A retrospective study of profile of leprosy patients in a District Hospital in North India

Introduction: There is a high prevalence of leprosy in certain areas of our country. The main problem with leprosy is the prevalence of disability in untreated patients. Aims: To know the clinical profile of leprosy patients and to find out the risk factors for disabilities. Methods: A retrospective study of 10 years was conducted from April 2003 to March 2014 was conduced. Results: There were 137 MB (75.6%) and 44 PB (24.4%) cases. There were 35 (19.33%) MB patients with disability and 5 (2.76%) PB patients with disability. There were 5 cases (2.7%) with childhood leprosy. The percentage of defaulters was 9 (4.97%). The Patients were grade II disability were 19.4% and patients with grade I disability were 2.8%. Regarding the nerve involvement in leprosy, ulnar nerve was most commonly involved in 45 (24.86%) patients, lateral popliteal nerve in 20 (11.04%) patients, posterior tibial nerve in 15 (8.28%) patients and median nerve was involved in 12 (6.62%) patients. Conclusions: The multibacillary patients are more susceptible to neuritis as compared to the paucibacillary patients. The occurence of neuritis is a significant risk factor for disabilities in leprosy. Early diagnosis and treatment is important to reduce the load of infection.

record of the patients was taken from the registers maintained.The registers had all the details about the dermatoneurological examination and WHO grading of disability.According to the WHO grading of disability: Grade 0-No disability due to leprosy; Grade I-Sensory impairment only; Grade II-Motor dysfunction and sequelae due to leprosy.All the thickened peripheral nerves were noted.The photographic record of the patients was also retrieved.The data including the age and sex of the patients, clinical profile and disability grading was tabulated and the data was analyzed statistically using chi square test.

DISCUSSION
The present study shows that more males were involved as compared to females which is not unusual as males have more exposure as compared to females who mostly stay indoors.It was also seen that multibacillary cases had higher chances of disability as compared to the paucibacillary cases (Fig. 4) as the patients with multibacillary leprosy required a long treatment and therefore some of the patients have poor compliance [3].There were 2.7% cases of childhood leprosy in our study.With the decrease in the prevalence of leprosy in India, the number of childhood cases of leprosy have decreased significantly [4].Contact tracing in leprosy is very important in leprosy and in our study 11% patients had history of contact in the family.India has achieved elimination of leprosy in 2005.Although elimination of leprosy has been achieved, still there are some high endemic zones in our country [5,6].The main problem with leprosy is the development of impairments.The neurological sequelae are responsible for the stigma of leprosy as being a deforming disease.
Leprosy is a chronic granulomatous disease which mainly involves skin and peripheral nerves [7,8].
According to the WHO classification, leprosy is divided into MB or multibacillary leprosy and PB or paucibacillary leprosy depending upon the number of lesions.Several factors have been associated with disabilities in leprosy [9,10].The main risk factors associated with disability in leprosy are patients having multibacillary leprosy, delay in the diagnosis of leprosy, old age, the extent of clinical disease and the presence of neuropathy.All the high risk patients with disabilities must be carefully followed up to prevent any further impairments [11,12].

CONCLUSIONS
To conclude, the multibacillary patients are more susceptible to neuritis as compared to the paucibacillary patients.The occurence of neuritis is a significant risk factor for disabilities in leprosy.Also, there are many other multiple factors causing disability in leprosy.Also, timely diagnosis and treatment is an important factor for the prevention of neural function impairment in leprosy.Early diagnosis and treatment is important to reduce the load of infection.

CONSENT
The examination of the patient was conducted according to the declaration of Helsinki principles.

Figure 1 :
Figure 1: Claw hand in a 50 years old male

Figure 3 :Figure 4 :
Figure 3: Facial deformity in a 78 years old male

Table 1 :
Age distribution of patients Sr

Table 2 :
Type of leprosy and disability

Table 3 :
Nerve involvement in leprosy Sr

Table 4 :
Risk factors for disability in leprosy Sr