There is a paucity of data on quality of life issues in patients with leprosy suffering from erythema nodosum leprosum (ENL). Thus, we aim to study the effect of ENL on quality of life.
Congo red screening of tissue blocks from 37 consecutive autopsies on leprosy patients revealed 7 cases of systemic amyloidosis, indicating a prevalence rate of 19%. 5 were males and 2 females. All were ethnic Chinese. Their ages ranged from 52 to 85 years with a mean of 69 years. Six had lepromatous leprosy while the remaining 1 had tuberculoid leprosy. In all 7 cases, the amyloid was AA in type, being permanganate-sensitive and immunoreactive with anti-human AA protein antiserum. Hepatic deposition was limited to blood vessels, a pattern typical of AA (secondary) amyloidosis. With regard to renal involvement, 4 showed a predominantly vascular pattern of infiltration while 3 exhibited the more ominous glomerular pattern. Three died of chronic renal failure and 2 of congestive cardiac failure attributable to renal and cardiac amyloidosis respectively. One patient succumbed to septicaemia and the remaining 1 to acute myocardial infarction. AA amyloidosis remains a serious and significant complication of leprosy among Malaysians.
In Sarawak, some tribes stay in communal longhouses whilst others live in villages of single dwellings. The present study looks into the question of whether there is an association between the prevalence of leprosy and tuberculosis with the quantum of social contact that occurs in these two types of settlement patterns. It was found that the prevalence of leprosy and tuberculosis is significantly higher among longhouse dwellers compared with single house dwellers. It was also noted that social groups tended to be larger and to persist for much longer among longhouse dwellers than among those in single dwellings. This lends support to the evidence that social contact in longhouses is more extensive and contributes towards a higher prevalence of leprosy and tuberculosis.
In 1984, in Sarawak, there were a total of 1,099 recorded cases of leprosy for a population of 1.3 million. However, for each case recorded, it is estimated that two others remain undiagnosed as a consequence of the stigmatization associated with leprosy. For the five year period, 1979-1983, an average of 29 new cases were detected each year of which 8.6 (30%) were deformed due to the late stages at which it was being reported. To increase the case-finding rate, human behavioural research was applied to the leprosy control programme so as to develop culture-specific health education packages aimed at self diagnosis and self referral in order to detect the large pool of undiagnosed cases hidden behind the veil of aversion, fear and ignorance. This was achieved through anthropological studies to identify how the various major ethnic groups perceived leprosy and their attitudes towards leprosy. Taking into account these findings, health education packages aimed at adults as well as children were developed for the Chinese as well as the non-Chinese, and consisted of newspaper articles, cartoon tape-slides, cartoon story books and posters.
Matched MeSH terms: Leprosy/ethnology*; Leprosy/prevention & control
A study in Sarawak, Malaysia, revealed diverse opinions, prejudices and degrees of knowledge about leprosy among various ethnic groups. The information gathered was used as the base on which a health education package relating to the disease was established. It is intended that this will lead to the early detection and treatment of a higher proportion of cases than has previosly been possible
Introduction: Leprosy is a chronic granulomatous disease which also known as Hansen’s disease caused by Mycobacterium leprae. The social rights and health requirements should not be neglected among the remaining survivors. Although nutritional status and leprosy invasion has been studied in the past, there is still an unclear relationship between these two. The aim of this study was to assess the relationship between nutritional status and disability among the leprosy survivors.
sampling was conducted at Sungai Buloh, Selangor area from June 2014 to July 2014. The degree of disability was assessed using Barthel’s Index and the nutritional status assessment was assessed using Mini Nutritional Assessment. The data was analysed using SPSS version 20.
Results: A total of 73 patients were involved in the study (60.3% were male and 89.0% were Chinese). The prevalence of disability was 56.2% (95% CI: 44.5 – 67.8) with walking up-stair s the highest item that need help (50.7%). There were 9.6% malnourished and 49.3% were at risk of malnutrition. There was a negative strong correlation between Nutritional score and the Barthel’s index score (Spearman rho, ρ = -0.714, p < 0.001).
Conclusions: Measures must be taken to improve their nutritional status in order to increase their ability to be more independent particularly those who are very old. The degree of disability increases with malnutrition.
KEYWORDS: Functional dependence, nutritional status, leprosy
This is an interesting comparison between the types of leprosy seen among Chinese, Malays and Indians in Malaya, based on a large experience. The disease is most virulent among Chinese and least so among Indians, three-fourths of the cases among the latter being of mild tuberculoid disease with a tendency to self-healing, but among the Chinese only one-third are of the tuberculoid type. The climate of Malaya is of the hot humid type, in which leprosy flourishes. On the other hand, a higher standard of living than in India tends to hinder the spread of the disease. The age incidence is important. Among, the Chinese, early macules are commonly found in children of 5 to 15 years of age, most of which tend to clear up, but in about one-fourth tuberculoid lesions develop and may go on to the lepromatous condition, especially if the onset of the tuberculoid stage occurs early. When a reliable history is obtained in Chinese, in nearly every lepromatous case a tuberculoid stage was first observed, commonly in the age group 16-40. In a smaller number of persons of over 40 years of age, the proportion of tuberculoid cases is very much higher, but the tendency to become lepromatous is very much less. Major tuberculoid cases are more liable than minor to become lepromatous, but nerve thickening in tuberculoid leprosy is less evident in Chinese than in Indians and it is rare in children and in those over 40. In view of the foregoing peculiarity of the evolution of leprosy in tuberculoid cases in Chinese subjects, active treatment is necessary, in order to prevent them becoming lepromatous. For this purpose, intradermal injections are of little value and they tend to obscure any evolutionary changes. Hydnocarpus oil or esters (deep subcutaneous injections) should therefore be pushed to the limit of tolerance in doses of 1 cc. per 10 pounds body weight twice weekly, or 30 cc. per week, for a patient of 150 Ibs. as a minimum and increased by at least fifty per cent, in acute or reacting cases, when improvement may be expected within three months. Some years' experience of this intensive treatment as compared with weekly injections of 1-5 cc. has shown much more marked improvement and much less incidence of lepromatous change with the high doses. In lepromatous cases, reactions should be avoided, but dosage should be as high as possible short of producing increased erythrocyte sedimentation and plantar pain on heavy stroking. Surveys of school children are of great importance in finding the early macular stage and their discovery may lead to the detection of infective adults who require to be segregated. L. Rogers.
Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae with predominant involvement of skin and nerves. We present a 70-year-old man with leprosy whose initial presentation resembled rheumatologic disease, due to leprae reaction. He presented with an 8-week history of worsening neuropathic pain in the right forearm, associated with necrotic skin lesions on his fingers that had ulcerated. Physical examination revealed two tender necrotic ulcers at the tip of the right middle finger and the dorsal aspect of the left middle finger. The patient had right wrist tenosynovitis and right elbow bursitis. Apart from raised inflammatory markers, the investigations for infection, connective tissue disease, vasculitis, thromboembolic disease and malignancy were negative. During the fourth week of hospitalization, we noticed a 2-cm hypoesthetic indurated plaque on the right inner arm. Further examination revealed thickened bilateral ulnar, radial and popliteal nerves. A slit skin smear was negative. Two skin biopsies and a biopsy of the olecranon bursa revealed granulomatous inflammation. He was diagnosed with paucibacillary leprosy with neuritis. He responded well to multidrug therapy and prednisolone; his symptoms resolved over a few weeks. This case illustrates the challenges in diagnosing a case of leprosy with atypical presentation in a non-endemic country.
Neural leprosy is rare. This is a report of a 63-year-old Indian man who had long standing multiple peripheral neuropathy. The slit skin smear for acid-fast bacilli of Mycobacterium leprae was positive. The skin and nerve biopsies were normal. He was treated with rifampicin, dapsone and clofazimine.