases (12%) these cells represented 25–50% of the infiltrate, while in the other 10 cases (62%) they were present only focally (< 25% of the infiltrate). CD123+ cells were not observed in any of the studied specimens. Conclusions Data presented here suggest that cell‐mediated immune responses to M. leprae are preserved at the site of disease and that in the absence of CD4+ cells, CD8+FOXP3+ and CD20+ cells may be involved in granuloma formation.     

T regulatory cells (TREG)(TCD4+CD25+FOXP3+) distribution in the different clinical forms of leprosy and reactional states

BACKGROUND

Leprosy is characterized histologically by a spectrum of different granulomatous skin lesions, reflecting patients'' immune responses to Mycobacterium leprae. Although CD4+CD25+ FoxP3+ T regulatory cells are pivotal in the immuneregulation, presence, frequency, and distribution of Tregs in leprosy, its reactional states have been investigated in few studies.

OBJECTIVES

This study aimed to verify the frequency and distribution of regulatory T cells in different clinical forms and reactional states of leprosy.

METHODS

We performed an immunohistochemical study on 96 leprosy cases [Indeterminate (I): 9 patients; tuberculoid tuberculoid: 13 patients; borderline tuberculoid: 26 patients; borderline borderline: 3 patients; borderline lepromatous: 8 patients; lepromatous lepromatous: 27 patients; reversal reaction: 8 patients; and erythema nodosum leprosum: 2 patients].

RESULTS

FoxP3-positive cells were present in 100% of the cases with an average density of 2.82% of the infiltrate. Their distribution was not related to granulomatous structures or special locations. There was a statistically significant increment of FoxP3 expression in patients with leprosy reversal reactions when compared with patients presenting with type I leprosy (P= 0.0228); borderline tuberculoid leprosy (P = 0.0351) and lepromatous leprosy (P = 0.0344).

CONCLUSIONS

These findings suggest that Tregs play a relevant role in the etiopathogenesis of leprosy, mainly in type I leprosy reaction.     

酚糖酯-免疫球蛋白M和鼻分泌物中麻风菌PCR检测在麻风流行病学中的应用

目的通过对流行乡村(同烘和南丘)麻风病患者、家内接触者及普通人群麻风菌感染的检测,评估实验流行病学对预测麻风病传播的意义。方法采用酚糖酯-酶联免疫吸附试验(PGL-ELISA)和检测鼻携带麻风菌的PCR方法,开展流行病学调查。结果(1)麻风病家内接触者的酚糖酯-免疫球蛋白M(PGL-IgM)阳性率和PCR检测的麻风菌鼻携带率分别为30.4%和23.1%;但PGL抗体阳性率在家内接触者和普通村民之间却无显著性差异。(2)两村普通村民的PGL-IgM阳性率,在统计学上无显著差异。然而,在<20岁的年龄组中,同烘村的PGL-IgM阳性率却显著高于南丘村。无论同烘或南丘村,PGL-IgM阳性率高峰均在<20岁的年龄组。随年龄的增加,阳性率逐渐下降。此外,女性的PGL-IgM阳性率高于男性。结论两村的新发现病人主要为年轻人,这与两村PGL-IgM阳性高峰位于<20岁年龄组相关。在<20岁的年龄组中,同烘村的PGL-IgM阳性率显著高于南丘村,除与同烘村患病率和发现率均高于南丘村相关,也与消除麻风病运动(LEC)后,同烘村仍有新病人出现有关。这一现象似乎支持麻风患病率与PGL-IgM阳性率相关。为评价麻风病的传播是否得到控制,以PGL的血清学仍是一种有用的方法。     

Leprosy elimination campaign, Amazonas-Brazil 1997

A leprosy elimination campaign (LEC) was carried out in 15 endemic areas of Amazonas State, Brazil, in 1997. The LEC concentrated effort to detect leprosy cases during a multi-vaccination national campaign for serious public health problems other than leprosy, such as polio, diphtheria, hepatitis, measles, etc. The national campaign involved intensive population mobilization, giving a valuable opportunity to examine people for leprosy. The LEC personnel included 2964 individuals (municipal and state health workers and community volunteers), distributed in 688 health units and 53 reference health centres. As a result of the LEC, 74,814 person-to-person communications in the community were given; 10,297 clinical skin examinations were conducted, and 40 new leprosy cases were detected on the day of the campaign in urban areas of the municipalities. This total was low, compared to results in other states of Brazil, possibly due to the development of health education activities and regular community services in the state of Amazonas since 1987 and to the early implementation of WHO multiple drug therapy (MDT) from 1982 onwards. Despite the fact that the LEC was carried out only in the urban areas of the municipalities, the finding of no cases of leprosy in 7 out of 15 of them was surprising and may indicate that the prevalence of hidden cases of leprosy is not all that high, at least in these areas of the Amazonas State.     

Epidemiological situation of leprosy in Salvador from 2001 to 2009

Mycobacterium leprae was first described as the bacillus that causes leprosy, a chronic granulomatous infectious disease, in 1873 by Amauer Hansen. Leprosy is part of a group of 10 neglected diseases and Bahia has endemic levels of this illness, varying between high and very high. The detection of 52 new cases of leprosy in children under 15 years old in Salvador in 2006 is alarming, and suggests an early contact with the disease. The aim of this review is to analyze the epidemiological situation, the detection rate and evaluate the clinical and epidemiological profile of leprosy in Salvador, in the period 2001-2009. A retrospective cross-sectional study was performed using secondary data collected at Notifiable Diseases Information System Database (SINAN) through the notification of patients with leprosy. Over these nine years 3,226 patients were reported, with a predominance of: females (51.5%), and clinical multibacillary forms in the general population (51.7%), but when we analyze those under 15 years old, paucibacillary forms (tuberculoid + indeterminate) prevailed. The tuberculoid form was the most diagnosed type of presentation. The annual detection rate in Salvador remained at a very high level of endemicity during the studied period and for those under 15 years old it ranged between high and very high. Grade 2 disabilities both at the time of diagnosis and at discharge after cure, varied between low and medium. Based on these data we conclude that the high levels of leprosy detection rates in the general population, plus the variation between high and very high levels in those under 15 years old, associated with the medium level of grade 2 disabilities at the time of diagnosis and discharge, demonstrate the need for improvement on the existing services, investment in active case finding and training of the healthcare professionals in Salvador.     

Erythema nodosum leprosum unter Chemotherapie Erfolgreiche Behandlung mit Thalidomid

The severity and outcome of a chronic granulomatous infection caused by M. leprae depend on the cell-mediated immunity towards the pathogen. The disease classification is based on the host's response to M. leprae ranging from high to low resistance (polar tuberculoid leprosy to polar lepromatous leprosy). The host's position in the spectrum is not stable; leprosy reactions reflecting changed immune status may occur spontaneously or during chemotherapy. The type II reaction or erythema nodosum leprosum can most often be seen in patients with lepromatous leprosy, a multiorgan disease characterized by an unrestricted bacillary replication. Clinically, this reaction is characterized by crops of painful bright pink, dermal and subcutaneous nodules arising in clinically normal skin, in association with fever, malaise, glomerulonephritis and arthralgias. Therefore, prompt institution of immunosuppressive therapy with corticosteroids or thalidomide is recommended. This case report describes the development of erythema nodosum leprosum during chemotherapy treated successfully with thalidomide. Furthermore, immunologic effects and potential side effects of this drug are discussed.     

LEPROSY IN CHILDREN: A PROSPECTIVE STUDY

Background. Leprosy has been identified as an important health problem in the pediatric age group. The study of leprosy in children is imperative as it may unravel the missing links in the natural evolution of the disease and dispel the uncertainty of the precise incubation period. Methods. The study was undertaken on patients attending the Urban Leprosy Centre. There were 161 children in the age group of 0 to 14 years, amongst 3184 cases of leprosy, detected between 1981 and 1991. The diagnosis in each was formed after meticulously recording the clinical features, slit-skin smear examination, and histopathologic characteristics. In addition, a detailed history of duration of the disease was elicited by complement recall method. Results. The study revealed an incidence of 5.06% amongst leprosy patients, in an urban setting. The boys:girls ratio was 2.6:1. The mean duration of the disease was 1.2 years in paucibacillary and 2.8 years in multibacillary. History of intra- or extrafamilial contact was elicited in 8.7%. The typical lesion was a “hypopigmented macule,” either of indeterminate, tuberculoid, borderline tuberculoid, or borderline borderline leprosy. Borderline lepromatous, lepromatous, and polyneuritic leprosy were uncommon. Conclusions. Leprosy in children is a well-established distinct entity. Any hypopigmented macule in pediatric age group should arouse suspicion of leprosy. The diagnosis is clinical. Other investigative parameters, namely slit-skin smear, and histopathology may supplement but not supplant the diagnosis.     

Leprosy – an overview of clinical features,diagnosis, and treatment

Leprosy is a chronic infectious disease caused by Mycobacterium (M.) leprae. Worldwide, 210,758 new cases were diagnosed in 2015. The highest incidence is found in India, Brazil, and Indonesia. While the exact route of transmission remains unknown, nasal droplet infection is thought to be most likely. The pathogen primarily affects the skin and peripheral nervous system. The disease course is determined by individual host immunity. Clinically, multibacillary lepromatous variants are distinguished from paucibacillary tuberculoid forms. Apart from the various characteristic skin lesions, the condition is marked by damage to the peripheral nervous system. Advanced disease is characterized by disfiguring mutilations. Current treatment options are based on WHO recommendations. Early treatment frequently results in complete remission without sequelae. While paucibacillary forms are treated with rifampicin and dapsone for at least six months, multibacillary leprosy is treated for at least twelve months, additionally requiring clofazimine. Leprosy reactions during therapy may considerably aggravate the disease course. Besides individual treatment, WHO‐supported preventive measures and strategies play a key role in endemic areas.     

IMMUNOLOGICAL ASPECTS OF LEPROSY

Leprosy has been regarded as a host dependent disease that presents an immunological spectrum. Various parameters of in vivo and in vitro cell-mediated and humoral responses in different forms of leprosy were studied. Lepromatous leprosy patients showed hyper gammaglobulinemia with significantly elevated levels of IgG and IgA while tuberculoid leprosy patients showed raised IgG levels. Cutaneous reactions to lepromin antigen were significantly depressed in patients with lepromatous leprosy while those to PPD were normal. Mitogenic response of peripheral leucocytes to phytoheamagglutinin was considerably depressed in untreated lepromatous leprosy and normal in tuberculoid leprosy. Dapsone-treated patients with lepromatous leprosy showed a normal or enhanced response. Contributory factors were also found in plasma. T-lymphocytes were significantly reduced in lepromatous leprosy with high bacillary load. B-cells were increased in lepromatous patients. Tuberculoid leprosy patients had normal values. Phagocytic and bacteriolytic activity of blood derived macrophages was not altered in the lepromatous or tuberculoid patients.     

HLA AND LEPROSY: SEGREGATION AND LINKAGE STUDY

Background. The presence of a genetic factor in the determination of leprosy has long been debated. This study tests whether the HLA-linked control of susceptibility to leprosy and/or for the types of leprosy could be confirmed. Materials and Methods. In 15 multicase families, the method of DeVries et al., 1976, was used to detect nonrandom segregation of parental HLA haplotypes in their affected and healthy siblings. Linkage analyses, for two and three alleles were performed by the computer program LIPED. Results. For the affected siblings, the segregations of the parental HLA haplotype were significantly nonrandom from the healthy parents and random from the affected parents, indicating that affected siblings were sharing their HLA haplotypes (segregated from the healthy parents) more than expected. The segregations to the healthy siblings from both the healthy and affected parents were random. Healthy siblings inherited the haplotypes shared among the leprosy siblings randomly as expected. There were excess DR₂/DR₂ homozygote individuals among tuberculoid siblings. The highest lod score was achieved when we considered our suggested three-alleles model for the susceptibility to the different types of leprosy. Conclusions. A closely HLA-linked gene on chromosome number 6 with multiple alleles (3 or more) in recombination fraction between 0.05 and 0.1 with 70 to 100% penetrance may be responsible for the susceptibility to the different types of leprosy, whereas the susceptibility to leprosy per se maybe the responsibility of non-HLA linked gene/s. DR₂/DR₂ homozygote individuals may be relatively at high risk of developing leprosy or tuberculoid leprosy.     

Treatment outcome and impact of leprosy elimination campaign in Sokoto and Zamfara states, Nigeria

A Leprosy Elimination Campaign (LEC) was implemented in 37 districts of Sokoto and Zamfara states, Nigeria from 13 August to 30 November 1998. The campaign utilized intensive community mobilization and training of local health personnel to detect hidden leprosy cases. During 8 weeks of case finding, 160,127 persons were screened; 353 new cases of leprosy were detected and placed on MDT; 236 (67%) of new cases detected were classified as MB, 64 cases (18%) suffered visible deformities and 24 patients (6.8%) were children. Follow-up in December 1999 of patients placed on MDT revealed 97% PB and 96% MB cure rates, respectively. Detection of cases in communities led some community leaders to ask for repeat surveys in their communities. Repeat surveys continue to yield new cases. The authors recommend that LECs be maintained for 3 years to accelerate leprosy elimination in the region. The cost effectiveness and impact of LEC in Sokoto-Zamfara are discussed.     

Subpolar tuberculoid leprosy

Existence of subpolar tuberculoid leprosy was postulated by a few leprologists to explain clinical variations near the tuberculoid pole but failed to precisely identify the same. An attempt has been made to describe the clinical and histological features of subpolar tuberculoid leprosy. 76 cases of the TT-BT range according to Ridley-Jopling classification were examined by detailed clinical, histological and immunological methods. Definite clinical and histological discrepancies from either BT or TTp were seen in 30 (39.4%) cases, confirming the existence of subpolar tuberculoid leprosy (TTs) and thus clarifying the immunological spectrum of leprosy.