印度德里一家三级护理医院的儿童麻风病：消除后时代的重新评估

Childhood leprosy in a tertiary-care hospital in Delhi, India: a reappraisal in the post-elimination era.

作者信息

Singal Archana, Sonthalia Sidharth, Pandhi Deepika

机构信息

University College of Medical Sciences & GTB Hospital, (University of Delhi), Dilshad Garden, Delhi-110095, India.

出版信息

Lepr Rev. 2011 Sep;82(3):259-69.

PMID:22125934

Abstract

OBJECTIVE

To assess the profile and describe the clinical presentations, clinico-histopathological profile, complications and treatment compliance of childhood leprosy at a tertiary care hospital in north-east district of Delhi during 2000-2009.

DESIGN

A retrospective institutional study of children less than 14 years of age diagnosed with leprosy and registered in a leprosy clinic during 2000-2009. Demographic, clinical, investigative and treatment data was extracted from a pre-designed proforma.

RESULTS

A total of 1790 cases of leprosy were registered during this period, of which 172 (9.6%) were children. The majority of patients (70.3%) were more than 11 years of age with a male preponderance. History of contact was present in 25 (14.5%) patients. Borderline tuberculoid (BT) was the commonest clinical type (70.3%) followed by tuberculoid (TT) seen in 5.8%, mid-borderline (BB) in 1.2%, borderline lepromatous (BL) in 9.9%, lepromatous (LL) in 4.1%, pure neural (PNL) in 4.6% and indeterminate in 4.1% cases. More than half (52.9%) patients had a single lesion. Nerve thickening was detected in 70% cases. Slit skin smears were positive in 34 (19.8%) patients. Eighty-nine (51.7%) children were classified as multibacillary (MB) and 83 (48.3%) as paucibacillary (PB) disease by NLEP criteria. Of the available biopsy records, clinico-histological correlation was observed in 130/151 (86.1%) patients. Lepra reactions were observed in 32 patients (18.6%), Type I in 29 cases and Type II in three cases. Neuritis occurred in 11 (6.4%) and deformities in 22 (12.8%) patients. Thirty-four (19-8%) children defaulted from treatment. Two patients relapsed.

CONCLUSIONS

Despite the statistical elimination of leprosy in this region, childhood leprosy cases continue to present in alarming numbers. Our study confirmed that multibacillary disease and the complications of lepra reactions and deformities remain common in children. Early detection, treatment and contact tracing may be important reducing the burden of leprosy in the community. There is a need to continue leprosy control activities with full vigour even in areas where, statistically, it has been eliminated.

摘要

目的

评估2000 - 2009年期间德里东北部一家三级护理医院儿童麻风病的概况，描述其临床表现、临床组织病理学特征、并发症及治疗依从性。

设计

一项对2000 - 2009年期间在麻风病诊所确诊并登记的14岁以下麻风病患儿的回顾性机构研究。从预先设计的表格中提取人口统计学、临床、检查及治疗数据。

结果

在此期间共登记了1790例麻风病病例，其中172例（9.6%）为儿童。大多数患者（70.3%）年龄超过11岁，男性居多。25例（14.5%）患者有接触史。边缘结核样型（BT）是最常见的临床类型（70.3%），其次是结核样型（TT）占5.8%，中间界限类（BB）占1.2%，界限类偏瘤型（BL）占9.9%，瘤型（LL）占4.1%，纯神经炎型（PNL）占4.6%，未定类占4.1%。超过一半（52.9%）的患者有单个皮损。70%的病例检测到神经粗大。34例（19.8%）患者的皮肤涂片呈阳性。根据全国麻风病防治规划（NLEP）标准，89例（51.7%）儿童被归类为多菌型（MB）麻风病，83例（48.3%）为少菌型（PB）麻风病。在现有的活检记录中，130/151例（86.1%）患者观察到临床组织学相关性。32例患者（18.6%）出现麻风反应，其中I型29例，II型3例。11例（6.4%）患者发生神经炎，22例（12.8%）患者出现畸形。34例（19.8%）儿童治疗中断。2例患者复发。