Lancet ; The challenge is even greater in low-prevalence areas, where the diagnosis of new cases, though less frequent, still exists and should continue for years or even decades. Ignotti E, Paula RC. Leprosy control is based on early diagnosis and adequate, timely treatment.
The training of human resources, from undergraduate courses in the health area to continuing education, plays a fundamental role. However, the small number of cases observed in basic health units in low-prevalence areas makes it difficult to maintain expertise and to train new human resources.
Saunderson P. Learning to manage leprosy after preserving critical knowledge and exploiting new technology. Lepr Rev ; Indeed, how to teach about leprosy in scenarios marked by great disparities in the epidemiological situation of the disease has caused worldwide restlessness and discussions. Leprosy control: knowledge shall not be neglected. J Epidemiol Community Health ; Ebenso J.
An overview of training and development needs. Global leprosy situation, Week Epidemiol Rec ; Ensino da hansenologia: desafios atuais. An Bras Dermatol ; The objective of the present study was to evaluate leprosy instruction in a large, public medical school located in a metropolis of southeastern Brazil with low leprosy prevalence rates. The student body consists of approximately students divided into 12 one-semester periods, with an average of students per period.
The Medicine course starts with a basic cycle during the first four periods, with essentially biological and theoretical content.
Following this, there is a professional cycle divided into ambulatory practice and internships. In this phase, the student begins patient clinical assessment in the presence of a teacher who supervises the student and has legal responsibility for the medical procedure.
Initially, this occurs in basic outpatient units, which includes attending patients in public health services with no direct connection to the teaching hospital; the outpatient clinic is the main practice site during most of the course. In the last three periods, clinical and surgical internships are undertaken in teaching hospitals. The internship in public health is carried out in small towns and rural communities and includes public health activities and patient assistance.
Six hundred and thirty-two students in the first and in the last year of the Medicine course in were included in this study. A structured self-administered form with 16 closed questions and 3 open questions was used for Group 1; 21 closed questions and 6 open questions was used for Group 2. The questionnaire was developed by the researchers based on the manuals of the Brazilian Ministry of Health. Leprosy control guide.
Aspects related to sociodemographics, theoretical knowledge regarding the topic, and attitudes toward the disease were included as well as questions regarding the practical instruction during the course. The questionnaire was pretested, and the necessary adjustments were made.
The students were approached without prior notice and were given a brief explanation about the study and its objectives. After agreeing and providing signed informed consent, the students gave anonymous, individual, immediate answers without consulting books or other material. To evaluate their theoretical knowledge and attitudes toward the disease, the two groups were compared using univariate and multivariate analyses.
The following variables were used: knowledge regarding the cause, transmission, signs and symptoms, diagnosis, treatment, cure, mandatory notification, and where patients are assisted; perception about the importance of the doctor being able to diagnose and treat leprosy; attitudes toward the disease, that is, maintaining contact with a friend who has been diagnosed with leprosy and being willing to treat people with this disease.
The data were stored in databanks using SPSS software. The variables were described by their frequency distribution. The other role of major histocompatibility complex class II HLA genes at chromosome 6 has been implicated in the clinical type of patient leprosy. The lepromatous form affects the skin and peripheral nerve, causing well-defined infiltrated plaques that are annular or ovoid form. Immunohistochemical findings in skin biopsies show mainly interleukins 4 and The immune response to M.
The steps in the transmission of the disease are not entirely clear. However, it is acceptable that the mycobacterium reservoir is exclusively human, and it is most often transmitted through the spread of basil aerosol. In many cases, the infection appears to occur during childhood, with an incubation period ranging from 6 months to several years.
Rarely, very long incubation periods of up to 40 years have been reported, although infection rates in adults with close contact with infected individuals e. Leprosy usually begins as an indeterminate form that can heal spontaneously, remain unchanged for long periods, or progress to a more severe form. This initial indefinite form can produce patches or macules of the skin, which is not clear with little hypopigmentation.
In parallel, such patches may coincide with hypoesthesia of the corresponding skin nerve. If the disease develops, tuberculoid leprosy can develop as long as the host immune response is preserved enough. At this stage, rapid skin sensation loss due to severe neurological damage can occur, as well as local paralysis, loss of sweat and sebaceous glands, and hair loss.
The skin shows macular lesions with significant hypopigmentation; peripheral nerves are infiltrated and may present as thick subcutaneous bundles. Secondary symptoms include bruised skin under hypoesthesia due to local external damage and superinfection with poor healing ulcers [ 21 ].
The lepromatous stage occurs in individuals with poor immune reactions. Clinically, this is the most severe form and can lead to mutilation. Skin lesions may appear as macules, papules, or plaques with hypopigmentation. The most affected areas are the ears, the central face, the fingers, and toes, but the distal extremities, such as the extensor surfaces of the thighs and forearms, can also be affected.
Often, blindness can occur when the eye is exposed. Osseous resorption of the nostrils and destruction of the bridge of the nose result in severe facial mutilation. The Mycobacterium leprae affected throat can cause a distinctive hoarseness. In fact, all other body areas can also be affected, leading to varying clinical features.
The fourth stage, called the borderline stage, also exists, which is somewhat intermediate between tuberculoid and lepromatous stages in clinical symptoms. Considering the various clinical symptoms, especially the early stages and stages of minor illness, leprosy can easily be confused with various other diseases. In contrast, typical skeletal mutilation in the form of severe leprosy leaves a distinctive footprint of disease that may be identified in historic relics with high levels of certainty [ 21 ].
More advanced leprosy presentations have been reported and classified as tuberculoid leprosy and lepromatous leprosy. Many other clinical presentations, known as intermediate or borderline leprosy, have been identified and classified among the two types.
But according WHO classification, leprosy is divided into two major groups: pauci-bacillary subtype and multi-bacillary subtype. The WHO system is based on the quantity of skin lesions and the number of bacilli on skin smear. Skin smears are made by squeezing a fold of skin and making a shallow slit in the skin with a scalpel [ 23 ]. The Ridley-Jopling classification system is based on the histopathology of skin lesions and essentially represents a spectrum of disease. The spectrum of leprosy classification is not static.
For example, in some cases, untreated TT can progress into LL, given a long enough time and the proper immunologic environment. There are the two classification systems that are mutually exclusive. This was confirmed by the WHO Expert Committee on Leprosy at the seventh meeting in , which defined a case of leprosy as follows: A case of leprosy is someone who has one or more of the following features and who still needs to complete a complete treatment: skin lesions hypopigmentation or redness with a definite loss of sensation, peripheral nerve involvement, as shown by neural thickening accompanied by loss of sensation, as well as positive skin-smears for acid-fast bacilli [ 24 ].
The referral of a suspect who has no anesthetic symptoms is given to a person with a higher experience who has been taught peripheral nerves should be straightforward. Skin smear on new case samples can provide quality control. Research into laboratory tests e. Leprosy patients have been traditionally classified based on the number and type of skin lesions into various clinical groups. However, according to current WHO guidelines, only the number of skin lesions determines the length of therapy patients received for leprosy.
Various studies have reported and highlighted the differences between clinical and skin classification and nerve biopsy findings of leprosy patients [ 26 ]. The patients are categorized into PB and MB leprosy depending upon whether the slit skin smears demonstrate any bacilli or not.
Earlier, the cases with a bacterial index of 2 or less had been categorized as PB, but later on, for feasibility and operational difficulties, all the patients with demonstrable bacilli in slit skin smear without any reference to bacterial index were to be categorized as MB, whereas WHO Classification for leprosy control program was based on the total number of leprosy lesions in the patient.
This is a corollary to the fact that PB patients have good immunity and present with only limited number of lesions.
Furthermore, the single lesions leprosy was also segregated on the ground that this can be treated with the limited amount of chemotherapy. Pauci-bacillary leprosy is found in people with good CMI.
The disease remains localized to produce single or little skin lesions with or without peripheral nerve involvement. The skin lesion may be macular flat or papule slightly raised and plaque.
People with strong immune responses are capable of destroying large amounts of normal organisms and skin normally most of them exhibit negative skin examinations. Multi-bacillary leprosy is found in people with poor CMI. Bacilli multiply and spread more widely resulting in a common disease: usually accompanied by widespread lesions in the skin, nerves, and at lower levels in other organs such as the eyes, respiratory mucosa, testes, and reticuloendothelial system in men and usually the central nervous system and the upper reproductive system in women.
The skin lesions may be multiple borderline or uncountable lepromatous. Lepromatous lesions may be symmetrical and unclear bilateral macules or diffuse infiltration, which may develop into plaque and nodule formation.
The scores were converted into logMAR. This study involved subjects which included eyes 2 eyes were anophthalmic. The mean difference between the Snellen chart and Peek Acuity was 0. Peek Acuity is an accurate and repeatable visual acuity screening tool as effective as the Snellen Chart, which also can be used for leprosy patients to overcome barriers in accessing eye health services, especially in rural areas. DOI: About home.
Pages - Volume 91 , Issue 3. Peek Acuity vs Snellen Chart for visual impairment screening in leprosy: a cross-sectional study. Yunia Irawati Yunia Irawati Affiliation. Find this author on Google Scholar. Find this author on PubMed. Krystle Gabriella Krystle Gabriella Affiliation.
Anis Fitriana Anis Fitriana Affiliation. Carennia Paramita Carennia Paramita Affiliation. Made Susiyanti Made Susiyanti Affiliation. Tri Rahayu Tri Rahayu Affiliation. Gitalisa Andayani Gitalisa Andayani Affiliation. Objective: Leprosy is a chronic infectious disease caused by Mycobacterium leprae , which has a high incidence of ocular involvement.
Methods: A population-based cross-sectional study was carried out at a leprosy settlement village near Sitanala Hospital, Tangerang and Alverno Hospital, Singkawang. Results: This study involved subjects which included eyes 2 eyes were anophthalmic. Conclusion: Peek Acuity is an accurate and repeatable visual acuity screening tool as effective as the Snellen Chart, which also can be used for leprosy patients to overcome barriers in accessing eye health services, especially in rural areas.
Original Papers. Irawati Yunia. Bani Anna Puspitasari. Gabriella Krystle. Fitriana Anis. Paramita Carennia. Susiyanti Made. Rahayu Tri. Andayani Gitalisa. Lestari Yeni Dwi. Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Visual acuity can be measured using various methods, such as the Snellen Chart and Optotype. The Snellen Chart has been commonly employed as the standard for measuring visual acuity in daily practice due to its familiarity, well-recognized scoring system, small chart size and the speed of performing the test.
Nevertheless, it is limited by the non-geometric progression in the letter sizing from line to line and the inconsistent number of letters per line. The examiner needs to ensure good natural light and place the chart at 6 meters or 20 feets distance.
Moreover, lack of systematic approach to letter legibility and secondary effects such as crowding could lead to measurement bias. Indonesia is endemic for leprosy and is the country with the third highest number of new cases each year, after India and Brazil.
Over 19, new cases were reported in Facilities and health access in rural and suburban area are limited, so new methods that are more practical but still effective for visual acuity screening are required. Reducing the burden of visual impairment in leprosy patients is a major ophthalmic concern in Indonesia , and depends upon early screening and intervention. In this era of globalization , the number of smartphone users is forecast to grow and the technology has evolved rapidly in providing accessibility to health care.
Peek Acuity has the logMAR measurement option built into the application. The examination is quicker because the results will be automatically converted into logMAR. Optimizing the use of Peek Acuity can further reduce the cost of visual acuity screening. This study examines the reliability of Peek Acuity in performing visual acuity screening for leprosy patients to overcome barriers in accessing ophthalmic healthcare, by comparing results of visual acuity measured with Peek Acuity and the Snellen Chart.
We conducted an examination on residents in the Sitanala leprosy village because of the large number of former leprosy patients in the area. We also conducted an examination in Singkawang because of the existence of Alverno Leprosy Hospital. The hospital does not have an ophthalmologist, so eye screening for leprosy patients is needed at the hospital. Image source: The Motley Fool. This spring, the U. The regulatory agency recommended Ocugen pursue the lengthy traditional route of an approval request instead of an Emergency Use Authorization EUA request.
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