Leprosy is a complex infectious diseases cause by Mycobacterium Leprae. As the nation is passing through the eradication phase of leprosy, reports are suggesting a change in epidemiology and symptomatology of the disease. Current therapeutic strategies like multidrug therapy (MDT) although effective in treating the majority of cases but not sufficient to eradicate still the new leprosy cases alone and with the complication of diseases like deformities, relapses, and recurrence of cases are occurring in the society. For eradication, there is a requirement of modification of current treatment strategies. The current management of patients affected with leprosy is insufficient to prevent nerve disabilities and control relapses, reactions, and recurrences. The need for newer anti-leprosy agents has been felt for a complete cure without complications and deformities. Various agents like fluoroquinolones (FQs), macrolides, and minocycline have also been tried in various combinations and duration. We reviewed the various issues related to treatment, drug resistance, and the possible steps of complete eradication of this stigmatized disease from the world. While alternative chemotherapy or supplemental immune therapies that would offer shorter or easier treatment regimens appear to be feasible, only a small number of trials are performed. More proactive strategies appear necessary in the drive for eradication. This article also reviews the addition of an immunotherapeutic strategy against leprosy.

Introduction: Central nervous system (CNS) manifestations in children with rickettsial diseases are increasingly being reported from various parts of India but still rickettsial disease, as a cause of central nervous system (CNS) infections are underdiagnosed because of lack of freely available rapid and cheap diagnostic tests and varied clinical spectrum of rickettsial fever. Objective: To report CNS manifestations in probable cases of rickettsial diseases so as to increase awareness amongst pediatricians. Materials and Methods: A retrospective analysis of children (birth to 18 years) hospitalized in Bapuji Child Health Institute, which is secondary referral centre catering to children from five districts of Karnataka, with diagnosis of rickettsial disease from January 2016 to December 2018. The diagnosis of rickettsial infections was made by scoring system proposed by Rathi Goodman Aghai (RGA), weil felix test, prompt response to doxycycline within 48 hours and exclusion of differential diagnoses. Results: Out of 278 patients, who were diagnosed as probable case of rickettsia, 172 patients had neurological involvement. Out of 172 patients with diagnosis of rickettsial disease having symptomatic neurological involvement, 148 (86%) had neurological manifestation as the main presenting feature while remaining presented with non-neurological manifestations of rickettsial diseases too, along with neurological manifestations. The youngest patient was 3 month old infant. The various neurological manifestations seen were altered mental status (76%), irritability (61%), headache (48%), meningeal signs (32%), seizures (31%), papilloedema (26%), focal neurological deficits (18%), cerebrospinal fluid (CSF) abnormalities (76%) and neuroimaging abnormalities (28%). Conclusions: The myriads of neurological manifestations were seen with varying range of severity. Pediatricians should be aware of neurological manifestations seen in rickettsial infections and should have high index of suspicion for rickettsial diseases in febrile patients having neurological features specially in endemic areas.