Objectives: If leprosy is a public health problem, it is due to the disabilities it causes. Surprisingly little is known about the risk of disabilities. Even now, mainly cross-sectional studies report disability prevalence. The present study aims to report the risk of disability in pre and post-WHO multidrug therapy (MDT) in multibacillary leprosy patients and to assess the extent of the incidence of disability.

Summary Two groups of MB leprosy patients, one treated to the point of smear negativity (TSN) and the other given therapy for fixed duration (24 doses of WHO MB regimen) (FDT), were compared for relapse rates during treatment and in the post treatment period. During the follow-up of980· 2 person years in 260 patients treated with FDT, 20 relapses (2·041100 patient years) were observed. In the other group of 301 patients, who received therapy till smear negativity, 12 relapses in 1085·46 person years (1· 10/100 patient years) occurred. Comparison of survival rates (without relapse) has shown that although there is no difference up to 4 years, the risk of relapse was significantly higher on longer follow-up in the FDT group. In addition, when patients were compared on the basis of initial bacterial load, it was found that the relapse rates in patients with BI �4 was significantly higher (P < 0·01) in the FDT group as compared to those receiving treatment till the point of smear negati vity (4· 29 versus 1 · 2711 00 patient years). All the relapsed patients responded to retreatment with the same drug combina tion, indicating that the exacerbation in their condition was because of insufficient treatment. It is suggested that to prevent or reduce relapses, treatment where feasible would be continued till smear negativity, at least in patients with high BI.Multi-drug therapy (MDT) was introduced in the treatment of leprosy in the 1980s and since then there has been a significant change in leprosy scenario both at the global and the national level. More than 8·4 million patients had been cured by MDT up to the beginning of 1997.1 In India, the caseload of active patients has come down to less than 0·6 million from an earlier estimate of about 5 million, with many leprosy related parameters also having shown a downward trend ? This has been attributed to the high efficacy of MDT, in addition to increased political commitment and better supervision in the field. The early results with the use of drug combinations have been generally good, with very few practical problems. 3The success with MDT administered to the point of negativity in MB patients has encouraged workers to test shorter regimens of 2 years and even 12 months. The observation of continued clinical improvement and fall in BI, even after stoppage of treatment at the end

The mouth in 40 consecutive, unselected bacilliferous leprosy patients has been examined. The fr equency and various types of lesion are reported. Twenty-three patients showed lesions inside the mouth. Although all parts of the mouth were found. to be affected in a varying percentage of patients, the hard palate was involved in ali 23 patients. Further, of these 23 patients, 21 showed acid-fast bacilli on the surface of mouth as judged by surface smears and mouthwash. A review of the literature concerning oral lesions in lepromatous' leprosy is also presented.

BackgroundMany studies have focused on multidrug therapy (MDT) for multibacillary (MB) leprosy and rarely on long-term outcome of paucibacillary (PB) leprosy having recommendation of therapy for 6 months fixed duration therapy for PB patients. Studies on measuring risk of disability are rare. The present study is to assess the cure; default, relapse and disability in a prospective cohort of PB leprosy during follow-up of >4 years after treatment.DesignProspective.SettingPrimary in our field area of Agra District.Participants920 PB leprosy patients entered the study, 621 completed treatment, 599 followed finally including 271 males, no ethnic differentiation, patients of all age groups except for children below 5 years and old persons above 70 years were not included.Treatment6 months fixed duration MDT as recommended by WHO.Primary and secondary outcomesTreatment completion, cure, relapse and development of disability based on clinical assessment by well-experienced doctors.Statistical methodsData have been analysed using SPSS software, risk is computed as incidence per 100 person–years (PY) and test of significance used.ResultsStudy reports 91% cure rate. Incidence of relapse was 1.3/100 PY with no significant variation by age, sex, delay in detection, patches and nerves. Crude incidence of disability was 2.2% and varied significantly by age and nerve thickening but not by sex, number of patches, nerves and delay in treatment. Incidence of disability was 0.50/100 PY in treatment completed and 0.43 among defaulters.ConclusionThe study concludes that relapses do occur after MDT treatment but at the level of 1–2%, incidence of disability remains low (<1/100 PY) in PB leprosy. Low incidence of relapse and disability suggests that 6 months therapy is quite effective. However, further improvement may help to improve its efficacy. Longer follow-up may add to efficacy measures.

Till 2010, several countries have declared less than one leprosy patient among population of 10,000 and themselves feeling as eliminated from leprosy cases. However, new leprosy cases are still appearing from all these countries. In this situation one has to be confident to diagnose leprosy. This review paper highlighted already explored antigens for diagnosis purposes and finally suggested better combinations of protein antigens of M. leprae versus immunoglobulin as detector antibody to be useful for leprosy diagnosis.

The study shows that PB-MDT and ROM-6 have almost similar acceptability, cure rate and relapse rate.

We have searched for Mycobacterium leprae DNA for 36kDa protein in urine using a M. leprae specific PCR technique. A limited number of 16 patients (of which 11 belonged to lepromatous leprosy and five to tuberculoid leprosy) and eight healthy individuals were included for the present study. The number of urine samples positive by PCR were 36.4% (4/11) in lepromatous patients and 40% (2/5) in tuberculoid patients. None of the samples from healthy individuals was positive. To our knowledge, the results indicate, for the first time, the presence of M. leprae DNA in urine from leprosy patients. Another important finding obtained out of the study is that amongst treated patients 66.6% (4/6) were positive whereas amongst untreated only 20% (2/10) were positive. From the present indicative data it appears that treatment improves the PCR results with urine as a sample. Thus, the approach could prove to be useful for monitoring the treatment response of individual patients and needs to be further evaluated with a large number of patients.

Infestation of the nose with larvae of certain files can occur in leprosy patients. This results in severe distress and agony and can cause extensive tissue damage. The predisposing fa ctors, clinical presentation and treatment is de scribed.