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Clinical, bacteriological, and

histopathological characteristics of
children with leprosy : A retrospective,
analytical study in dermatology outpatient
departement of tertiary care centre

Perceptor : dr. Resati Nando Panonsih Sp.KK
Penyaji : Arum mananti pradita
Robertus dery elvantora

Background Leprosy is a major public – health problem in developing countries. According to National Leprosy Elimination Program report of March 2012. Studies pertaining to propotion and characteristics of pediatric cases are few in number .13 million cases in India.7% of which were children. there were a total of about 0. 9.

bacteriological and histopathological characteristics of pediatric leprosy cases in community .Aim The aim of the following study is to examine clinical.

bacteriological and histopathological characteristics of childhood leprosy. . It was a retrospective.Methods This study is aimed at outlining the clinical. analytical study of pediatric patients seen from 01 January 2009 to 30 June 2013 in dermatology out-patient department of a tertiary care center.

02% of the Dominican Republic’s and 0. The crucial role of frequency of leprosy in children as an indicator of the level of transmission in the community has been acknowledged. Children are believed to be the most vulnerable group to Mycobacterium leprae infection and clinical manifestation is often seen in adolescence or young adulthood following the long incubation period. Within America. South-East Asia. In the year 2007.Introduction Leprosy has been a major public-health problem in many developing countries for centuries.34% compared to 14. .1% in Timor-Leste. on the other hand showed a narrower range with Nepal reporting 3. in Africa.96% in the Comoros. The World Health Organization (WHO) found a wide variation in the proportion of children amongst newly detected cases in different regions.89% in Togo to 37.32% of Argentina’s new leprosy cases were children. this proportion ranged from 2. 14.

most of the cases were multibacillary (MB) (95. . one case had deformity (grade 2) and 8.7%) showed features of borderline tuberculoid. The age of the child hood cases detected during this study ranged from 3 to 12 years.33.8%).Results A total of the 262 new cases were detected during the study out of which 24 (9. Overall. 1 (9%) each of borderline lepromatous. 8 (72. Overall 2 patients had history of contact.7% of MB cases were smear positive. The mean duration of symptoms was reported to be about 16. Study yielded 24 peditric cases of leprosy. A large proportion of children (45.25 ± 2.8%) had single skin lesion (SSL) Of the 11 SSL cases examined histopathologically.5 months (range: 1 .48 months).33 years.16%) were children (16 males and 8 females). indeterminate type and tuberculoid leprosy. The mean age was 9. The age of child leprosy cases ranged from 3 to 12 years with mean of 9.25 ± 2.

.9% (9/22) had single skin lesion (SSL) of which 36. only one had a Grade 2 deformity. 40. Among the MB cases.Table 1 : clinical presentations of childhood leprosy Number of skin lesion Single 2-5 >5 Pure neuritic Number of patients 11 (4 on face) 6 7 0 Clinical Findings A majority of the child hood cases in the population were MB (22/24). On examination for the grade of deformity. it was found that 23 children had no deformity. No pure neural case was detected [Table 1].36% (4/11) had lesion on the face. One patient presented with type 2 lepra reaction.

majority showed characteristic features of borderline tuberculoid (BT) leprosy (19/24). of skin lesions 1 2-5 >5 > total Total TT Histopathological classification BT BB BL LL Indeterminate 0 0 0 0 9 5 5 19 11 6 7 24 0 0 0 0 0 1 2 3 0 0 0 0 2 0 0 2 Bacteriological and Histopathological Findings On examination for bacteriological status using SSS. three were borderline leprosy (BL) and 2 indeterminate. it was found that 2 MB cases were smear positive with a BI of >2+ able. Notably.Table 2 : clinical and histopathological classification No. Of the four facial lesions. Both the PB cases were smear negative. Of the 24 children examined histopathologically. tuberculoid leprosy (TT) features were not seen in any biopsy . which were examined histopathologically. three showed features of BT leprosy and one was indeterminate.

Discussion Figure 1 : A 10-year-old child with single hypopigmented lesion on face. Father is a known case of borderline tuberculoid Hansen’s .

Father was a known case of borderline tuberculoid leprosy .Figure 2: An 8-year-old child with a hypopigmented patch over left knee.

36%) leprosy. as assessed by histopathology and none of them were TT leprosy indicating progressive nature of the disease and less likelihood of self-resolution. respectively.This study also found a large proportion of children (45.83%) had SSL and (36.3%).5% (30/48) and 12. which is similar to findings by Kumar et al (58. Similar findings have been documented in an earlier study wherein 62. (66. Jain et al. Single hypopigmented patch on the face in children has high-risk of misdiagnosis.Another finding was. Notably. all the SSL biopsies were proved to be cases of leprosy. majority of cases had BT (86.5% (6/48) of SSL showed cellular characteristic features of BT and borderline leprosy-BL. . since there are numerous common causes of hypopigmented patches in children.3%) and Rao (68%).3%) had it on the face.

That there is a four-fold risk of developing leprosy in presence of a contact in the neighborhood and this risk increases to nine-fold if there is a contact with leprosy patient within the household. . This is a positive sign.2%) had deformity (Grade 2). This study found that only a small proportion of children with leprosy had history of contact with leprosy cases. Only two cases were smear positive which is a positive sign as they also represent a major source of infection. These findings point to the fact that most of these childhood leprosy cases were detected early during the course of the disease. Only one child (4.

bacteriological and histopathological characteristics of cases in children. recent active transmission and highlight implications on individual patients and the community.Conclusion The clinical. . especially the high percentage of MB cases evidently indicate the grave nature of the problem of undetected child leprosy.