Childhood leprosy - still a problem in the era of elimination!
Background: In the era of leprosy elimination, childhood leprosy is a surrogate marker of recent transmission of the disease and reflects the efficacy of the control program The objective of the present work was to study clinical profile of childhood cases of leprosy presenting at a tertiary care hospital in Northern India, in the decade after its elimination.
Methods & Materials: A retrospective analysis of 5-year data retrieved from case records of patients younger than 18 years registered in the leprosy clinic at a tertiary care hospital in Northern India was undertaken. Demographic (age, sex) and disease characteristics (history of contact, duration of disease, type of leprosy, bacteriological status, and presence of reactions and disabilities) were noted.
Results: Of the 1926 cases registered in leprosy clinic, 124 (6.4%) werechildren withmeanage of 14.7 + 1.7 years and with a male preponderance (3·9:1).Ahistory of contact with leprosy was present in 13 (10.5%). Mean duration of illness before diagnosis was 28.3 + 6.1 months. Based on clinicohistological and bacteriological parameters, borderline tuberculoid leprosy was the commonest clinical type of leprosy (43.5%) followed by borderline lepromatous (23.4%) and then other types. There were no patients with histoid or indeterminate leprosy. Slit skin smear was positive in 14 (11.3%) and lepra reactions were observed in 28 (22.6%) patients with 14 (11.3%) children each with type 1 and 2 reactions. Grade 1 disability was noted in 4% and grade 2 in 35.5% children.
Conclusion: Despite elimination, children (and a third of them with deformities) continue to present in alarming numbers in India, indicating recent transmission and importantly gaps in the national program aimed at leprosy elimination. This data also emphasisizes the need for early detection of childhood cases through proactive methods to prevent development of deformities.