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首页> 外文期刊>Leprosy review >Childhood leprosy through the post-leprosy-elimination era: a retrospective analysis of epidemiological and clinical characteristics of disease over eleven years from a tertiary care hospital in North India
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Childhood leprosy through the post-leprosy-elimination era: a retrospective analysis of epidemiological and clinical characteristics of disease over eleven years from a tertiary care hospital in North India

机译：麻风后消除时代的儿童麻风病：对印度北部一家三级医院十一年来疾病流行病学和临床特征的回顾性分析

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Background: Children are believed to be the most vulnerable group for leprosyand childhood leprosy reflects disease transmission in the community as well as theefficiency of ongoing disease control programmes.Objectives: To study the epidemiological and clinical trends of childhood cases ofleprosy at a tertiary care hospital in North India during 2001–2011.Methods: A retrospective study was undertaken analysing the clinic records ofchildren with leprosy less than or equal to 18 years registered at the leprosy clinicof this institute over an 11- year period. Demographic and disease characteristicsincluding age, sex, history of contact, duration of disease, clinical pattern,bacteriological and histopathological parameters, reactions and disabilities werenoted from a predesigned format.Results: A total of 1225 cases of leprosy were registered during this period, ofwhom 59 (4·81%) were children. The mean age of the patients was 10·06 ^ 3·35years with a male preponderance (3·9:1). History of close contact with a leprosy casewas present in 15 (25·4%) patients. Mean duration of illness before diagnosis was18·5 months (range: 1–70 months). Borderline tuberculoid (BT) was the commonestclinical type in 40 children (67·8%), followed by lepromatous (LL) in 7 (11·9%),borderline lepromatous (BL) in 6 (10·1%), pure neuritic (PNL) in 2 (3·4%),tuberculoid (TT), mid-borderline (BB), histoid and indeterminate leprosy in 1 patient(1·7%) each. Lesions were located over upper extremity in 32 (54·2%), lowerextremity in 29 (49·2%), face in 27 (45·8%) and trunk in 26 (44·1%) patients. A singlelesion was observed in 23 (39%), 2–5 lesions in 12 (20·3%) and more than five lesions in 22 (37·3%) children. The slit skin smear was positive in 17 (28·8%) patients. Lepra reactions were observed in 20 patients (33·9%), of whom 14 (70%) had Type 1, and six (30%) had Type 2 lepra reaction. Thickened peripheral nerve trunks were present in 48 (81·4%) children, of which, 27 (56·3%) had more than one thickened nerve and 21 (43·7%) had only a single nerve involved. Neuritis occurred in 9 (15·3%) and disability (both grade 1 and 2) at the time of diagnosis was noted in 24 (40·7%) patients. Six (10·2%) children defaulted from treatment. Three cases (5·1%) of relapse were observed. Conclusions: Childhood leprosy cases and their complications continue to present in alarming numbers in India and this suggests possible gaps in the national programmes aimed at leprosy elimination. We stress the importance of continuous and sustained efforts for early case detection in the community in general, and close follow-up of susceptible children amongst household contacts of leprosy cases in the post-leprosy-elimination era.
机译：背景：儿童被认为是麻风病最易受伤害的人群，儿童麻风病反映了社区的疾病传播以及正在进行的疾病控制计划的有效性。目的：研究位于麻省三级医院的儿童麻风病的流行病学和临床趋势方法：对印度北部在2001年至2011年期间进行的一项回顾性研究，分析了该机构11年内在麻风病诊所登记的18岁以下麻风病儿童的临床记录。通过预先设计的格式记录了人口统计学和疾病特征，包括年龄，性别，接触史，疾病持续时间，临床模式，细菌学和组织病理学参数，反应和残疾。结果：在此期间，共登记了1225例麻风病患者，其中59例（4·81％）是孩子。患者的平均年龄为10·06 ^ 3·35岁，男性占优势（3·9：1）。 15名（25·4％）患者有与麻风病患者密切接触的历史。诊断前平均病程为18·5个月（范围：1-70个月）。交界性结核（BT）是40例儿童（67·8％）的普通临床类型，其次是7例（11·9％）的麻风病（LL），6例（10·1％）的边界麻风病（BL），纯神经炎（PNL）2例（3·4％），结核样（TT），中边界线（BB），组蛋白和不确定性麻风病各1例（1·7％）。病变位于上肢以上32例（54·2％），下肢29例（49·2％），面部27例（45·8％）和躯干26例（44·1％）。在23个（39％）儿童中观察到单个病变，在12个（20·3％）儿童中观察到2–5个病变，在22个（37·3％）儿童中观察到五个以上的病变。缝隙皮肤涂片阳性17例（28·8％）。在20例患者中观察到Lepra反应（33·9％），其中14例（70％）为1型，6例（30％）为2型Lepra反应。 48名（81·4％）儿童出现周围神经干增粗，其中27名（56·3％）多于一根粗大神经，21名（43·7％）仅涉及一根神经。神经炎发生在9位（15·3％），诊断时出现残疾（1级和2级）的患者有24位（40·7％）。六名（10·2％）儿童没有接受治疗。观察到3例复发（5·1％）。结论：在印度，儿童麻风病及其并发症继续以令人震惊的数字呈现，这表明在旨在消除麻风病的国家计划中可能存在差距。我们强调了在整个社区中为早期发现病例而持续和持续努力的重要性，并且在消除麻风后的时代中，在麻风病例的家庭接触者中密切跟踪易感儿童的重要性。

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