Leprosy In India Research Articles

Challenges of sustaining leprosy elimination in India and prospects of eradication: Current status & way forwards

Leprosy Elimination in India has been a public health priority for decades and on December 31, 2005, India achieved the World Health Organization’s (WHO) goal of eliminating leprosy as a public health problem at the national level, with the prevalence rate falling below one case per 10,000 population. Despite this, India still accounts for the highest number of new leprosy cases globally, contributing more than 50 percent of the leprosy burden of the world. The country has made considerable progress in reducing the burden of leprosy over the years but challenges remain in maintaining the elimination status and preventing disabilities due to leprosy. The present review discusses the current status of leprosy in India, identifies challenges/lacunae in the implementation of the leprosy eradication program, and suggests potential steps that could be undertaken for sustained elimination of leprosy and future possible eradication of the disease from the country.

Dermatology Photo Quiz 3

Leprosy has been prevalent in India for a very long time. To control the prevalence rate (PR) of leprosy in India, Government of India (GOI) launched “National Leprosy Control Programme (NLCP)” with Dapsone monotherapy in 1955. The PR in 1983 was 57/10000 population. In 1983 GOI launched “National Leprosy Eradication Programme (NLEP)” with "Multi Drug Treatment (MDT)”. PR came down to <1/10000 population in 2005. World Health Organization (WHO) declared leprosy was eliminated from India in 2005. Clinicians all over India are diagnosing leprosy cases and treating them. Multi Bacillary (MB) and Pauci Bacillary (PB) cases are commonly detected. Detection of new cases reminds us that transmission of leprosy is still active in the community. We are reporting a case of leprosy. Keywords: GOI, NLCP, NLEP, MDT, WHO, MB, PB

The ‘Migrant-Leper’ as the Undeserving Outsider: Historicising Leprosy Policy in Delhi, 1920–60

Discussions on migration and leprosy in India, largely absent from historical enquiries, feature dominantly in epidemiological studies that frame the migrant with leprosy as a bacterium-carrying outsider, crossing interstate boundaries to spread infection and increase prevalence rates in urban spaces. The paper seeks to reframe the debate by analysing the migrant with leprosy not as a risk factor, but as a social identity that has historically animated public policy. By analysing leprosy policy in Delhi from 1920 to 1960, the paper explores how leprosy-affected beggars in Delhi were seen as an indolent class of outsiders burdening state finances, unworthy of adequate support.

Clinico-Epidemiological Trends of Leprosy at a Tertiary Care Centre of South Rajasthan: A 10-Year Retrospective Study.

Leprosy is a major public health problem in India, which affects many people every year and has significantly high new case detection rates in certain districts and blocks. According to the National Leprosy Elimination Program (NLEP) report of March 2019, there were a total of 1.14 lakhs new cases of leprosy in India with an Annual New Case Detection Rate (ANCDR) of 8.1 per 100,000 population. The present study aimed at determining the epidemiological and clinical profile of leprosy patients from a tertiary level teaching hospital in South Rajasthan. A retrospective, record-based study was carried out on patients registered in the leprosy clinic of a tertiary level teaching hospital of South Rajasthan during a period of ten years (2010-2019). Data regarding the demographic profile, clinical features, treatment given, and complications were analysed. A total of 1372 patients registered in the leprosy clinic during a period of 10 years were evaluated. There were 1007 (73.4%) males and 365 (26.6%) females with a male-female ratio of 2.76:1. The majority of patients 671 (48.9%) belonged to the middle age group (21-40 years). Multibacillary leprosy was the most common clinical type seen in 1109 patients (80.8%). Borderline leprosy was the most common morphological type, determined in 625 (45.6%) patients, of which BL (21.0%) was the most common group. 16.7% patients presented with leprosy reaction at the time of initial diagnosis. Type 1 reaction was seen in 91(6.6%) and type 2 reaction in 138 (10.1%) patients. Grade I disability was observed in 347 (25.3%) patients whereas grade II disability was seen in 456 (33.2%) patients. 54 patients (3.9%) had a definite history of contact in the family. 28 patients defaulted during the study period. Yearly trend of epidemiological and operational parameters was observed, and the parameters were compared with the national data. Persistent high proportion of multibacillary cases and grade 2 disability indicates that leprosy continues to be a significant health care problem despite statistical elimination. There is a clear need to strengthen early detection, treatment and regular follow-up of these cases in both high and low endemic settings.

History of leprosy in India: An overview of historic and modern contributions.

Traditionally, India holds the unenviable position of the origin of leprosy. The disease is thought to have spread, via trade and war, to China, Egypt, and the Middle East, and later to Europe and the Americas. From antiquity to modernity, Indian society treated leprosy singularly for custom and law, a response shaped by both scientific knowledge and cultural attitudes. Over the past centuries, tireless research by eminent physicians and scientists working in India have helped establish a better understanding of clinical, bacteriologic, pathologic, and immunologic aspects of leprosy. Therapeutic modalities that were initially restricted to chaulmoogra expanded to include newer anti-leprotic medications and even surgical reconstruction of deformities. India's future challenges in leprosy control include stigmata, educational knowledge gaps, and multiple systems of medicine. This contribution is an attempt to comprehensively discuss the historic aspect of this exclusive disease focusing on the varied scientific contributions from India.

Pediatric leprosy in a tertiary care hospital in Hubballi – Are we walking on a thin ice?

Context: Leprosy is a major public health problem in developing countries where districts and blocks are reporting high prevalence indicating ongoing transmission. According to the National Leprosy Elimination Program Report of March 2017, there were about 0.13 million cases of leprosy in India, 8.7% of which were children. This study offers insight into the current status of the pediatric leprosy. Aims: The aim of the study is to assess the current scenario and clinical profile and to describe the clinico-epidemiological features of childhood leprosy at our tertiary care hospital in Hubballi. Settings and Design: This study was a 13-year retrospective analysis of hospital data from April 2005 to March 2018. Subjects and Methods: A retrospective, record-based study was carried out on patients diagnosed and registered in urban leprosy center of our tertiary care hospital in Hubballi (April 2005–March 2018). Data regarding demographic details, clinical features, treatment started, and complications were noted and analyzed. Results: Of total 1305 patients, 189 (14.48%) pediatric patients were seen. Age group of 12–18 years constituted 64.02% of patients. Male: female ratio was 1.3:1. Family history was present in 22 (11.6%). 142 had lesions ranging from 1 to 5 (75.13%), among them single lesion was common. Skin lesions are most often seen on the upper limb (52.38%). Borderline tuberculoid leprosy was common (72%). Majority had ulnar nerve involvement. Deformity was present in 21 patients. Majority received multibacillary multidrug therapy. Conclusions: This study showed a prevalence of 15.6% of pediatric leprosy cases. Pediatric leprosy reflects that there are active infectious cases in the community, which needs active intervention including vigilant and rigorous screening for early diagnosis and treatment initiation, which are essential components for leprosy elimination and disability prevention.

Epidemiological scenario of leprosy in marginalized communities of India: Focus on scheduled tribes.

The Scheduled Tribes (STs) are designated among the most disadvantaged social groups in India. Until the year 2005 (pre-elimination era of leprosy in India), several leprosy-specific control field programmes were implemented, which have been discontinued subsequently. Since then, leprosy diagnosis and treatment have been integrated with General Health Services. Thereafter, specialized expertise for the early diagnosis of leprosy has been gradually diminishing, especially at the peripheral clinics in remote areas. Hence, leprosy cases usually remain undetected for a long time and persist as endemic reservoirs. The tribal population of India accounts for just 8.6 per cent of the overall population. However, 18.5 per cent of the new leprosy cases were detected within the tribal community in the year 2020, indicating a disproportionately high burden of leprosy among the tribal population. Recent data suggest that these health disparities can be mainly related to the increased marginalization of STs as compared to other communities. This shows the need to further explore the current situation of leprosy in STs so that suitable interventions can address the contributing factors, leading to health inequalities in disadvantaged socio-economic groups. Therefore, this review aims to present the current distribution of leprosy in marginalized communities with a special emphasis on STs. Further, this review discusses how resources might be mobilized for such communities to find and treat undetected leprosy patients in STs to enable effective control of leprosy through early detection and timely treatment.

Finding Correlation in Clinical and Pathological Diagnosis in Reemerging Context of Leprosy in India: A Tertiary Care Center Experience

Background:
 Leprosy was supposed to be eliminated by WHO from the world by the end of the year 2000. However, it still affects the major population in India. It is well realized that even after elimination target has been achieved, new leprosy cases will keep coming for at least some years due to continuation of some level of disease transmission or manifestation of disease by subclinical cases. Hence there is the need to review this disease with proper understanding.
 Objective:
 To determine the current leprosy profile and its relation between clinical and pathological diagnosis, at our centre catering the population of Western Uttar Pradesh.
 Methods and Material: 
 It’s a retrospective study and was carried out on skin biopsy samples sent for histopathological diagnosis in clinical suspicion of leprosy at Jawaharlal Nehru Medical College and Hospital, Aligarh, from June 2015 to November 2017. Tissue Sections were stained with Haematoxylin and Eosin stain for morphological studies, and modified fite stain to identify acid fast bacilli.
 Results:
 Out of 325 clinically suspected leprosy cases, we diagnosed leprosy in 282 cases with 86.7% parity. Most commonly affected age group was between 16 -30 years (110 cases). Tuberculoid leprosy was the most common histological subtype (69/282, 24.4%) followed by lepromatous leprosy (58/282, 20.56%), borderline tuberculoid (53/282, 18.7%), borderline lepromatous (42/282, 14.8%), indeterminate leprosy (34/282, 12%) and mid borderline leprosy (22/282, 7.8%). Additionally, histioid type of leprosy was diagnosed histologically in 1.4% (4/282) of the cases.
 Conclusions:
 Identification of suspicious skin patch as leprosy with prompt histological diagnosis especially in population of below 30 years is required for timely intervention and eradication. Both clinician and pathologist should have a focused approach especially in diagnosing indeterminate leprosy.

Renaissance of Hansen's Disease in Post-Elimination Era in North India: A Retrospective Clinico-Bacteriological Study.

IntroductionHansen’s disease is a chronic infectious disease caused by Mycobacterium leprae. India declared the elimination of leprosy in December 2005, but a slow resurgence of the disease still continues in several parts of India. The diagnosis of leprosy is primarily clinical but slit-skin smear microscopy aids in an accurate diagnosis. There are very few studies on clinico-bacteriological patterns of leprosy at this post-elimination phase.AimThis study aimed to analyze the clinical and bacteriological findings of newly diagnosed cases of Hansen’s disease in the post-elimination era.Materials and methodsThis is a descriptive, hospital-based, retrospective study of newly diagnosed cases of Hansen’s disease, enrolled in the Hansen’s disease clinic attached to the dermatology outpatient department (OPD) of a tertiary care hospital in North India. A retrospective chart review of newly diagnosed cases of leprosy for a period of one year was done. Information about demographics, clinical characteristics, spectrum of disease, and slit skin smear data of patients were collected. Statistical analysis was performed using SPSS Version 16.0 (Chicago, IL, SPSS Inc.).ResultA total of 116 patients were included of which 68.1% (79) were males. The age of patients ranged from 7 to 72 years and children (<15 years) constituted 6% (7/116) of all cases. The most common clinical spectrum was borderline lepromatous leprosy 37.9% (44/116) followed by lepromatous leprosy 32.8% (38/116). Out of 116 cases, 39.6% of cases showed slit-skin smear positivity.ConclusionThe study brings forth evidence on the slow re-emergence of leprosy in India. In this study, multibacillary cases outnumber the paucibacillary cases; also, childhood cases were encountered indicating active community spread of the disease in the "post-elimination era." There is an urgent need to step up the surveillance for Hansen’s disease to curb the further spread of the bacilli in the community.

Current scenario of leprosy in post elimination era at a tertiary care hospital in central India

Background: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae primarily affecting the skin and peripheral nerves. Though India announced statistical elimination of leprosy as public health problem under the National Leprosy Eradication Programme in December 2005, still wide variations exist in prevalence rates of this disease across the country. Objectives: Of the study were to determine the pattern, occurrence and trends of smear positive leprosy cases at Government medical college, Akola. Materials and Methods: This is a retrospective study conducted from January 2018 to February 2020. All patients suspected of leprosy were confirmed by slit skin smear examination. Record details of age, type and duration of disease, deformity status were noted. Results: Total 520 clinically suspected were examined. 175 were diagnosed smear positive foe acid fast bacilli. Males outnumbered females. Smear positivity was highest in 21- 40 years age group. Multibacillary cases were 103(58.85%) and paucibacillary were 72(41.14%). Interpretation and Conclusion: Present study shows that despite statistical elimination, leprosy still continues to be a challenge. Approaches like destigmatising the disease, family counseling, integrating leprosy care into general health care systems, developing newer diagnostic and epidemiological tools, chemoprophylactic regimens and vaccines are needed to develop eradication strategy that can reduce the burden of leprosy in India. Keywords: Leprosy, Acid fast bacilli, Smear positive cases.

Clinical study to relook into the case definition and treatment of leprosy

Introduction: The statistical elimination of leprosy in India is something to cheer about but the steady appearance of newer cases still haunt us. It is sad to note that countries with high prevalence of Leprosy administer once a month of rifampicin while developed nations administer daily rifampicin. Materials and Methods: We have done a retrospective analysis of all the leprosy cases seen in the department of Dermatology, Belagavi Institute of Medical Sciences, India. A total of 64 cases were analyzed using the case records and various parameters were recorded. Results: Out of 64 cases, 13 were treated as out patients and 51 were treated as in patients. The most common age group was 21-40. Males outnumbered the females. There were 62 cases of multibacillary and only 2 cases of paucibacillary. Of 64, 30 were newly detected, 19 were receiving treatment and 15 cases had completed treatment but had one or more complications. Family h/o leprosy was noted in 4.The most common presenting complaints were: Multiple painful, reddish raised skin lesions – 24; Spontaneous blisters/Ulcers on the hand/feet – 21; Hypopigmented patches – 13. As per the clinical criteria of WHO, only 37 patients had anaesthetic patches, 52 had nerve thickening and only 11 demonstrated bacilli in the slit skin smear. Discussion: A good number of patients are being seen with lepra reactions or complications. Conclusions: It is quite evident that the presentation of leprosy is changing. This is a paradigm shift in the initial presentation and needs a relook into the existing diagnostic criteria. Keywords: Leprosy, Multidrug therapy, Leprosy elimination.

Looking into Array of Clinical Presentations of Patients with Leprosy and their Clinico-epidemiological Profile: A Retrospective Study

Introduction: The prevalence of leprosy in India has decreased to &lt;1 per 10,000 population by 2016 after the introduction of Multidrug Therapy (MDT) in 1982; still wide variations in Prevalence Rates (PR) continue to exist across the states and regions in the country. Aim: To determine the current clinical profile of leprosy and study various presenting features of patients with leprosy at a tertiary care hospital in North India. Materials and Methods: A retrospective study, based on seven years data, was conducted on patients diagnosed and registered in the leprosy clinic of a tertiary care hospital in North India, from January 2013 to December 2019. Data regarding their demographic details, presenting complaints, clinical features, associated complications and treatment administered was analysed and was entered into Microsoft Excel and presented as tables. Results: A total of 181 patients of leprosy were registered over a period of seven years. There were 133 males and 48 females with M:F ratio of 2.77:1. Of the total patients registered, 3.86% were children (≤14 years) and 97.8 % patients were immigrants from the adjoining states. The most common clinical type was Multibacillary (MB) leprosy in 88.95% patients whereas most frequent morphological type was Borderline Tuberculoid (BT) leprosy (72.93%). Thirty-three (18.23%) patients presented with leprosy reaction (Type 1 reaction in 16.6% and Type 2 reaction in 1.66%). World Health Organisation (WHO) grade 2 deformities (G2D) were diagnosed in 3 (1.66%) patients, with claw hand being the most common deformity (1.10%). Anaesthetic to hypoaesthetic patches were the most common presenting feature (64.1%). Conclusion: Despite statistical elimination, MB disease and leprosy reactions are commonly seen as presenting manifestations. It highlights the need for high quality leprosy services including good referral system for an active case detection. Varied clinical presentations of leprosy should be contemplated while examining patients that can assist in an early and better case detection that will prevent delay in therapy and associated deformities and also decrease the transmission of disease in the community.

A single dose of rifampicin to prevent leprosy; quantitative analysis of impact on perception, attitudes and behaviour of persons affected, contacts and community members towards leprosy in India, Nepal and Indonesia

Introduction: This study looked at the effect of post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR) and the education given along with SDR-PEP on stakeholders’ perception regarding leprosy. It is a side study of the Leprosy Postexposure Prophylaxis (LPEP) Program. Methods: The study was done in LPEP implementation areas in India, Nepal and Indonesia. A before and after survey design was used, with qualitative and quantitative data collection methods. This paper presents the quantitative results. In each country 100 interviews were held with representatives of leprosy patients, contacts and community members, before and 1-1.5 years after starting the LPEP Program. Three tools were used: a knowledge, attitudes and practices questionnaire, EMIC community stigma scale and social distance scale (SDS). Results: The most notable effect at follow-up was increased knowledge regarding leprosy in all stakeholder groups, especially leprosy patients. A positive effect was seen on how people think about persons affected by leprosy, reflected by the lower SDS scores in the contact groups in India and Nepal. No negative effects were found on people’s perception and reported behaviour. Participants did express or perceive reluctance to disclose a person’s leprosy status, but this did not negatively affect willingness to participate in the LPEP Program. Conclusion: This study showed that implementation of SDR-PEP and accompanied education led to increased knowledge on leprosy among patients, contacts and community members and it had no negative effect on perception. SDR-PEP implementation provides an opportunity for health education, including messages to help reduce stigmatisation of persons affected by leprosy.

Clinical study of nerve function impairment in newly diagnosed leprosy patients at a tertiary care center in Shahjahanpur district

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; In leprosy nerve function impairment may result from pathological and immunological processes that take place in peripheral nerves. Prevalence rate of leprosy in India is 0.81 per 10,000 populations. The study was undertaken to determine the status of nerve function impairment at the time of registration for therapy in new leprosy patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; History of the patients was taken and clinical examinations were performed and they were assisted for nerve function impairment by performing sensory test and voluntary muscle power.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The most commonly affected nerve by function impairment was the posterior tibial, followed by the ulnar nerve. In the present study 29% patients had grade 1 disability and 10% had grade 2 disabilities.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The loss of nerve function and incapacitating deformities occurring in a small proportion of leprosy patients result in serious social and psychological impact in their quality of life. Therefore, early detection of nerve function impairment is needed to avoid complications and better management of leprosy.&lt;/p&gt;

Evidence for Mycobacterium leprae Drug Resistance in a Large Cohort of Leprous Neuropathy Patients from India.

Resistance to anti-leprosy drugs is on the rise. Several studies have documented resistance to rifampicin, dapsone, and ofloxacin in patients with leprosy. We looked for point mutations within the folP1, rpoB, and gyrA gene regions of the Mycobacterium leprae genome predominantly in the neural form of leprosy. DNA samples from 77 nerve tissue samples were polymerase chain reaction (PCR)-amplified for M leprae DNA and sequenced for drug resistance-determining regions of genes rpoB, folP1, and gyrA. The mean age at presentation and onset was 38.2 ± 13.4 (range 14-71) years and 34.9 ± 12.6 years (range 10-63) years, respectively. The majority had borderline tuberculoid leprosy (53 [68.8%]). Mutations associated with resistance were identified in 6/77 (7.8%) specimens. Mutations seen were those associated with resistance to rifampicin, ofloxacin, and dapsone. All the six patients were drug-naive. The clinical and pathological manifestations in this group did not differ from the drug-sensitive group. This study highlights the occurrence of resistance to the standard multidrug therapy and ofloxacin in leprosy. Among the entire cohort, 1/77 (1.3%) showed resistance to rifampicin, 2/77 (2.6%) to dapsone, and 5/77 (6.4%) to ofloxacin. Six new patients showing infection by mutant strains indicated the emergence of primary resistance. Resistance to ofloxacin could be due to frequent use of quinolones for many bacterial infections. The results of the study indicate the need for development of a robust and strict surveillance system for detecting drug resistance in leprosy in India.

Patients help other patients: Qualitative study on a longstanding community cooperative to tackle leprosy in India.

BackgroundAlthough leprosy is portrayed as a disappearing disease, leprosy affected persons in India are still suffering massively. Even further, nearly 60% of the world’s newly detected cases are appearing from India alone. The problem has exacerbated due to the drastic decrease of global funding after India’s official declaration of ‘elimination’, which did not foster the actual pain of patients beyond prevalence. Leprosy patients have hardships in their lives due to disabilities, stigma and poverty; thus, they require sustained, continuous care even after release from treatment. Yet, current interventions mostly have a vertical, short-term approach, not showing much progress in lightening the burden of leprosy. In contrast, Little Flower Hospital Community (LFHC) in India has been remarkably providing holistic care for thousands of leprosy patients for 35 years. However, there has not been any research conducted to uncover the underlying factors of this longstanding leprosy control model. Therefore, this research explores the in-depth contextual attributes of this hospital community that has been able to successfully provide sustainable care for a long time even without excessive external funds.Methods and findingsThis qualitative research used a grounded theory approach, involving 28 in-depth interviews of 11 patients, 13 workers, and 4 board members from the hospital. The interview data were inductively analyzed to examine the contextual factors of the hospital’s sustainability. Open coding, axial coding and selective coding were conducted, and Glaser’s Six C’s model was used to create a theoretical model of the sustainability of LFHC. The fundamental cause of the sustainability was the leprosy patients’ strong craving for life with dignity, despite the isolation from the society. The desire resulted in a bottom-up formation of a ‘consumer-provider cooperative’, where patients mutually support each other with basic treatment learned from experience. The profits earned from the patients’ occupational efforts such as dairy farming, cover the costs needed to manage the hospital community, which contributes to economical sustainability. Social sustainability was established through the holistic care including psychosocial, educational, medical, and residential support. The wholesome care socially rehabilitated the patients to be included in the society with satisfaction, social justice and social cohesion. The main limitation of this study is that this study cannot be generalized due to the nature of Grounded Theory based study.ConclusionsThis study investigated the determinants that made LFHC sustainable, and the findings suggested the importance of forming a cooperative community and implementing social rehabilitation for sustainable leprosy control. More exploration on transferring this model to other leprosy colonies will have great impact in maintaining sustainable care for leprosy patients. Furthermore, this research may highlight the importance of sustainable development in policies targeting neglected tropical diseases beyond leprosy as well.

The DermLep Study I: Results of Prospective Nation-Wide Survey of the Number & Profile of Leprosy Patients seen by Dermatologists in India.

Introduction:There is evidence to suggest that there is a mismatch between the number of reported cases of leprosy in India and the number of actual cases in the country. One reason could be that many patients are diagnosed and treated outside the NLEP network and dermatologists may be managing some of these patients not captured by official statistics. To estimate these missing numbers, the DermLep survey was carried out to study the number and profile of leprosy patients seen by dermatologists and their significance.Methodology:The DermLep survey was a questionnaire-based study to be filled in by participating dermatologists from all over India, both in private practice and in medical institutions. Participating dermatologists provided information on old and new leprosy patients seen in their clinic over a 3-month period.Results:Total of 201 dermatologists from 20 states of India participated in the survey. 3701 leprosy patients (M: F ratio 2.1:1) were seen. Of them 46.62% (n = 1680) were new; 22.89% (n = 825) were under-treatment; and 19.65% (n = 708) were post RFT patients. Children <15 years constituted 4.29%, while elderly >60 years were 22.21%. As per WHO classification, MB were 73.36% and PB 28.46%. Of all patients 30.91% had lepra reactions, with T2R being more frequent. While 23.58% of all patients in the survey had G2D; in new patients 17.79%; and in post RFT patients 37% had G2D. Among the 1680 new cases seen, 59% were reported to NLEP by the dermatologists and 41% remained unreported mainly by the private dermatologists, among whom for 20% of the cases they mentioned “no access to register”. Source of MDT was WHO-MDT in 60.09% of new cases and for rest of 39.91% it was private pharmacies where private dermatologists had no access to MDT blister packs.Conclusion:This survey suggests that a good number of new-untreated leprosy patients, treatment defaulters and post RFT cases are managed by dermatologists in India. About 40% of the new patients managed mainly by private dermatologists are not being reported to NLEP for various reasons, and these constitute the “missing numbers” from government statistics. If extrapolated to the large of number of practicing dermatologists in India, these numbers could be very significant. The high percentage of G2D noted in patients surveyed (23.58%) and post RFT patient issues observed need special attention. There is a need to develop access for dermatologists to confidentially report leprosy patients treated at their clinics to the NLEP.

Disability due to leprosy: a socio-demographic study in Leprosy Hospital, Chamba, Himachal Pradesh

Background: Leprosy is a chronic granulomatous disease caused by M. leprae bacilli and one of the important cause of preventable disability.Methods: This study was a cross sectional one, conducted at Leprosy Hospital, Sarol, Chamba, Himachal Pradesh over a period of two months, May and June 2018. The study used convenient sampling and all 20 disabled patients who were receiving treatment at Leprosy Hospital were included in the study. Socio demographic data which included age, marital status, occupation, type and duration of disability was collected and analyzed. To screen for activity limitation and safety awareness SALSA scale was used. A score of 25 or more points is indicative of activity limitation and disability.Results: In total 20 patients were evaluated, out of which 12 were male and 8 female and the mean age of patients was 51years. Around 90% of female patients were illiterate and financially dependent while on the contrary 90% male patients were literate and financially independent. All the patients presented with some or severe disability according to Salsa scale. There was significant association of age, education, marital status and employment status with disability.Conclusions: Inspite of elimination of leprosy in India, cases of disability and deformity have not declined as expected. Awareness about warning signs among patients and timely diagnosis by health professionals can curb cases of disability among leprosy patients.

Disabilities and their lifelong burden in people affected by leprosy in India

Disabilities in persons affected by leprosy pose a life-long disease burden, both for patient and the responsible medical service. The obligate intracellular pathogen Mycobacterium leprae affects skin, as well as peripheral nerve cells, and can result in leprosy reactions, which can be intensifications of the host’s immune response, or antibody reactions to immune complexes. Leprosy can thus lead to disabilities, that are currently graded in three categories. The proportion of grade-2 disabilities in newly diagnosed leprosy patients (G2D) is one of the main indicators for leprosy monitoring. In total numbers, G2D are declining according to the size of the analyzed populations. The G2D-Rate per 1 Million persons however, shows fluctuations, which correspond to the efforts made in case-finding, and the public awareness concerning early reporting. Furthermore, no global data has been published yet, regarding the development of grade-0 and grade-1 disabilities throughout the course of treatment and beyond. The practical prevention of disabilities, and the exacerbation of those in already impaired persons, poses a great difficulty, especially in India, where historically stigmatization is present, the integration of leprosy services into the public health sector was described as failure, and funding is scarce, due to the fact, that leprosy was officially eliminated on a public health level in 2005.

Detection of Mycobacterium lepromatosis in patients with leprosy in India [Retraction

[This retracts the article on p. 1677 in vol. 11, PMID: 30349325.].