Clinical characteristics predicting erythema nodosum leprosum(ENL) among patients with multibacillary leprosy(MBL) in Sarawak

Objective:To determine the clinical features predicting erythema nodosum leprosum(ENL) in a non endemic leprosy area.Methods:Twenty newly diagnosed patients with MBL attending the skin clinic,Sarawak General Hospital from 1992 to 2007 were analyzed.They were divided into 2 groups,one with ENL and one without. Analysis of the presenting clinical features was done to determine the risk factors for ENL.Chi square and student t test was used for statistical analysis.Level of significance was set at 0.05.Results:ENL was present in 40%patients,all with lepromatous leprosy(LL).Clinical features that were seen more frequently in patients developing ENL include earlobe thickening(100%cf.25%,P =0.00),loss of the lateral third of the eyebrows(75%cf.16.7%,P=0.02) and mean bacteriology index(BI)(5.1 cf.2.9,P=0.03) and mean morphological index(MI)(17.8 cf.7.0,P =0.02).Number of thickened nerves(mean 2.5 cf. 1.4,P = 0.12),number of skin lesions(mean 19.4 cf.10.9,P = 0.15) and duration of illness(mean 15. 3 cf.12.8 months,P =0.68) did not predict ENL development.Conclusion:Finding LL patients with thickened earlobes,loss of lateral third of the eyebrow,high BI and MI should alert treating clinician to the possibility of ENL in a non endemic leprosy area.

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.

Theoretical Assessment of the Transmission Dynamics of Leprosy

Leprosy is a communicable disease which can cause hideous deformities to the afflicted and social stigmatization to them and their families. The continued high endemicity of leprosy in pockets of Sub-Saharan Africa is a source of bafflement to researchers. In this paper, we investigate non-compliant behavior by patients on treatment and possible inadequacy of the prescribed treatments as the reason for the persistence of the disease in the region. We construct theoretical, deterministic mathematical models of the transmission dynamics of leprosy. These models are modified to encapsulate non-compliance and inadequate treatment. The models are then analyzed to gain insight into the qualitative features of the equilibrium states, which enable us to determine the basic reproduction number. We also employ analytical and numerical techniques to investigate the impact of non-compliance and inadequate treatment on the transmission dynamics of the disease. Our results show that, as long as there is treatment, leprosy will eventually be eliminated from the region and that the disposition under investigation only serves to slow the rate at which the disease is eradicated.

Epidemiology of Leprosy in China,2021:An Update

Objective:Leprosy is an infectious diseases that remains a concerning public health issue.The infection of Mycobacterium leprae still exists at the county level in hard-to-access areas in southwest China.An accurate analysis of the prevalence of leprosy in various regions is necessary for the formulation of prevention and control strategies,so we conducted this study to describe the epidemiological characteristics of leprosy in China in 2021 and provide essential information for future national leprosy control and prevention strategies.Methods:We collected epidemiological data of leprosy from 31 provinces,autonomous regions,and municipalities of China(except for Hong Kong,Macao,and Taiwan)provided by the Leprosy Management Information System.We performed a comparative analysis of the epidemiological features of patients with leprosy including age,sex,geographical distribution,and grade of disability.Results:In total,374 newly detected leprosy cases were reported nationwide in China in 2021,giving an incidence rate of 0.27 per million population,which represented a decrease of 7.9%compared with 2020.Among the population with leprosy in 2021 that comprised 238 males(63.6%)and 136 females(36.4%),1.9%(7/374)were children younger than 15 years,92.8%(347/374)had multibacillary leprosy,and 18.2%(68/374)had grade 2 disability.More than half of the new leprosy cases(54.8%,205/374)were distributed in southwest China.There were 33 relapsed leprosy cases reported in 2021.By the end of 2021,there were 1,897 registered leprosy cases reported nationwide,giving a prevalence rate of 1.35 per million population.Conclusion:The leprosy epidemic in China shows a downward trend in terms of the prevalence and incidence rates.However,the high prevalence of leprosy in southwest China is still a matter of concern.