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Childhood leprosy: a retrospective descriptive study from Government Medical College, Kozhikode, Kerala, India
Insights
Childhood leprosy remains a concern, with a significant rise in multibacillary (MB) cases and a high relapse rate, suggesting delayed diagnosis and inadequate treatment in children under 15.
Area of Science:
- Pediatrics
- Dermatology
- Infectious Diseases
Background:
- Childhood leprosy represents a significant portion of new leprosy cases.
- Understanding the epidemiological and clinical characteristics of childhood leprosy is crucial for effective control strategies.
Purpose of the Study:
- To analyze the profile, clinical presentations, and complications of childhood leprosy.
- To investigate changes in age-sex distribution and clinical patterns over a decade.
- To assess treatment outcomes and relapse rates in pediatric leprosy patients.
Main Methods:
- Retrospective descriptive study of children (<15 years) diagnosed with leprosy from 2003-2012.
- Data collection included demographics, clinical details, investigations, and treatment records.
- Statistical analysis to identify trends and significant changes over the study period.
Main Results:
- 138 (12.1%) of 1143 leprosy cases were in children under 15.
- Borderline tuberculoid (BT) was the most common type (65.9%).
- A significant increase in multibacillary (MB) leprosy and a decline in paucibacillary (PB) leprosy were observed.
- A high relapse rate of 7.2% was noted, with a female predilection in adolescent relapses.
Conclusions:
- Childhood leprosy indicates ongoing horizontal transmission.
- Increased MB cases and high relapse rates suggest delayed diagnosis and inadequate treatment.
- Incorrect classification of MB as PB leprosy may lead to treatment failure.
Objective:
To assess the profile and describe the clinical presentations and complications of childhood leprosy in a tertiary care hospital in North Kerala, South India during 2003-2012 and to analyse any change in the age-sex profile and the clinical pattern of leprosy in children below the age of 15 years over the 10-year study period.
Design:
A retrospective descriptive study of children less than 15 years of age diagnosed with leprosy and registered for treatment in a tertiary care institution from 2003 to 2012. Demographic, clinical, investigative and treatment data were collected using a pre-set proforma.
Results:
138 (12.1%) of the total 1143 leprosy cases registered for treatment during the 10-year period were below 15 years of age. The 10-year study period witnessed a statistically insignificant decrease in the new childhood leprosy cases registered for treatment in our tertiary care institution. The majority of cases belonged to the 6-12 year age group (61.6%) with a male predominance. Borderline tuberculoid (BT) was the commonest clinical type (65.9%) followed by indeterminate leprosy (18.8%); 101 patients required paucibacillary (PB) and 37 needed multibacillary (MB) treatment. The number of patients requiring MB treatment showed a statistically significant increase and there was a significant decline in number of cases requiring PB treatment. During the entire study period no Type 2 lepra reaction was documented in patients below Hema 15 years and only two patients manifested Type 1 reaction. Ten (7.2%) out of the 138 patients were cases of relapse. There was a clear female predilection among relapse cases with the majority belonging to the adolescent age.
Conclusions:
Childhood leprosy still contributes to a significant proportion of the total case load denoting the continuing active horizontal transmission of leprosy. The rise in number of patients with more extensive disease in the background of declining disease prevalence is suggestive of the delay in diagnosis and treatment. A high relapse rate noted in the present study may be due to incorrect classification and treatment of MB as PB leprosy which in turn might have resulted in treatment failure due to inadequate treatment.