Clinico-Epidemiological study of New Multibacillary Leprosy patients Visiting a Tertiary Care Hospital: A Prospective Observational study

Pavithra, Gunasekaran (2017) Clinico-Epidemiological study of New Multibacillary Leprosy patients Visiting a Tertiary Care Hospital: A Prospective Observational study. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION: Leprosy is a chronic infectious disease. Following the integration of leprosy services into the general health care system the dedicated survey of areas has been stopped and only voluntary reporting of cases is being done. Though India attained national level elimination of leprosy in December 2005, the recent trends of increasing new multibacillary leprosy cases and deformities are a cause for alarm and warrant focussed attention. AIM OF THE STUDY: To study the clinical and epidemiological profile of newly detected multibacillary leprosy patients attending Government Rajaji Hospital, Madurai during a period of one year. MATERIALS AND METHODS: This study was a prospective, observational study conducted in the department of Dermatology, Government Rajaji Hospital, Madurai Medical College, Madurai during a period of one year from August 2015 - July 2016. Inclusion Criteria: All new multibacillary patients according to the National Leprosy Eradication Programme (NLEP) classication were included. Exclusion Criteria: All paucibacillary cases, cases started on treatment before the period of study, treatment defaulters and cases with relapse were excluded. Data Collection: Screening of all patients with clinical features suggestive of leprosy was done and they were classified as per NLEP guidelines. Among them the newly detected multibacillary cases were included for the study. The clinical and epidemiological data was obtained based on a predesigned proforma which included details regarding epidemiological data, history and clinical findings, slit skin smear and details of household contacts with leprosy. OBSERVATION AND RESULTS: Of a total of 97 new leprosy patients, 67 multibacillary patients were included. A high MB proportion of 69% was seen.The highest number of patients were in the fourth decade (28%) followed by the fifth decade (22%). Of the total patients 6% were children, 24% were women and 70% were men. The most represented spectrum was the Borderline Tuberculoid group (61.1%) followed by Lepromatous group (17.9%). Histoid leprosy, consisting of de novo type, was present in 10.4%. Of the total 37.3% of patients had reaction. Among the total, 52.2% had deformities with 12% having Grade 1 deformities and 40.3% having Grade 2 deformities. Of the lepromatous cases 75% had deformities while only 43.9% of BT cases had deformities despite their higher representation in the study. Among patients presenting in less than one year 40% had deformities and this was 61.5% for one to three years duration and 83.3 for more than three years disease duration. Among the patients with deformity, 42.9% were in reaction. Also 60% of total patients in reaction had deformity. Slit skin smears were positive in 41.8% patients. About 13.4% of patients could be traced to a household contact of leprosy. Among the four children in our study, three (75%) had a MB contact in the house. CONCLUSION: The high MB proportion was seen. The ages at detection of MB cases were late as predicted by previous studies. The representation of females was lower in the study. Even among the MB cases, Borderline tuberculoid leprosy accounted for the majority of cases detected as supported by current literature. A higher than usual detection of de novo histoid leprosy was noted. Among the patients with late presentation the factors including neuritis, reactions and deformities prompted health care seeking behaviour. More than half of the patients reported with deformities, with higher number of Grade 2 deformities. The delay in diagnosis was directly proportional to the occurrence of deformities with reactions in leprosy also contributing to deformities. There were contacts with leprosy in 13.4% of the study population. The contacts in majority, especially in children, were MB cases. The findings of high MB proportion with late presentation, deformities, and presence of household contacts of leprosy reinforces the need for better education regarding leprosy to the public and active screening in in areas of high numbers of multibacillary patients.

Item Type: Thesis (Masters)
Additional Information: Reg.No.201430101
Uncontrolled Keywords: Leprosy, multibacillary cases, delay in diagnosis, deformities, reactions, screening of household contacts.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 22 Jul 2020 14:43
Last Modified: 22 Jul 2020 14:43

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