Leprosy in Nepal: a re-emerging threat

Houghton, Frank; Winterburn, Michael

doi:10.1057/s41271-020-00260-z

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…In 2018, there were 3249 cases reported, and a significant transmission was notable in the pediatric population. 6 The disease course and spectrum of clinical manifestations are determined by individual cell-mediated immunity of the host, the most severe form is lepromatous leprosy (LL), where the patient has a compromised cell-mediated immunity and tuberculoid leprosy (TL), being the mildest one. 3 Oral-mucosal involvement has been reported in 20%-60% of patients with LL, where tongue, anterior hard palate, lips, and vulva are the most frequently affected sites.…”

Section: Discussionmentioning

confidence: 99%

“…Leprosy is endemic in Nepal. In 2018, there were 3249 cases reported, and a significant transmission was notable in the pediatric population 6 . The disease course and spectrum of clinical manifestations are determined by individual cell‐mediated immunity of the host, the most severe form is lepromatous leprosy (LL), where the patient has a compromised cell‐mediated immunity and tuberculoid leprosy (TL), being the mildest one 3 …”

Section: Discussionmentioning

confidence: 99%

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Borderline tuberculoid leprosy misdiagnosed as Cheilitis Granulomatosa Miescher: A case report

Sitaula

Mishra

Chalise

et al. 2022

Clinical Case Reports

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Macrocheilia, as an initial manifestation of leprosy, is uncommon. We present a case of a 50‐year‐old female, with lower lip swelling, initially diagnosed as Cheilitis Granulomatosa Miescher. Unresponsiveness to local intralesional corticosteroids necessitated further evaluation. Repeat tissue sampling yielded a confirmatory diagnosis of borderline tuberculoid leprosy, which was managed successfully.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Borderline tuberculoid leprosy misdiagnosed as Cheilitis Granulomatosa Miescher: A case report

Sitaula

Mishra

Chalise

et al. 2022

Clinical Case Reports

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“…There was an overall expectation of leprosy being on its way out, an expectation nurtured by radio messages about Nepal having reached 'the leprosy elimination goal.' A message believed by many to mean 'no more leprosy' (see F. Houghton and M. Winterburn, 2020, for a recent article on the subject).…”

Section: In 2009 and 2010mentioning

confidence: 99%

Health Seeking Processes of Leprosy Patients in a Hill District of Nepal

Engelbrektsson¹,

Subedi

2021

AMC J.

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To shorten delays in leprosy diagnosis, health-seeking processes have to be understood and documented. In 2015, the International Nepal Fellowship launched a three-year research project on the subject. One part of the project was a community study in which recent health-seeking efforts were to be studied in the light of earlier ones. The focus of this article is upon insights gained in field research in a village and its immediate surroundings in the district of Jajarkot, western Nepal. The research highlights the importance of a longitudinal, patient-focused study that covers the period from just before the start of leprosy services until late 2018. The research methods include participant observations, narratives, in-depth interviews, and documentary and statistical enquiries. The research shows that the introduction of the Multi Drug Therapy (MDT) in the early 1980s has drastically changed the local leprosy situation. The number of new cases has declined, there are far less impairments and disabilities, and those recognized as affected are no longer excommunicated. However, the delays before diagnosis tend to be long. A lack of leprosy diagnosing skills within the health services sector is one reason. The residents not recognizing early signs and symptoms is another. An expectation of leprosy endemic in certain kinship groups, and not in others, is yet another. And, for some, so is the fear of social stigma. Moreover, there is the delaying factor of more than one set of beliefs and practices in relation to leprosy:a traditional, mainly magic-religious outlook and approach which co-exists with allopathic (biomedical) views and methods.

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“…17 The treatment period may be prolonged during recurrence, but the adverse neuropathic and teratogenic effects should be noted. 18 The incidence of leprosy has decreased significantly in recent years. As the skin lesions of leprosy are various, only some young dermatologists or non-dermatologists have knowledge of leprosy, which leads to misdiagnosis or missed diagnosis of leprosy in clinical settings.…”

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confidence: 99%

One Case of Tuberculosis-Like Leprosy with a Type I Leprosy Reaction

Li,

Wang,

et al. 2023

CCID

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Leprosy is a chronic infectious disease primarily affecting the skin and peripheral nerves and is caused by Mycobacterium leprae. Although effective control measures have significantly reduced its global incidence in recent years, its insidious onset and diverse skin manifestations pose considerable challenges to early diagnosis, particularly among young medical practitioners. This study reports a case of tuberculoid leprosy accompanied by a type I reaction (T1R) to leprosy, aiming to contribute to the broader understanding and management of the disease. The patient came from a leprosy-endemic region and had a family history of leprosy. They first presented with neuritis, characterised by numbness in the left upper limb, which is an early-stage symptom often overlooked. This case accentuates the importance of comprehensive examination techniques, including bacteriological and histological investigations, ultrasound and magnetic resonance imaging, to identify early nerve damage, which is critical for prompt diagnosis and intervention. According to World Health Organization data, approximately 200,000 new cases of leprosy are reported worldwide each year, with a prevalence rate of 0.2 cases per 10,000 individuals. The disease exhibits two clinical forms based on the host's immune response: tuberculoid leprosy in a well-immunised population and lepromatous leprosy in a poorly immunised host. The patient in this study demonstrated signs of tuberculoid leprosy, marked by isolated skin papules and plaques, and a T1R, a tissuedestructive, immune-driven inflammatory process. This case underscores the need for ongoing education and updated diagnostic tools to facilitate the early detection of leprosy, particularly in endemic areas. Moreover, attention must be given to the comprehensive care of patients, encompassing both physical and psychological aspects, to improve their quality of life and mitigate social discrimination and prejudice.

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Leprosy in Nepal: a re-emerging threat

Cited by 4 publications

References 22 publications

Borderline tuberculoid leprosy misdiagnosed as Cheilitis Granulomatosa Miescher: A case report

Borderline tuberculoid leprosy misdiagnosed as Cheilitis Granulomatosa Miescher: A case report

Health Seeking Processes of Leprosy Patients in a Hill District of Nepal

One Case of Tuberculosis-Like Leprosy with a Type I Leprosy Reaction

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