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Leprosy in children: a prospective study
1Department of Dermatology and Venereology, Lady Hardinge Medical College, New Delhi, India.
Insights
Pediatric leprosy, a distinct entity, often presents as a hypopigmented macule. Early clinical diagnosis is crucial for effective management of childhood leprosy.
Area of Science:
- Dermatology
- Pediatrics
- Infectious Diseases
Background:
- Leprosy (Hansen's disease) is a significant health concern in children.
- Studying childhood leprosy is vital for understanding disease evolution and incubation periods.
Purpose of the Study:
- To investigate the characteristics and incidence of leprosy in children.
- To highlight the diagnostic challenges and clinical presentations of pediatric leprosy.
Main Methods:
- Retrospective analysis of 161 pediatric leprosy cases (0-14 years) from 1981-1991.
- Diagnosis based on clinical features, slit-skin smears, and histopathology.
- Disease duration elicited via complement recall method.
Main Results:
- Incidence of 5.06% in an urban pediatric leprosy cohort; male predominance (2.6:1).
- Typical lesion: hypopigmented macule; paucibacillary leprosy mean duration 1.2 years, multibacillary 2.8 years.
- Intra/extrafamilial contact in 8.7%; severe forms uncommon.
Conclusions:
- Childhood leprosy is a distinct clinical entity.
- Hypopigmented macules in children warrant suspicion for leprosy.
- Clinical diagnosis is primary; ancillary tests support but do not replace clinical judgment.
Background:
Leprosy has been identified as an important health problem in the pediatric age group. The study of leprosy in children is imperative as it may unravel the missing links in the natural evolution of the disease and dispel the uncertainty of the precise incubation period.
Methods:
The study was undertaken on patients attending the Urban Leprosy Centre. There were 161 children in the age group of 0 to 14 years, amongst 3184 cases of leprosy, detected between 1981 and 1991. The diagnosis in each was formed after meticulously recording the clinical features, slit-skin smear examination, and histopathologic characteristics. In addition, a detailed history of duration of the disease was elicited by complement recall method.
Results:
The study revealed an incidence of 5.06% amongst leprosy patients, in an urban setting. The boys:girls ratio was 2.6:1. The mean duration of the disease was 1.2 years in paucibacillary and 2.8 years in multibacillary. History of intra- or extrafamilial contact was elicited in 8.7%. The typical lesion was a "hypopigmented macule," either of indeterminate, tuberculoid, borderline tuberculoid, or borderline borderline leprosy. Borderline lepromatous, lepromatous, and polyneuritic leprosy were uncommon.
Conclusions:
Leprosy in children is a well-established distinct entity. Any hypopigmented macule in pediatric age group should arouse suspicion of leprosy. The diagnosis is clinical. Other investigative parameters, namely slit-skin smear, and histopathology may supplement but not supplant the diagnosis.