Does Leprosy Need a Stronger Surveillance System Now? A point of view article.

Multi Drug Therapy (MDT) for leprosy was introduced by WHO in 1982 and the programme has been implemented for more than 3 decades. The main presumption out of the PR based elimination was that with reduction of disease load below 1 per 10000 persons, the transmission of leprosy would be arrested resulting in disappearance of the disease. MDT made the disease description, definition and epidemiological indicators so different that it ceases to be like any other disease.

Trend in decline in leprosy disabilities of a LEPRA project in Malkangiri district, Odisha, India.

This a retrospective analysis of the changes in 646 disabilities occurred amongst 3979 cases registered during 19 years from 1992 to 2010 in Malkangiri district. This amounted to 16.2% of cases with disability segregated to 310 (48%) Grade 1 and 336 (52%) Grade 2.

Transfer of disability care of leprosy to the affected persons and the community members.

Bargarh district in the western Orissa had high leprosy burden and LEPRA India supported in control activities. Its main focus was on POD care with community participation. After motivation and capacity building, it transferred the responsibility of POD care to affected persons, family, community partners and GHS staff in 2006.

Satisfaction of leprosy patients on integrated MDT services: as evaluated by Bargarh Integrated Community Health Project (BICHP).

Functional integration can be viewed successful if general health system (GHS) delivers services to the satisfaction of leprosy patients. The study elicits responses from 307 leprosy cured persons of 3 blocks and one town covering a population of about 3,50,000 in district Bargarh, Orissa. 229 (74.

Can the skin smear examination in NLEP be reconsidered?

Slit and skin smear examination is an important laboratory test which was made optional in the NLEP. In a laboratory managed by LEPRA Society, this test was provided to voluntary reporting cases and those referred by the general health service institutions of the area. Total cases tested were 1180, out of which 152 (12.

Response of thickened nerve trunks and skin lesions of leprosy patients to MDT.

This paper indicates the responses of thickened nerve trunks in leprosy patients to MDT. Out of 1625 cases, 557 (34.2%) cases had thickened nerve trunks at the time of registration.

A review of trends in new case-detection in Subarnapur district of Orissa.

Trends in new case-detection are analysed by reviewing the demographic and leprosy epidemiological data and current indicators in Subarnapur district, Orissa State and India. Population-specific new case-detection rates were calculated for analysis. The trend of skin-smear positive cases over a period of 10 years was reviewed in respect of smear positive cases of 1991.

Reaction cases treated at the Regional Leprosy Training and Research Institute, Aska, Orissa: a retrospective analysis.

This study is a retrospective analysis of 147 cases of leprosy reaction selected out of 942 cases of leprosy registered between 1992 and 2002 at the RLTRI, Aska (Orissa). The occurrence of reaction was about 16% with a slight increase over the years. There was a preponderance of males, with about 80% cases among males, and the peak occurrence of reaction was found in the age-group of 21-49 years.

Neural pathology in leprosy during treatment and surveillance.

The histological findings of 22 patients with neuritis, 14 developing pain, tenderness and swelling during treatment and 8 during surveillance are presented in this study. Seven patients' biopsies showed macrophage type and 14 had epithelioid cell type of granulomas. All biopsies showed evidence of active disease, except for two patients with macrophage granulomas where some regressive changes were evident.

Practical problems in the management of leprosy.

The categorization of leprosy into paucibacillary or multibacillary depends on the report of slit-skin smears. Unfortunately, in many control programmes the quality of slit smears is below par. Taking the example of India, the main reasons were that the work of laboratory technicians was unrewarding as compared to serving in a general health care system.

Cellularity of macrophage granuloma and morphological index.

In the present study, morphological index (MI) and average macrophage count per microscopic field in skin sections of 94 lepromatous (LL) patients is correlated. The subjects included 14 cases with some histoid features. The MI in the lepromatous cases varied from less than one to 40 and the corresponding macrophage counts ranged from 40 to 156.

Non acid-fast fluorescent M. leprae (?) in skin smears from leprosy patients.

Smears from 74 known smear negative cases of leprosy were examined after staining with Auramine 'O'. 40.54% cases were positive for fluorescent bacilli.

Ambiguities in leprosy histopathology.

This paper presents the percentage of definite or suggestive evidence present in 482 biopsies from different types of leprosy. The presence of acid-fast bacilli (AFB) and nerve involvement were taken as definite features for a diagnosis of leprosy, and infiltration of the dermal appendages, neurovascular bundles and dermis by granuloma cells and lymphocytes were regarded as suggestive signs of leprosy. Using these criteria, all cases were categorized into three groups having definite, suggestive, or no signs of leprosy.

BI of patient vs BI of individual sites.

An analysis of 200 skin smear results from multibacillary patients showed that the average bacteriological index (BI) of a patient varied considerably from his site-wise highest BI. The average BI was equal to site wise highest BI only in 17.5% of cases and in the rest, it ranged from 99% to as low as 36% of the highest site-wise BI.