Dogra Sunil, Narang Tarun, Khullar Geeti, Kumar Ramesh, Saikia Uma Nahar
Lepr Rev. 2014 Dec;85(4):296-310.
Children are believed to be the most vulnerable group for leprosy and childhood leprosy reflects disease transmission in the community as well as the efficiency of ongoing disease control programmes. Objectives: To study the epidemiological and clinical trends of childhood cases of leprosy at a tertiary care hospital in North India during 2001-2011.
A retrospective study was undertaken analysing the clinic records of children with leprosy less than or equal to 18 years registered at the leprosy clinic of this institute over an 11-year period. Demographic and disease characteristics including age, sex, history of contact, duration of disease, clinical pattern, bacteriological and histopathological parameters, reactions and disabilities were noted from a predesigned format.
A total of 1225 cases of leprosy were registered during this period, of whom 59 (4·81%) were children. The mean age of the patients was 10·06 ± 3·35 years with a male preponderance (3·9: 1). History of close contact with a leprosy case was present in 15 (25·4%) patients. Mean duration of illness before diagnosis was 18·5 months (range: 1-70 months). Borderline tuberculoid (BT) was the commonest clinical 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%), lower extremity in 29 ( 49·2% ), face in 27 ( 45·8%) and trunk in 26 ( 44·1%) patients. A single lesion 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.
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.
儿童被认为是麻风病最脆弱的群体，儿童麻风病反映了社区中的疾病传播以及现行疾病控制项目的成效。目的：研究2001 - 2011年印度北部一家三级护理医院儿童麻风病病例的流行病学和临床趋势。
进行一项回顾性研究，分析该机构麻风病诊所11年间登记的18岁及以下麻风病儿童的临床记录。从预先设计的表格中记录人口统计学和疾病特征，包括年龄、性别、接触史、病程、临床类型、细菌学和组织病理学参数、反应及残疾情况。
在此期间共登记了1225例麻风病病例，其中59例（4.81%）为儿童。患者的平均年龄为10.06 ± 3.35岁，男性居多（3.9:1）。15例（25.4%）患者有与麻风病病例密切接触史。诊断前的平均病程为18.5个月（范围：1 - 70个月）。40例儿童（67.8%）中最常见的临床类型为界线类偏结核型（BT），其次为瘤型（LL）7例（11.9%）、界线类偏瘤型（BL）6例（10.1%）、纯神经炎型（PNL）2例（3.4%），结核样型（TT）、中间界线类（BB）、组织样型和未定类麻风各1例（1.7%）。32例（54.2%）患者的皮损位于上肢，29例（49.2%）位于下肢，27例（45.8%）位于面部，26例（44.1%）位于躯干。23例（39%）儿童观察到单个皮损，12例（20.3%）有2 - 5个皮损，22例（37.3%）有超过5个皮损。17例（28.8%）患者的皮肤涂片阳性。20例患者（33.9%）观察到麻风反应，其中14例（70%）为1型，6例（30%）为2型麻风反应。48例（81.4%）儿童有周围神经干增粗，其中27例（56.3%）有不止一条增粗神经且21例（43.7%）仅累及一条神经。9例（15.3%）发生神经炎，诊断时24例（40.7%）患者有残疾（1级和2级）。6例（10.2%）儿童未坚持治疗。观察到3例（5.1%）复发。
在印度，儿童麻风病病例及其并发症的数量仍然惊人，这表明在旨在消除麻风病的国家项目中可能存在差距。我们强调，在整个社区持续不断地努力进行早期病例检测非常重要，在麻风病消除后的时代，对麻风病病例家庭接触者中的易感儿童进行密切随访也很重要。
