Clinico-epidemiological study of untreated multibacillary leprosy patients visiting a tertiary care hospital in Madurai

India had attained elimination of leprosy as public health problem at the national level in December 2005. Despite this, there has been an increasing occurrence of new multibacillary (MB) cases of leprosy at several centres and areas. This study was undertaken to assess the clinical and epidemiological parameters of such cases as these are considered to be much more important because of their known higher infectivity and morbidity. A total of 61,080 new outpatients attended the Dermatology Department in a Tertiary Care centre in Madurai for a period of one year (August 2015 to July 2016). There were 172 leprosy patients undergoing treatment in this period and of these 97 were newly detected cases of leprosy. Of the 97 new patients, 67 (69%) patients were found to have multibacillary (MB) leprosy whereas remaining 30 were of paucibacillary (PB) type. These newly diagnosed were investigated for clinical profile, AFB positivity and epidemiological parameters. It was found that borderline tuberculoid (BT) cases were the majority with 41 patients (61.1%) followed by 12 patients (17.9%) with lepromatous leprosy and 7 patients (10.4%) BL types respectively. Other borderline groups were comparatively small. 25/67 (37.3%) were in reaction of which 23 (34.3%) and two (2.9%) had type 1 and type 2 reactions respectively. It was observed that the incidence of disabilities was very high (overall=35/67, 52.2%; 11.9% Grade 2 with one child also having Grade 2 disability) in our study population. About 41.8% of these patients were also smear positive. All these characteristics indicate delayed diagnosis. Of these 49 (73.1%) were residents of Madurai district. Further some patients from Dindigul, Virudhunagar, Sivaganga, Tirunveli and Thoothikudi were also there in the study group suggesting the need to improve the access and confidence in the services in these areas. Among the study population, 13.4% of patients had household contact suffering from leprosy in the family. Of the four children in our study three had traceable history of household contact with leprosy. Also a new untreated case of multibacillary leprosy was detected among the contacts during their screening. The possibility of undetected or untreated leprosy patients among the contacts or community emphasises the need of proper and periodic contact screening/ periodic surveys to detect especially in the post elimination era. Community level studies in these geographical areas appear necessary.