Division of Dermatology, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa; Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2021 Sep 2;111(9):879-885.
The World Health Organization announced a strategy to eliminate childhood leprosy infections, visible deformities and discriminatory legislation against leprosy patients by 2020. However, challenges in achieving a leprosy-free world and preventing neurological sequelae still exist. HIV infection is a challenge in South Africa (SA). HIV-leprosy co-infection may result in an increase in the frequency of leprosy reactions without affecting the spectrum of leprosy. From 1921 to 1997, the prevalence of leprosy remained <1 patient per 10 000 population. Current SA literature has very scanty information regarding leprosy infections.
To describe the trend of new leprosy patients at Chris Hani Baragwanath Academic Hospital, Johannesburg, SA, from 1999 to 2015, including demographics, clinical spectrum and treatment outcomes.
A retrospective review of patients' clinical records was undertaken. Data on demographics, clinical spectrum including the leprosy classification, reactions, neurological involvement, association with HIV infection and treatment outcomes were extracted. Data analysis was performed using descriptive and inferential statistics and a time series analysis.
An upward trend from 1999 to 2001 was followed by a decline in the number of new patients. Eighty patients were registered over a period of 17 years, with a male-to-female ratio of 3:1. Thirty-six patients were immigrants, and 5 were children aged <15 years. Multibacillary leprosy was the most common type (n=71 patients). Thirty-six patients had the lepromatous leprosy subtype, 22 were borderline lepromatous, 13 were borderline tuberculoid, 6 were borderline borderline, and 3 had tuberculoid leprosy. Thirty-one patients presented with reactions, type 1 in 9 patients and type 2 in 21 patients, with both types in 1 patient. Grade 2 neurological deformities were diagnosed in 37 patients, of whom 2 were children. Eight patients were found to have HIV-leprosy co-infection. Of 52 patients who completed treatment, 26 were cured and 26 were lost to follow-up. Twenty-one patients defaulted from treatment, while 3 patients relapsed.
This study highlights the current status of leprosy in a low-endemic centre with declining numbers of new patients. Multibacillary forms with grade 2 disabilities (G2Ds) are common. The constant emergence of leprosy in our population highlights shortfalls in our control campaigns. Furthermore, a high rate of G2Ds necessitates scrutiny of education directed at early patient detection and follow-up strategies.
世界卫生组织宣布了一项战略，旨在到 2020 年消除儿童麻风病感染、可见畸形和针对麻风病患者的歧视性立法。然而，在实现无麻风世界和预防神经后遗症方面仍然存在挑战。在南非（SA），艾滋病毒感染是一个挑战。HIV-麻风病合并感染可能导致麻风病反应的频率增加，而不影响麻风病的光谱。从 1921 年到 1997 年，麻风病的患病率一直<每 10000 人口 1 例。目前南非的文献中关于麻风病感染的信息非常稀少。
描述 1999 年至 2015 年在约翰内斯堡克里斯·哈尼·巴哈格万萨医院（Chris Hani Baragwanath Academic Hospital）新麻风病患者的趋势，包括人口统计学、临床谱和治疗结果。
对患者临床记录进行回顾性分析。提取人口统计学、临床谱（包括麻风病分类、反应、神经受累、与 HIV 感染的关联以及治疗结果）的数据。使用描述性和推断性统计以及时间序列分析进行数据分析。
从 1999 年到 2001 年呈上升趋势，随后新患者数量下降。17 年来共登记了 80 名患者，男女比例为 3:1。36 名患者为移民，5 名为年龄<15 岁的儿童。多菌型麻风病是最常见的类型（n=71 例）。36 例患者为瘤型麻风，22 例为边界型瘤型，13 例为边界型结核样，6 例为边界型边界型，3 例为结核样麻风病。31 例患者出现反应，9 例为 1 型，21 例为 2 型，1 例为 1 型和 2 型。诊断为 2 级神经畸形 37 例，其中 2 例为儿童。发现 8 例 HIV-麻风病合并感染。52 例完成治疗的患者中，26 例治愈，26 例失访。21 例患者停药，3 例复发。
本研究强调了低流行中心的麻风病现状，新患者人数呈下降趋势。常见多菌型伴有 2 级残疾（G2D）。我们人群中麻风病的不断出现凸显了我们控制运动中的不足。此外，高比例的 G2D 需要仔细审查针对早期患者发现和后续策略的教育。
