Transmission Of Leprosy Research Articles

Knowledge, attitude, and health seeking behavior on leprosy among urban adults in Kancheepuram district of Tamil Nadu: A Community-based cross-sectional study.

Introduction:Although various measures are taken to create awareness about the epidemiological features of leprosy and encourage health-seeking behavior, they have seldom been able to tackle the high incidence of new leprosy cases in India.Objective:To determine Leprosy-related knowledge, attitude, and health seeking behavior among the urban population in Kancheepuram district of Tamil Nadu.Materials and Methods:This community-based cross-sectional study was conducted among a sample size of 640 people above 18 years of age residing in the study area, selected by multistage random sampling. A structured pretested questionnaire was used for data collection, and the data analysis was done using SPSS version 22.Results:Among the study participants, 54.7% of the participants had adequate knowledge and 23.3% had favorable attitude towards leprosy. With regard to knowledge, 66% of the participants believe that leprosy is a serious disease, and 71.2% of them were aware of transmission of leprosy from person to person. With regard to attitude, 57.7% were afraid of being diagnosed with leprosy, and 57% felt compassion and desire to help those diagnosed with leprosy. With regard to health-seeking behavior, around 83% preferred treatment from government hospitals and allopathic treatment. Male sex, occupation, education, and marital status were found to be having statistically significant association with knowledge, while the latter two were found to be associated with favorable attitude towards leprosy.Conclusion:Unfavorable attitude and inadequate knowledge regarding leprosy was found among the study participants. Behavior change communication programs have to be enhanced at community level to improve the knowledge and attitude regarding leprosy among the population.

Fatores de risco para hansení­ase identificados a partir de casos notificados num perí­odo de 15 anos

Objetivo: Identificar e analisar os fatores de risco í transmissão da hansení­ase num perí­odo de 15 anos. Métodos: Estudo quantitativo, observacional, de corte histórica, histórica e observacional. Dados extraí­dos do SINAN. As análises estatí­sticas foram método de U de Mann-Whitney e correlação de spearman, além de análises univariadas. Resultados: No perí­odo foram notificados 514 casos. Na análise univariada, os homens chegam ao serviço para serem diagnosticados com maior número de lesões (valor-p<0,05), com as formas clí­nicas dimorfa e virchowiana, (valor-p<0,05) e com Grau de incapacidades 1 e 2 (valor-p<0,05). No modelo final de análise multivariada realizada por meio de regressão logí­stica, encontrou-se significância para associação entre presença de deficiências fí­sicas e forma clí­nica multibacilar, idade maior de 52 anos e mais de 3 lesões no momento do diagnóstico. Conclusão: O sexo e a idade possuem maior risco de infecção í hansení­ase. Fatores de riscos sociodemográficos não demonstraram significância nas variáveis clí­nicas.

Phenomenology Study: Community Perception Of Lush Disease In The Working Area Of Puskesmas Talango, 2020

Leprosy (Morbus Hansen) is a chronic infectious disease of the skin caused by Mycobacterium leprae, leprosy is also known as "the great imitator disease" because of the similar manifestations to other skin diseases such as fungal infections so that a person rarely realizes that he has had leprosy. This qualitative study was conducted to explore community perceptions about leprosy with 6 male and 4 female participants. The method used is a phenomenological approach with consecutive sampling as a sampling technique. There are 5 themes obtained in this study, namely factors that influence perception, the form of public perception of leprosy patients, community behavior in preventing leprosy transmission, hope for leprosy patients, and hope for health workers. Health education about leprosy is needed by the community to deepen their knowledge about leprosy and the attitude of the community towards people with leprosy.

Patients with skin smear positive leprosy in Bangladesh are the main risk factor for leprosy development: 21-year follow-up in the household contact study (COCOA).

BackgroundLeprosy transmission is ongoing; globally and within Bangladesh. Household contacts of leprosy cases are at increased risk of leprosy development. Identification of household contacts at highest risk would optimize this process.MethodsThe temporal pattern of new case presentation amongst household contacts was documented in the COCOA (Contact Cohort Analysis) study. The COCOA study actively examined household contacts of confirmed leprosy index cases identified in 1995, and 2000–2014, to provide evidence for timings of contact examination policies. Data was available on 9527 index cases and 38303 household contacts. 666 household contacts were diagnosed with leprosy throughout the follow-up (maximum follow-up of 21 years). Risk factors for leprosy development within the data analysed, were identified using Cox proportional hazard regression.FindingsThe dominant risk factor for household contacts developing leprosy was having a highly skin smear positive index case in the household. As the grading of initial slit skin smear of the index case increased from negative to high positive (4–6), the hazard of their associated household contacts developing leprosy increases by 3.14 times (p<0.001). Being a blood relative was not a risk factor, no gender differences in susceptibility were found.InterpretationWe found a dominance of a single variable predicting risk for leprosy transmission–skin smear positive index cases. A small number of cases are maintaining transmission in the household setting. Focus should be performing contact examinations on these households and detecting new skin smear positive index cases. Conducting slit-skin smears on new cases is needed for predicting risk; such services need supporting. If skin smear positive cases are sustaining leprosy infection within the household setting, the administration of single-dose rifampicin (SDR) to household contacts as the sole intervention in Bangladesh will not be effective.

Risk Factors Related to the Events of Leprosy in Children age 5-14 Years in City of Sorong West Papua

Leprosy is an infectious disease which is a national public health problem, because several regions in Indonesia have a high prevalence rate. There were 17,012 new cases of leprosy in Indonesia in 2010, consisting of 13,734 cases of Multi Basiler and 3,278 cases of PausiBasiler with a Newly Case Detection Rate (NCDR) of 7.22 per 100,000 population. The number was recorded as many as 20,329 cases with a prevalence of 0.86 per 10,000 population. In Indonesia, there are 12 provinces that still have leprosy rates above one person per 10,000 population, including the Province of Nangro Aceh Darussalam (1.51), South Kalimantan (1.07), East Java (1.67), North Sulawesi (2.57), Central Sulawesi (1.17), South Sulawesi (2.02), Southeast Sulawesi (1.21), Gorontalo (3.62), NTT (1.17), North Maluku (9.51), Maluku (3.47), and Papua (4.62). This study aims to see the risk factors for leprosy in children aged 5-14 years in Sorong City, West Papua Province. This type of research is a case control study and the population is children 5-14 years old in Sorong City with a sample of 54 respondents. The research data were analyzed using SPSS 16. Data analysis used the Chi-Square test. The results showed that the socioeconomic level p (0,000) 1 = risk risk) history of home contact p (0.000) 1 = risk risk) associated with the incidence of leprosy in children aged 5-14 years in Sorong City, while education p (0.569)&gt; sig (0.05), parent’s occupation p (0.766)&gt; sig (0, 05), personal hygiene p (0.136)&gt; sig (0.05) is not a risk factor for the incidence of leprosy in children in Sorong City. It is recommended that parents increase knowledge about leprosy transmission by seeking information from both health workers and the mass media, as well as the public who can actively participate in supporting government programs and efforts to prevent leprosy.

Post-exposure prophylaxis (PEP) efficacy of rifampin, rifapentine, moxifloxacin, minocycline, and clarithromycin in a susceptible-subclinical model of leprosy.

BackgroundSubclinical infection with Mycobacterium leprae is one potential source of leprosy transmission, and post-exposure prophylaxis (PEP) regimens have been proposed to control this source. Because PEP trials require considerable investment, we applied a sensitive variation of the kinetic mouse footpad (MFP) screening assay to aid in the choice of drugs and regimens for clinical trials.Methodology/Principal findingsAthymic nude mice were inoculated in the footpad (FP) with 6 x 103 viable M. leprae and treated by gastric gavage with a single dose of Rifampin (SDR), Rifampin + Ofloxacin + Minocycline (SD-ROM), or Rifapentine + Minocycline + Moxifloxacin (SD-PMM) or with the proposed PEP++ regimen of three once-monthly doses of Rifampin + Moxifloxacin (RM), Rifampin + Clarithromycin (RC), Rifapentine + Moxifloxacin (PM), or Rifapentine + Clarithromycin (PC). At various times post-treatment, DNA was purified from the FP, and M. leprae were enumerated by RLEP quantitative PCR. A regression analysis was calculated to determine the expected RLEP value if 99.9% of the bacilli were killed after the administration of each regimen. SDR and SD-ROM induced little growth delay in this highly susceptible murine model of subclinical infection. In contrast, SD-PMM delayed measurable M. leprae growth above the inoculum by 8 months. The four multi-dose regimens delayed bacterial growth for >9months post-treatment cessation.Conclusions/SignificanceThe delay in discernable M. leprae growth post-treatment was an excellent indicator of drug efficacy for both early (3–4 months) and late (8–9 months) drug efficacy. Our data indicates that multi-dose PEP may be required to control infection in highly susceptible individuals with subclinical leprosy to prevent disease and decrease transmission.

Leprosy: A Review of History, Clinical Presentation and Treatments

Leprosy is an ancient disease of mankind that has persisted for generations across various continents. The disease is caused by Mycobacterium leprae and Mycobacterium lepromatosis with humans acting as the natural reservoir. The transmission of Leprosy is still poorly understood, however it is widely accepted that the inhalation of aerosol droplets from cases with high mycobacterial loads is the most common mechanism. Leprosy affects the skin and peripheral nerves and has been a focus of a worldwide eradication campaign by the World Health Organisation which has been largely successful. Treatment is with the use of a multi drug therapy with Dapsone, Rifampicin and Clofazamin for 6 to 12 months depending on the type of leprosy.

Poor WASH (Water, Sanitation, and Hygiene) Conditions Are Associated with Leprosy in North Gondar, Ethiopia.

Access to safe water, sanitation, and hygiene (WASH) is critical for preventing the spread of neglected tropical diseases (NTDs) including leprosy. WASH-related transmission factors remain largely unexplored in the leprosy transmission cycle. The aim of this project is to better understand WASH exposures among leprosy cases through a case-control study in North Gondar, Ethiopia. We hypothesized that leprosy cases were more likely to have inadequate WASH access and were more likely to have concurrent schistosomiasis, as schistosomiasis immune consequences may facilitate leprosy infection. Forty leprosy cases (forty-one controls) were enrolled, tested for Schistosoma mansoni, administered a demographic and WASH survey, and assigned a WASH index score. WASH factors significantly associated with leprosy on adjusted analyses included open defecation (aOR = 19.9, 95% CI 2.2, 176.3) and lack of access to soap (aOR = 7.3, 95% CI 1.1, 49.9). S. mansoni was detected in 26% of participants and in stratified analysis those with leprosy had a 3.6 (95% CI (0.8, 15.9)) greater odds of schistosomiasis in districts bordering the lake, compared to 0.33 lower odds of schistosomiasis in districts not bordering the lake (95% CI (0.09, 1.2)). Overall, results suggest that leprosy transmission may be related to WASH adequacy and access as well as to schistosomiasis co-infection.

Distribution of RNA M. Leprae Household Contact in Endemic Area Indonesia

Background and Objective: Chronic leprosy disease is caused by the transmission of Mycobacterium &#x0D; leprae bacilli, and leprosy is still as an enigmatic disease which is not fully understood. In terms of the&#x0D; national level, leprosy disease in Indonesia remains a public health problem. 16S rRNA gene is a gene that&#x0D; encodes which codes the 16S part of the ribosome and it has specific nucleotides and can specifically be used&#x0D; to detect the cases of leprosy.&#x0D; Materials and Method: This study was classified as the observational study using a case-control research&#x0D; design. The total samples were 81 individuals that consisted of 27 leprosy patients (the case group) and 54&#x0D; non-leprosy patients (the control group). Analysis of 16S rRNA gene expression was conducted using the&#x0D; RFLP-PCR method to detect the risk of leprosy.&#x0D; Results: All samples of swabs of ear lobes for the case group (27 samples) were definitely positive infected&#x0D; by M. leprae and 2 dust samples (7%) collected from houses of the case group showed positive infected by&#x0D; &#x0D; leprae bacilli, i.e. S05 and S09 respectively. Of all samples of dust collected from houses of non-leprosy&#x0D; &#x0D; patients (the control group), 4 dust samples (14%) was positive infected by Mycobacterium leprae, i.e.&#x0D; C03, C05, C09, C11 respectively, and 2 non-leprosy patients were infected by M. leprae due to close social&#x0D; interactions with leprosy patients.&#x0D; Conclusion: Dust medium and close social interactions were the causal factors for the transmission of&#x0D; leprosy disease. Therefore, it is suggested to conduct strict control to prevent the widespread of leprosy&#x0D; disease by keeping the cleanliness of houses at the local areas and the surrounding environment as well as&#x0D; the caution to do social interactions with leprosy individuals.

Unfavorable Attitude and Perceived Stigma towards Leprosy: A Concern for Status Perpetuation in a Community in Cross River State, Nigeria

Background: Negative attitude and stigma against leprosy patients constrain them to resort to concealing their status thus resulting in delayed detection, treatment, complications and perpetuation of the condition in the locality. This study was aimed at finding out the prevailing attitude and stigma toward leprosy in the community with a view to addressing the fueling factors.&#x0D; Materials and Methods: It was descriptive cross sectional study. Semi-structured interviewer administered questionnaires were used for data collection. Explanatory Model Interview Catalogue (EMIC), was used to grade stigma against leprosy amongst participants. Answers to questions in the questionnaire were assigned scores which were summed up into percentage breakpoints. A respondent was interpreted as having favorable or unfavorable attitude to leprosy depending on his or her percentage sum of score.&#x0D; Stigma was categorized based on the sum of an individual’s EMIC score as high, moderate or low level of stigma. Data were analyzed using SPSS version 20.&#x0D; Results: The study revealed that only 44(15%) of respondents had favorable attitude towards leprosy whereas 250(85%) had unfavorable attitude towards this group. Attitude to leprosy was observed to be significantly related to age and sex of respondent, religion and ethnicity, p-value&lt; 0.05. EMIC profile of the study respondents revealed that 47(16%) demonstrated low stigma, 81(28%) demonstrated moderate stigma and 166(56%) demonstrated high stigma towards leprosy. There was no statistically significant relationship between stigma and socio-demographic variables.&#x0D; Conclusion: Misunderstanding and misconceptions about leprosy and leprosy patients is still well rooted in the norms and culture of the people of Ikun, breeding negative attitude and stigma toward leprosy. Vigorous leprosy awareness programs structured along the lines of attitude-stigma influencing socio-demographic variables, with emphasis on the cause, transmission, diagnosis and treatment of leprosy will help to stem the tide of myths and misconceptions.

Leprosy transmission in endemic and non-endemic areas based on the profile of antibody response of PGL-1 and PCR detection of Mycobacterium leprae DNA from nasal swab among healthy children of East Java, Indonesia.

BackgroundEast Java has become one of the provinces that have higher prevalence of leprosy, especially in the coastal region. Environment has also influenced for leprosy transmission and early detection could reduce the incidence rate of new leprosy cases. Epidemiological studies of leprosy in children can give an illustration of the important aspects of the environment. Presence of Mycobacterium leprae (M. leprae) DNA in nasal swabs and seropositivity level among them can describe M. leprae exposure in that area.ObjectiveAnalyzing PCR from nasal swab and seropositivity level among elementary school children between northern coast and southern coast of East Java province.MethodsFive hundred and thirty children in Pacitan and Lamongan were involved. Both areas are representation of northern and southern coastal region in East Java Province. After clinical examination, nasal swab and blood samples were obtained. ELISA test was performed to measure the titer of IgM anti Phenolic Glicolipid-1 (PGL-1) antibody then continued by PCR to detect M. leprae DNA.ResultsFrom 301 students in Pacitan, 25 students (8.3%) are sero-positives and 9 students (2.9%) are PCR positives. from 229 students in Lamongan, 110 (48,3%) students are sero-positives and 49 students (21.4%) are PCR positives. Both are analyzed by Chi-Square, and from the PCR and ELISA, it concluded that there are statistically significant differences between the two regions.ConclusionFrom study above shows that in the northern coast of East Java, incidence of subclinical leprosy is still high, it means that in this area still has a high risk of new cases of leprosy in the future and early detection tools need to performed as a preventative measure.

Delayed diagnosis and ongoing transmission of leprosy in the post-elimination era in Boru Meda hospital, Ethiopia.

Following the recommendation of the Global Leprosy Strategy, Ethiopia targeted to reduce the incidence of new leprosy cases, and the proportion with severe disability (grade 2) from 13.6% in 2016 to < 1% in 2020. This study assessed the clinical profile of new leprosy cases and the sequelae of previously treated ones 20 years after leprosy was eliminated as a public health problem in the country. Hospital based cross sectional study was conducted by reviewing the medical records of all leprosy patients seen at the dermatology clinic of Boru Meda Hospital from August to December 2018.The data were captured using a standard data collection form. Over the study period, 57 (27.4%) new cases and 151 (72.6%) previously treated cases were seen.The median age was 44 years (interquartile range 32-57). Among the newly diagnosed cases, two were under the age of 15 years , 51 (89.5%) were multibacillary and 34 (59.6%) had grade 2 disability. This included visual impairment in 10 (17.5%) and neurological complications in 44 (77.2%). Of the 151 previously treated cases, 104 (68.9%) presented with disabilities, including 97 (64.2%) with grade 2. Amongst previously treated cases, 130 (86.1%) had neurological complications. In addition, 53 (35.1%) had vision impairment. This study showed evidence of ongoing leprosy transmission and delayed diagnosis in the country. This calls for operational research to determine the underlying reasons and provide ways forward. At the same time, the high burden of disabilities in previously treated cases should be addressed.

Real-time PCR-based quantitation of viable Mycobacterium leprae strain from clinical samples and environmental sources and its genotype in multi-case leprosy families of India.

The potential role of environmental M. leprae in the transmission of leprosy remains unknown. We investigated role of environment as a possible source of viable M. leprae responsible for transmission of leprosy. The samples were collected from 10 multi-case leprosy families comprising, slit skin smear (SSS) from 9 multibacillary (MB), 16 paucibacillary cases (PB), 22 household contacts, and 38 environmental soil samples. The quantum of viable M. leprae was estimated by qRT-PCR using 16S rRNA gene from soil and SSS. Genotypes of M. leprae were determined by gene sequencing. We could observe presence of viable M. leprae in 11 (44%) leprosy cases (M. leprae 16S rRNA gene copies range from 1.78 × 102 to 8.782 × 109) and 4 (18%) household contacts (M. leprae 16S rRNA gene copies range from 2.54 × 103 and 7.47 × 104). Remarkably, presence of viable M. leprae was also noted in 10 (53%) soil samples where in M. leprae 16S rRNA gene copies ranged from 4.36 × 102 to 7.68 × 102. M leprae subtype 1D was noted in most of the leprosy cases their household contacts and in the surrounding soil samples indicating source of infection in household contacts could be from environment or patients. M. leprae 16S rRNA copies were approximately similar in both PB cases and soil samples along with presence of SNP type 1 subtype 1D in both samples indicating source of M. leprae from patients to contacts was either from patients or environment or both.

Genotyping of Mycobacterium leprae for understanding the distribution and transmission of leprosy in endemic provinces of China

ObjectivesUnderstanding the nature of Mycobacterium leprae transmission is vital to implement better control strategies for leprosy elimination. The present study expands the knowledge of county-level strain diversity, distribution, and transmission patterns of leprosy in endemic provinces of China. MethodsWe genetically characterized 290 clinical isolates of M. leprae from four endemic provinces using variable number tandem repeats (VNTR) and single nucleotide polymorphisms (SNPs). Attained genetic profiles and cluster consequences were contrasted with geographical and migration features of leprosy at county levels. ResultsConsidering the allelic variability of 17 VNTR loci by the discriminatory index, (GTA)9, (AT)17, (AT)15, (TA)18, (TTC)21, and (TA)10 are reported to be more highly polymorphic than other loci. The VNTR profile generated the low-density clustering pattern in the counties of Sichuan and Yunnan, whereas clusters have been observed from the isolates from Huayuan (N = 6), Yongding (N = 3), Zixing (N = 3), Chenxi (N = 2) and Zhongfang (N = 2) counties of Hunan, and Zhijin (N = 3), Anlong (N = 2), Zhenning (N = 2), and Xixiu (N = 2) counties of Guizhou. In some clusters, people’s social relations have been observed between villages. From the 290 clinical isolates, the most predominantly reported SNP was 3K (278, 95.8%), followed by SNP 1D (10, 3.4%), which are typically observed to be predominant in China. We also detected the novel SNP 3J (2, 0.8%), which has not yet been reported in China. ConclusionThe clustering pattern of M. leprae indicates the transmission of leprosy still persists at county levels, suggesting that there is a need to implement better approaches for tracing the close contacts of leprosy patients.

Reservoirs and transmission routes of leprosy; A systematic review.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) and the more recently discovered Mycobacterium lepromatosis (M. lepromatosis). The two leprosy bacilli cause similar pathologic conditions. They primarily target the skin and the peripheral nervous system. Currently it is considered a Neglected Tropical Disease, being endemic in specific locations within countries of the Americas, Asia, and Africa, while in Europe it is only rarely reported. The reason for a spatial inequality in the prevalence of leprosy in so-called endemic pockets within a country is still largely unexplained. A systematic review was conducted targeting leprosy transmission research data, using PubMed and Scopus as sources. Publications between January 1, 1945 and July 1, 2019 were included. The transmission pathways of M. leprae are not fully understood. Solid evidence exists of an increased risk for individuals living in close contact with leprosy patients, most likely through infectious aerosols, created by coughing and sneezing, but possibly also through direct contact. However, this systematic review underscores that human-to-human transmission is not the only way leprosy can be acquired. The transmission of this disease is probably much more complicated than was thought before. In the Americas, the nine-banded armadillo (Dasypus novemcinctus) has been established as another natural host and reservoir of M. leprae. Anthroponotic and zoonotic transmission have both been proposed as modes of contracting the disease, based on data showing identical M. leprae strains shared between humans and armadillos. More recently, in red squirrels (Sciurus vulgaris) with leprosy-like lesions in the British Isles M. leprae and M. lepromatosis DNA was detected. This finding was unexpected, because leprosy is considered a disease of humans (with the exception of the armadillo), and because it was thought that leprosy (and M. leprae) had disappeared from the United Kingdom. Furthermore, animals can be affected by other leprosy-like diseases, caused by pathogens phylogenetically closely related to M. leprae. These mycobacteria have been proposed to be grouped as a M. leprae-complex. We argue that insights from the transmission and reservoirs of members of the M. leprae-complex might be relevant for leprosy research. A better understanding of possible animal or environmental reservoirs is needed, because transmission from such reservoirs may partly explain the steady global incidence of leprosy despite effective and widespread multidrug therapy. A reduction in transmission cannot be expected to be accomplished by actions or interventions from the human healthcare domain alone, as the mechanisms involved are complex. Therefore, to increase our understanding of the intricate picture of leprosy transmission, we propose a One Health transdisciplinary research approach.

Socio-Cultural Factors in Family Independence Prevent the Transmission of Leprosy in Sampang, Madura Island.

Introduction: Leprosy is an infectious disease that causes various problems, not only in medical terms butalso extends to social, economic, cultural, security and social security issues. Efforts made to break the chainof transmission of leprosy cases focus more on individuals who have not focused on families that have ahigh transmission chain.Purpose: The research aims to explore the social factors of social and cultural factors in influencing familyindependence in preventing transmission of leprosy, describing the independence of the family in preventingtransmission of leprosy, then compiled an example of a culture-based family independence program modelfor the prevention of leprosy transmission in Sampang with a theoretical approach used namely FamilyCentered Nursing and the theory of Transcultural Nursing in the form of modules.Method: This study uses a qualitative research approach. Data saturation until five participants were obtainedwho carried out data retrieval in an in-depth interview. Data analysis using the Collaizi analysis method.Results: Identification found four main themes: ((1) Religious; (2) Social Factors; (3) Economic Factors;and (4) Cultural Value. Conclusions: The description of the independence of families who care for lepers isstill influenced by many factors, especially tradition and culture, efforts to break the chain of transmissionare also closely related to care efforts that still do not reflect preventive values.

Where in the World Did You Get That Rash?

1. Panteha Eshtiaghi, HBSc* 2. Miriam Weinstein, MD, FRCPC† 1. *Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 2. †Hospital for Sick Children, Toronto, Ontario, Canada * Abbreviations: ACD: : allergic contact dermatitis CD: : cercarial dermatitis CL: : cutaneous leishmaniasis CLM: : cutaneous larva migrans DF: : dengue fever HFMD: : hand, foot, and mouth disease HSV: : herpes simplex virus KD: : Kawasaki disease PCR: : polymerase chain reaction PR: : pityriasis rosea RT-PCR: : reverse transcriptase polymerase chain reaction The challenge to diagnose cutaneous eruptions and lesions in patients who have spent time in foreign countries is increasingly common. With the advent of increased global travel, foreign adoptions, immigration, and refugee seekers, rashes that were once relegated to the realm of the exotic and likely to show up in a tropical diseases clinic may now present to a general pediatrician. Furthermore, the pediatric traveler is at increased risk for dermatoses. (1) It behooves the practitioner to be aware of these skin findings, to be able to recognize them and distinguish them from other skin conditions. After completing this article, readers should be able to: 1. Identify and classify rashes by main morphologic patterns. 2. Develop a broad differential diagnosis and diagnostic approach for a rash in a returned pediatric traveler based on initial morphology, history, epidemiology, and other clinical features. 3. Consider both infectious and noninfectious causes of skin disorders presenting in a patient with a travel history. 4. Outline the basic investigations and principles of management for travel-acquired and non–travel-acquired dermatologic illnesses. 5. Discuss …

Interpretation systems, therapeutic itineraries and repertoires of leprosy patients in a low prevalence country.

In Peru, despite the small number of cases, there is evidence of late diagnosis and hidden prevalence of leprosy. In this context the objective of the study was to know the interpretation systems on leprosy, itineraries and therapeutic repertoires of patients diagnosed with leprosy who are in treatment or who have finished treatment. A qualitative study was carried out, applying se mi-structured interviews to patients diagnosed with leprosy from the Loreto and Ucayali regions. 30 patients were interviewed. Most did not know the mechanism of leprosy transmission. In relation to therapeutic itineraries, patients generally went to health facilities on the recommendation of third parties who knew the disease. In some cases, health personnel made a bad diagnosis. The importance of the treatment indicated by the "Ministerio de Salud" (Ministry of Health) is recognized; however, economic factors and the distance to health facilities negatively affect adherence to treatment. In addition, it was evidenced that stigma persists towards the disease. Patients recognize the importance of treatment; however, they express misconceptions about the pathogenesis of leprosy, and weaknesses in the health system are also identified. These problems would lead to delay in diagnosis and treatment. It is recommended to strengthen control strategies and decentralize the care of leprosy with the participa tion of the community, patients, health personnel and healers, considering the identified barriers and a probable underdiagnosis in women.

Prevention of transmission of leprosy: The current scenario.

With the worldwide implementation of WHO multidrug therapy in the 1980s, the global burden of leprosy has decreased. However, the annual new case detection rate around the world has remained nearly static over the past decade with India, Brazil, and Indonesia contributing the majority of these new cases. This has been attributed to the ongoing transmission of Mycobacterium leprae from existing untreated cases and partly to the intensive new case detection programs operative in endemic areas. The WHO has called for a "global interruption of transmission of leprosy by 2020". Targeted chemoprophylaxis of contacts may help bring down the number of new cases. The single-dose rifampicin currently in use for post-exposure prophylaxis (PEP) has limitations and so newer antileprosy drugs and regimens have been trialed for chemoprophylaxis. BCG re-vaccination in combination with chemoprophylaxis for the prevention of leprosy transmission has not been very encouraging. The use of the anti-phenolic glycolipid-1 (PGL-1) antibody test to detect subclinical cases and administer targeted chemoprophylaxis was unsuccessful owing to its low sensitivity and technical difficulties in a field setup. There is a pressing need for newer multidrug chemoprophylactic regimens using second-line antileprosy drugs. The Netherlands Leprosy Relief has proposed an enhanced PEP++ regimen. A simple but highly sensitive and specific serological test to detect subclinical cases at the field level needs to be developed. Although there are a number of challenges in the large-scale implementation of strategies to halt leprosy transmission, it is important to overcome these in order to move towards a "leprosy-free world."

Spatial analysis of epidemiological and quality indicators of health services for leprosy in hyperendemic areas in Northeastern Brazil.

ABSTRACTLeprosy is a public health problem due to the physical disabilities and deformities it causes. This study aimed to describe new leprosy cases using an operational classification and analyzing spatial patterns by means of epidemiological and quality indicators of health services in Pernambuco State, Brazil, between 2005 and 2014. This was an ecological study performed in 184 municipalities grouped into 12 health regions units for analysis. To analyze spatial patterns, the Bayesian local empirical method and Moran's spatial autocorrelation indicator were applied and box and Moran maps were used. Individuals aged ≥15 years old, grade zero physical disability and complete remission as the treatment outcome were predominant in both paucibacillary and multibacillary cases, the only difference was the predominance of females (n=9,286; 63.00%) and males (n=8,564; 60.70%), respectively. These variables were correlated (p<0.05) with the operational classification. The overall detection rate showed three high-priority areas; the indicator rate of grade 2 physical disability revealed clusters in regions IV, V, and VI; and the indicator rate of cases with some degree of disability showed precarious municipalities in seven health regions. Pernambuco maintains an active chain of transmission and ongoing endemicity of leprosy. Therefore, spatial analysis methods allow the identification of priority areas for intervention, thereby supporting the disease elimination strategy.