CHANGING TRENDS OF LEPROSY IN ARMED FORCES

A total of 651 cases of leprosy were hospitalised from Jan 1987 to Dec 1992. Each patient underwent haemogram, total and differential white cell count, urinalysis, liver function tests, skin slit smear for AFB and skin biopsy. Nerve conduction studies, electomyographic studies and nerve/nerve sheath biopsies were undertaken as and when indicated. These patients were managed with multidrug therapy. Paucibacillary (PB) leprosy accounted for 476 (73.1%) cases which comprised of indeterminate leprosy 90 (13.8%), tuberculoid leprosy 14 (2.2%), borderline tuberculoid leprosy 310 (47.6%) and neuritic leprosy 62 (9.5%). The remaining 175 patients (26.9%) were multibacillary (MB) which included borderline leprosy 9 (1.4%), borderline lepromatous leprosy 129 (19.8%) and lepromatous leprosy 37 (5.7%) patients. There were total 153 patients in 1987. This number declined to 44 in 1992. PB declined from 113 in 1987 to 39 in 1992 and MB cases from 40 to 5.KEY WORDS: Leprosy     

甘肃省麻风病联合化疗效果评价

目的总结评价全省麻风病联合化疗效果,为制定麻风病防治策略提供依据。方法以资料回顾性调查和现场随访相结合的方式,对甘肃省1986-2007年间采用联合化疗方案治疗者进行了以临床疗效为主的综合效果评价。结果采用联合化疗方案治疗者在治疗及监测的前1~4年间有效率分别为：88.98%,95.43%,99.53%,100.00%;治愈率分别为：4.88%,10.39%,19.69%,60.32%,至第7年底全部治愈;皮肤查菌阳性572例,细菌指数第1~5年年均下降0.46,至第7年全部阴转。监测1~9年130例,10~20年505例。发现联合化疗复发5例,复发率0.55/1 000人.年（0.79%）。结论联合化疗疗效快、治愈率高、疗程短、复发率低。     

利福平在非结核性疾病中的应用

目的 探讨利福平在治疗非结核性疾病中的作用。方法 选择220例皮肤化脓性感染，96例细菌性痢疾以及80例泌尿系感染病人，单用利福平口服进行治疗。结果 对皮肤化脓性感染疾病的总治愈率为88．9％，总有效率为100％；对细菌性痢疾显效89例(92．7％)，有效7例(7.3％)；对泌尿系感染显效68例(85％)，有效10例(12，5％)，无效2例(2．5％)。结论 利福平可用来治疗皮肤化脓性感染，细菌性痢疾和泌尿系感染；具有效果好，副作用小，价格低廉以及服用方便等优点。     

BORDERLINE TUBERCULOID LEPROSY: CLINICOPATHOLOGICAL EVALUATION OF MULTIDRUG THERAPY

Efficacy of multi-drug therapy as per WHO recommendation in 125 fresh cases of borderline tuberculoid (BT) leprosy was evaluated. There were 116 (92.8%) male and 9 (7.2%) female patients. Age of the patients ranged from 18-50 years but the majority (80.8%) were young adults in the age group 21-35 years. The commonest site of lesion was the upper extremity in 65 (52%) cases. Skin smear for acid fast Mycobacterium leprae was positive in 11 (8.8%) patients. All patients were given multidrug therapy consisting of rifampicin 600 mg once a month and dapsone 100 mg daily for 6 months. At the end of 6 months, 42 (33.6%) patients had shown marked improvement, 14 (11.2%) had increase in activity, 51 (45.6%) had shown regression and 12 (9.6%) cases became clinically inactive. Histologically complete clearance of the infiltration was not observed in any patient. Compact granulomas persisted in 30 (24%) cases. In 1 (0.8%) patient M. leprae were found in the skin smear at the end of 6 months. This study indicates that treatment with MDT for 6 months is inadequate to treat all types of BT leprosy cases.KEY WORDS: Drug therapy combination, Leprosy borderline, Leprostatic agents, Mycobacterium leprae.     

麻风病院患者用药情况及合理性分析

目的 分析麻风病患者的用药情况及趋势。方法 选取我院麻风病院药房2015年1月～2017年1月用于治疗麻风病患者药物处方单1278份,共涉及826例次患者。分析研究对象并发症相关疾病的诊断情况、抗菌(单一使用和联合用药)和抗炎药物(非甾体抗炎药)使用情况以及不合理用药情况。结果 临床诊断发病较多的为麻风溃疡、上呼吸道感染及神经痛,使用抗菌药物患者共826例次,其中使用单一药物治疗占抗菌药物治疗的79.30%,联合用药占20.70%;使用抗炎镇痛药物较多的为麻风溃疡(55.21%)、关节损伤(32.43%)及麻风眼病(12.36%);共有92例次患者出现用药不合理情况,占总数的11.13%,其中用药剂量不合理情况最多。结论 麻风病院患者的用药主要集中于麻风溃疡、上呼吸道感染和疼痛等疾病,应根据患者病情发展,合理调整药物的剂量,增强用药的合理性,减少不良反应的发生,提高麻风病患者的生活质量。     

江苏省无锡市1989—2018年麻风流行特征分析

目的 通过分析无锡市近30年来麻风流行特征,探讨目前麻风防治工作存在的挑战,以及在低流行状态下如何有针对性地开展好麻风病防治管理工作。方法 对无锡市1989—2018年麻风病例资料进行流行病学分析。结果 1989—2018年无锡市报告麻风病病例63例,其中新发病例48例,复发15例。30年来麻风发现率和患病率均呈下降趋势,患者确诊时平均年龄(43.81±14.52)岁。80.95%的患者职业为农民,近年来发病人群以外地来锡务工人员为主,其中来自高流行省份的病例占71.43%。患者延迟期中位数为8个月,新、复发病人诊断延迟期中位数为 13个月和2个月,差异有统计学意义(P <0.05),MB型别比(多菌型∶少菌型)为5.3∶1。新发病例Ⅱ级畸残率25%,22.92%新发患者为家庭内传播。73.02%的患者由皮肤科就诊发现。结论 根据无锡市近30年来的麻风流行病学特征,以及发现率、MB型比、Ⅱ级畸残率等主要指标的分析结果,无锡市仍处于麻风病低流行状态,但仍面临人口流动造成的输入性病例、因病例少造成防治意识松懈等问题带来的挑战。必须保持麻风病防治体系的健全和防治工作的持续性。加强技术培训,加大宣传力度,以麻风病症状监测为主要手段,从而尽早发现病人、治疗病人。早发现、早治疗是减少麻风病人因神经损害或畸残造成的疾病负担的重要手段。     

Leprosy without typical skin involvement but with concurrent tuberculosis: a case report

Leprosy is characterized by skin lesions and peripheral nerve damage. It may take a long time before the diagnosis can be confirmed if the patients have no typical skin involvements. Here we report an unusual case. A 40-year-old male with lepromatous leprosy showed a gradual onset of bilateral symmetrical neuropathies without characteristic skin manifestations seven years after onset and with pulmonary tuberculosis simultaneously. He was misdiagnosed as having Guillani-Barr6 syndrome and systemic necrotizing vasculitis for 10 years until the skin biopsy was performed. This case indicates that the risk of leprosy exists, though new cases being detected have significantly declined over the last 50 years; neurologists need to pay more attention to leprosy with various manifestations .     

生肌玉红膏促进麻风足底溃疡肉芽生长及愈合的临床观察

目的观察生肌玉红膏在麻风足底溃疡治疗中的作用。方法将37例麻风足底溃疡患者按随机数字表法分成2组,治疗组19例,对照组18例。治疗组外用生肌玉红膏纱布,对照组外用凡士林纱布,隔日换药1次,疗程12周。每次换药记录溃疡的情况,对比创面肉芽生长积分疗效。结果治疗12周时,治疗组创面肉芽生长积分明显低于对照组〔创面肉芽性质积分：（1.15±0.89）vs（1.94±1.06）分,P〈0.05;创面肉芽覆盖积分：（1.08±0.94）vs（1.89±1.02）,P〈0.05〕。治疗组与对照组的创面愈合率分别为47.37%、16.67%,总有效率分别为68.42%、33.33%,治疗组有增高趋势。治疗组用药期间未发生不良反应。结论采用生肌玉红膏治疗麻风足底溃疡疗效安全可靠,能明显改善创面微循环,促进肉芽生长,有利于提高溃疡愈合率。 更多还原     

麻风病患者细胞免疫状态的检测

本文应用麻风菌素,PHA皮肤试验,E玫瑰花形成试验(Et—RFC,Ea—RFC)和淋巴细胞转化试渡(TT)对80例麻风患者(LL型60例、TT型20例),20名健康人进行了细胞免疫的检测。结果显示,麻风患者细胞免疫明显低于对照者,尤以LL型患者更为显著,经统计学处理有显著差异(P均<0.01 )。     

Comprehensive treatment of complicated plantar ulcers in leprosy

heNationalLeprosyRehabilitationProjectStage 2wasstartedinMay 1 995 Theprojectcovered 1 2 provincesandareasinChina:Shanghai,Jiangsu ,Zhejiang ,Anhui,Fujian ,Jiangxi,Shandong ,Hubei,Guangxi,Yunnan ,ShanxiandYangzhou ,whichwereevaluatedbyexpertsfromnon governmentorganizationsinApril 1 998 Inthisreport,wepresenttheresultsofcomprehensivetreatmentofcomplicatedfootulcers METHODSSubjectsAccordingtoanagreementbetweentheChineseMinistryofHealth (MOH)andtheLeprosyMissionInternational(LMI)…     

Renal lesions in leprosy amongst north Indian patients.

Sixty consecutive patients with leprosy were investigated for renal involvement. Clinically overt renal disease was present in 4 patients; 3 presented with a nephrotic state and one patient with progressive renal failure. Urinalysis showed daily protein loss ranging from 0.4 to 8.9 g in 8 patients and microscopic haematuria in 4 cases. Elevated levels of blood urea and creatinine were seen only in one patient with diffuse proliferative glomerulonephritis. Of the 36 patients in whom distal tubular functions were evaluated, concentration and/or acidification defects were detected in 9 patients (25%). Renal histology revealed no abnormality in any of these patients. Serum C3 levels were decreased in 5 patients with lepromatous leprosy and 3 patients with borderline leprosy. Histological evidence of renal involvement was detected in 9 patients (15%). Amyloid deposits were seen in 3 (5%) patients of whom 2 had lepromatous leprosy and one had tuberculoid leprosy with chronic trophic ulcers. Mesangial proliferative lesions were seen in 5 (8.3%) and diffuse proliferative lesions (with crescents in more than 70% of glomeruli) in one patient. All of them had lepromatous leprosy. Three of the 5 patients with mesangial proliferative glomerulonephritis had erythema nodosum leprosum at the time of biopsy. Immunofluorescence studies revealed granular deposits of IgA, IgM and C3 in one patient with mesangial proliferation and IgA/IgM with or without C3 in 3 more patients in whom renal histology was normal. Glomerulonephritis associated with leprosy appears to be immune mediated but confirmation requires identification of lepra antigen in the glomerular immune complex deposits.     

12例麻风病临床病理分析

目的:了解麻风病临床和病理表现特点,期望减少误诊和漏诊.方法:对12例有皮肤损害或感觉障碍的患者活检组织作HE和抗酸染色,光镜观察.其中6例临床诊断为麻风病.结果:所有病例病理检查见麻风细胞、肉芽肿及神经损伤等病变,抗酸染色阳性,确诊麻风病.结论:对皮肤有红斑等慢性损害患者应检查周围神经,可疑病例应作涂片和活检及抗酸染色检查.     

TRENDS OF CASE DETECTION AND OTHER INDICATORS OF LEPROSY IN CHINA DURING 1985-2002

bjoctiw To analyze the trends of case detection and other indicators of leprosy in China during 1985-2002. Methods Data reported by each province were collected by China National Leprosy Database in Nanjing P.R.China.All data about registered cases were put into computer for analysis. Results From 1985 to 2002, a total of 49 477 leprosy new cases had been detected. Among them, 69.5% were multibacillary cases and 25.4% had grade 2 disability. The child cases aged below 15 years accounted for 3.74% of total cases.Totally, 5824 cases and 303 cases relapsed after dapsone (DDS) mono-therapy and multidrug therapy (MDT), respectively.Case detection showed a marked reduction from 0.47/100 000 in 1985 to 0.18/100 000 in 1993 although there were several spurts due to operational factors. From 1994, case detection showed no significant decline. The grade 2 disability among new patients decreased from 31.4% in 1985 to 23.4% in 2002. The child case detection rate among new cases fluctuated between 2.70%-3.56% from 1999 to 2002. The incidence of relapse declined after the introduction of DDS mono-therapy.However, it increased after the introduction of MDT. Conclusion China experiences in leprosy control show that it will take a long time with continuing present leprosy control activities to bring down the case detection and other indicators to a very low level even after reaching the elimination goal of leprosy.     

Effect of HIV infection on the clinical spectrum of leprosy in Maiduguri

The clinical features associated with different classes of leprosy patients co-infected with HIV in Maiduguri was studied and the classification of leprosy was done clinically and bacteriologically using Ridley-Jopling classification and bacteriological index respectively. The cases were classified as paucibacillary (Tuberculoid--TT and Borderline Tuberculoid--BTT) and multibacillary (Borderline Borderline--BB, Borderline Lepromatous BL and Lepromatous Leprosy--LL) leprosy. Eleven (10.5%) of 105 leprosy cases were HIV-seropositive comprising of 7 males and 4 females. Age range was 15 and 62 years. Among the HIV seropositive patients, those with paucibacillary (PB) leprosy were 6 (TT-1, BT-5) while multibacillary (MB) leprosy 5 (BB-1, BL-2, LL-2). The predominant clinical features were clawing of fingers (64%), ulcerations (64%), hand muscle atrophy (55%) and clawing of toes (45%). Some clinical features of paucibacillary leprosy such as sensory and hair losses (as is also seen in HIV negative patients) occurred in increased frequency in HIV positive patients belonging to the multibacillary class. The HIV infected leprosy patients are more likely to manifest advanced stages of the disease than the HIV seronegative patients.     

浙江省麻风受累者疾病负担及卫生服务利用研究

目的了解浙江省麻风受累者疾病负担及卫生服务利用情况,为今后采取相应的防治策略提供依据。方法采用自行研制的麻风病人疾病负担及卫生服务利用情况调查表,由麻风防治人员对158例麻风受累者进行面对面调查。结果37例麻风现症患者中有15例患者出现过麻风反应等并发症。37例现症患者的疾病诊断经济负担情况：直接、间接经济负担平均为（3229．5±149．7）元、（556．4±69．8）元;15例患者治疗并发症（麻风反应）所花费的直接、间接经济负担为（1983．9±159．9）元、（267．4±42．7）元。卫生服务利用方面：158例麻风受累者中还存在一部分麻风受累者享受不到较好的卫生资源,或是无钱66人（41．77％）或是因歧视36人（22．79％）不看病现象,甚或是看病不方便;医疗康复方面仅有97人（61．39％）满意当前的医疗康复服务。结论在麻风低流行状态下,麻风患者在诊疗过程中要承担较重的经济负担,应合理分配卫生资源,提高医务人员的麻风诊断水平的同时,加大各种医疗保险的覆盖和报销力度,以降低麻风受累者的经济负担,从而提高麻风受累者的生活质量。     

Rheumatological manifestations of leprosy

Rheumatological manifestations are common in leprosy. A study was conducted among 30 patients to observe the prevalence and spectrum of rheumatological manifestations in leprosy. Seventeen patients were referred from leprosy clinic from 287 consecutive leprosy cases and 13 patients presented de novo at the rheumatology clinic and later diagnosed to have leprosy. In the first group, the most common manifestation was small and large joints polyarthritis resembling rheumatoid arthritis found in 64.7% cases and in the second group tenosynovitis (38.5%) was the commonest. Rheumatoid factor was positive in 60% cases.     

Clinico-epidemiological study of leprosy in an urban area of West Bengal

A cross-sectional study was carried out at Naihati municipal area in West Bengal to study the prevalence and some epidemiological factors in transmission of leprosy. Side by side, the validity of WHO operational classification was also tested by using slit skin smear examination as gold standard. A group of trained paramedical workers, supervised by epidemiologist conducted house to house survey work. Experienced dermatologist and neurologist examined suspected cases. Overall prevalence of leprosy were 9.9 per 10000, of which 53% were new cases. Epidemiologically manual workers, living in slums and unhygienic surroundings had significantly higher risk of developing leprosy. Sensitivity and specificity of WHO operational classification (> 5 skin lesion= MB) was found to be quite high (sensitivity 85.9% and specificity 83.3%) in this study. However addition of > 2 nerve lesions to this criteria increase sensitivity to 90.1% without much affecting the specificity (79.8%).     

Variation of intraocular pressure in patients with leprosy

INTRODUCTION: There are various controversial reports on intraocular pressure (IOP) in patients with leprosy. PURPOSE: The current study was undertaken to study the level of intraocular pressure in leprosy patients and its association with the risk factors. MATERIALS AND METHODS: This was a prospective cross sectional comparative study. An ophthalmologist and a dermatologist evaluated consecutive 93 patients with leprosy. The risk factors studied were age, gender, bacillary index, clinical diagnosis, duration of disease and treatment; and ocular complications. The IOP in these patients was compared with healthy age and sex matched controls. RESULTS: A total of 186 leprosy patients (93) and healthy controls (93) were studied. The mean applanation IOP for the right and left eyes in leprosy patients was 12.87 1.20 mm of Hg and 13.222.70 mm of Hg respectively. This was found to be significantly lesser (p<0.001) than in the controls (RE=15.142.58 and LE=15.412.36 mmHg). The untreated leprosy patients had significantly lower IOP than those with treatment (p<0.001). None of the risk factors were found to be independently associated with the decrease in IOP. The duration of treatment, however, showed a trend towards having a significant association (p=0.057) with the lower level of IOP. CONCLUSION: The level of IOP is lower in leprosy patients than in the healthy controls. Age, gender, bacillary index and presence of ocular complications due to leprosy are not independently associated with the decrease in IOP. The untreated leprosy patient tends to have a lower IOP. This finding can be used to monitor effectiveness of treatment of leprosy.     

Multibacillary leprosy: erythema as the only clinical presentation

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, which primarily affects the skin and peripheral nerves. In this article, we present a 45-year-old man and a 39-year-old women who suffered from asymptomatic irregular erythemas on their trunk and extremities. Since both patients denied the history of exposure to leprosy patients and were absent clinical signs of superficial sensation dysfunction and enlarged peripheral nerves, they were diagnosed of mycosis fungoides and livedo reticularis clinically. Nevertheless the biopsies of erythemas showed perineural and periadnexal foamy-cell granulomas in the dermis and Fite staining revealed a large number of acid-fast bacilli. A diagnosis of multibacillary leprosy was made finally. These cases revealed that since leprosy is still epidemic in some remote area in China and in other developing countries and its clinical manifestations may be very weird sometimes, the dermatologists should be alert of it and skin biopsy could confirm the diagnosis.

     

MICRO-ENZYME-LINKED-IMMUNOSORBENT ASSAY IN DIAGNOSIS OF KALA-AZAR

The micro-enzyme-linked-immunosorbent as- say technic in kala azar diagnosis is described and possible factors influencing the assay are discussed. 20i kala azar cases examined before treatment had a 100% positive rate. 23 kala azar cases in another series examined l month t0 3 years after treatment still showed positive results in about five sixths. False positive reactions were recorded in some tuberculosis or leprosy patients, especially the latter.