|Year : 2020 | Volume
| Issue : 1 | Page : 66-69
A case series of pediatric leprosy
Deepika Uikey1, Rima Joshi2, Nikhil Verma3
1 Departments of Dermatology, Venereology and Leprosy, ESIC Medical College and Hospital, Faridabad, Haryana, India
2 Department of Dermatology, Venereology and Leprosy, B. J. Medical College, Civil Hospital, Ahmedabad, Gujarat, India
3 Department of Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
|Date of Submission||12-Oct-2018|
|Date of Decision||27-Dec-2018|
|Date of Acceptance||14-Jul-2019|
|Date of Web Publication||24-Dec-2019|
Dr Nikhil Verma
House No 203-D Block, ESIC Medical College and Hospital Campus, NIT 3, Faridabad - 121 001, Haryana
Source of Support: None, Conflict of Interest: None
Children are believed to be the most vulnerable group to most of the infectious diseases and similar is the case with Mycobacterium leprae infection owing to their weak immunity. Leprosy in children carries an epidemiological significance and can be considered an index of the prevalence of disease. We aim to know the incidence, duration, spectrum, reactions, and deformities in childhood leprosy through this study. Out of the total of 300 leprosy patients, 4% (12) patients belonged to the pediatric age group (<14 yeas) and 288 (96%) patients were adolescent/adults. Family history was present in 25% of the children with leprosy and only 2.47% adults with leprosy. Tuberculoid and borderline tuberculoid were the most common among pediatric patients. Indeterminate leprosy was specifically seen among children. Majority of the pediatric patients were paucibacillary (58.33%). In pediatric patients, two cases of both type 1 and type 2 reactions were seen. Deformities (Claw hand) were seen in 2 (16.67%) children. Leprosy occurs in children in substantial proportion, thus, adequate specific measures should be taken for children in leprosy control.
Keywords: Child, deformities, leprosy
|How to cite this article:|
Uikey D, Joshi R, Verma N. A case series of pediatric leprosy. Indian J Paediatr Dermatol 2020;21:66-9
| Introduction|| |
Leprosy is a chronic disease caused by Mycobacterium leprae, affecting the peripheral nervous system, skin, and certain other tissues. It has been a major public health problem in many developing countries for a long time. Children are believed to be the most vulnerable group to most of the infectious diseases and similar is the case with M. leprae infection owing to their weak immunity. Leprosy in children carries an epidemiological significance and can be considered an index of the prevalence of disease. It forms an important link in the study of a natural evolution of disease from children to adults. It is rare under 2 years of age., It is often unrecognized, and 75% of cases regress spontaneously without any treatment.
In this study, we aim to report the cases of pediatric leprosy. New cases of leprosy were included in the study. The patients were classified as per the World Health Organization (WHO) guidelines into paucibacillary (PB)/multibacillary (MB) cases for treatment purpose and treatment was provided accordingly. Written and informed consent was obtained from every patient. Since no treatment modification was done, ethical committee clearance was not taken. The data were entered into MS Excel spreadsheet and categorical variables were presented in number and percentage (%).
| Results|| |
Out of the total of 300 leprosy patients, 4% (12) patients belonged to the pediatric age group (<14 years) and the male-to-female ratio was 3:1 in children [Table 1].
Family history was present in 25% of the children with leprosy.
The clinical profile of the children leprosy patients has been shown in [Table 2]. Tuberculoid and borderline tuberculoid (BT) [Figure 1] were the most common among pediatric patients with few cases of indeterminate leprosy [Figure 2].
Majority of the pediatric patients were PB 7 (58.33%) and 5 (41.67%) had MB leprosy according to the WHO classification.
Eleven children had a history of such symptoms for less than a year and one child showed to the clinic after 3 years of symptoms.
In pediatric patients, two cases of both type one and type two reactions were seen. No cases of relapse were seen in children. Deformities were seen in two (16.67%) children [Table 3].
No deformity except claw hand (one child) [Figure 3] was noticed in children. The grades of deformities have been shown in [Table 4]. Ear involvement was seen in one child [Figure 4].
| Discussion|| |
We report an incidence of 4% children affected by leprosy in our study. The study was done in a hospital at Ahmedabad (Gujarat) and may not reflect the status of childhood leprosy in the community, but still caters to the majority of the surrounding areas in Gujarat. Since the beginning and reporting of this study, the incidence rates have fluctuated. In 2011, three countries made up 83% of the new cases detected worldwide, with India responsible for 58% of the cases, Brazil for 16%, and Indonesia for 9%. In 2014, 58.8% of worldwide new cases were from India. Child leprosy globally was 8.8%, and in India, it was 9.04%. A decreasing trend in childhood leprosy may be due to a well-run and long-established program, with increasing immunity in the population. Literature also discusses aspects relating to self-healing in child leprosy. Different states and Union territories in India present different subsets of leprosy cases accounting for the differences in the overall incidence in India and in different studies.
The gender ratio was 3:1 in our study. Literature reports child leprosy M:F from 3.3:1 to 1:1. Sex ratios are uncertain, and the WHO added that in children, there is “no significant difference” in the leprosy prevalence between the sexes.
Contact history was present in 25% of children. It presents as a strong factor in childhood leprosy. Literature reports a four-fold risk of developing leprosy in the presence of a neighborhood contact and nine-fold risk with a household contact. Gitte et al. reported contact history in 44.1% children. In Mahajan et al. study, 25 (29%) patients had a definite history of contact, out of which 23 (92%) were intrafamilial. In Kumaravel et al. study, household contact was 19.6%.
PB cases were comparable to MB cases (7 [58.33%], 5 [41.67%]). Literature does not differ in the distribution. Gitte et al. reports 59.9% PB and 40.1% MB child leprosy cases. In one study, 54 (63%) children had PB and 32 (37%) had MB leprosy. Immunity plays an important role in such distribution. Among familial contacts, the risk of infection increases from 35% to 65% if the index case is suffering from MB leprosy as compared to PB leprosy. Strong focus on contact examination, health surveys in schools, and early self-reporting by families may provide us early access to such children.
Among children, tuberculoid and BT leprosy cases predominated as compared to indeterminate leprosy cases. Mahajan et al. reported BT in 63 (73%) patients as the most common type in children. Kumaravel et al. also reports the most common spectrum in children as BT in 27 cases (58.7%).
The average duration of disease in children before reporting was 1 year. One year of delay in diagnosis shows a lack of awareness and urgency on the part of the parents and the guardians. Setting up of regular health setup and surveys in schools may reduce the duration. Mahajan et al. reported an even higher duration of 1.5 years. Gitte et al. report a mean duration of 13–14 months. This factor may sound insignificant but holds relevance in the leprosy prevalence in India.
Reactions were uncommon in children, with only two cases in our study, which was supported by other studies., No cases of relapse were seen in children. In contrast, Gitte et al. reported that 17.6% of children developed Lepra reaction.
Claw hand was seen in 2 (16.67%) children. No eye complaints were seen in children. Ocular leprosy among children is rare and nonbinding. Mahajan et al. reports 12 (13%) patients with deformity at presentation; with Grade 1 deformity in five and Grade 2 deformities in seven patients. Claw hand was the most common deformity, followed by a trophic ulcer, foot drop, and wrist drop in that order. Deformities and disabilities are uncommon in children, and the high rate of 16.67% in this study compared with the reported prevalence of deformity in India (2·1%) and Delhi (7·1%) could be a referral bias.
In our study, all children completed treatment, but one child was lost to follow-up in 4 months. In another study, only 68% of patients completed treatment within the prescribed time.
Not to underestimate the government contribution, the effectiveness of the control programs holds a scope of improvement. Even though leprosy is a notifiable disease in India; an important factor in official statistics is the proportion of children with leprosy treated by doctors that are not reported.
We thank Dr Ketan Garg for assistance in medical writing and editing.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jopling WH, McDougall AC. Definition, epidemiology and world distribution. Handbook of Leprosy. 5th
ed. New Delhi: CBS Publishers and Distributors; 1996. p. 1.
Noussitou FM, Sansarricq H, Walter J. Leprosy in Children. Geneva: World Health Organization; 1976.
Selvasekar A, Geetha J, Nisha K, Manimozhi N, Jesudasan K, Rao PS. Childhood leprosy in an endemic area. Lepr Rev 1999;70:21-7.
World Health Organization. Weekly epidemiological record Relevé épidémiologique hebdomadaire. Weekly epidemiological record 2012;34:317-28.
Mistry N, Kuruwa S, Pandya S, Minda R, Shetty V. Childhood leprosy revisited. Pediatr Oncall 2016;13:57.
Mahajan S, Sardana K, Bhushan P, Koranne RV, Mendiratta V. A study of leprosy in children, from a tertiary pediatric hospital in India. Lepr Rev 2006;77:160-2.
Kumaravel S, Murugan S, Fathima S, Anandan H. Clinical presentation and histopathology of childhood leprosy. Int J Sci Stud 2017;4:167-9.
Sehgal VN, Srivastava G. Leprosy in children. Int J Dermatol 1987;26:557-66.
Kaur I, Kaur S, Sharma VK, Kumar B. Childhood leprosy in Northern India. Pediatr Dermatol 1991;8:21-4.
Gitte SV, Sabat RN, Kamble KM. Childhood leprosy in an endemic area of central India. Indian Pediatr 2016;53:221-4.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]