Importance of contact examination in leprosy case detection

Leprosy Mailing List, July 3rd, 2009
Ref.: Importance of contact examination in leprosy case detection
From: Bhatki W. S., Mumbai, India
July 2, 2009

Dear Salvatore Noto,

Greetings from Mumbai.

We wish to share our experience on Contact Examination in leprosy case detection as narrated below with all those interested and request you to circulate the same through the LML.

Yours truly,

W S Bhatki

Sub: Importance of contact examination in leprosy case detection

During the current phase of Integration of leprosy services with General Health Services, all the methods of active case detection (i.e. surveys) have been suspended. There is emphasis on information education and communication (IEC) to promote voluntary case reporting. However, we have recently come across 4 new cases clustered in one family of 5 households in which early lepromatous leprosy (LL) case could be detected through contact examination.

We had recently undertaken a Selective Special Drive (SSD), a house to house leprosy awareness campaign, through trained Community Volunteers (CVs) in one of the slum pockets in our project area in Mumbai. A week following the SSD, a youth brought two of his younger siblings, i.e. 11 year old brother with patch on left knee and 9 year old sister with small patches 1 each on left forearm and right thigh for examination at nearby Leprosy Referral Centre (LRC). Both the children were diagnosed as paucibacillary (PB) leprosy. They were formally registered for multi-drug therapy (MDT). The youth was also examined but did not have any thing suggestive of leprosy. He was counselled on leprosy.

In the next week, the same youth visited the LRC accompanied by his father who had suspected patch on his right cheek. On examination, the father too, was found to be suffering from PB leprosy. According to the youth, he did not bring his mother for examination because she did not have any patch on the body. We however, got the mother examined at home by the paramedical worker and found that she had shiny, oily skin with mild infiltration on forehead and on ear lobes suggestive of early LL leprosy. Her skin smears examination done at the LRC showed bacterial index (BI) 3+ for acid fast bacilli.

From this experience, we want to suggest that even though the active case detection through surveys have been stopped, the contact examination needs to be continued especially when there are multiple child cases in one family. There is good awareness about skin patch as the early sign of leprosy but no so much about the early signs of infectious leprosy, i.e. lepromatous leprosy. While carrying out IEC programs, this aspect should be kept in mind and enough publicity should given.

W S Bhatki*, Leelamma Joseph*

Maharashtra Lokahita Seva Mandal, Santacruz (E),
Mumbai, India

* Dr W S Bhatki is working in the field of leprosy for over 3 decades. He was former Medical Superintendent of Acworth Leprosy Hospital, Mumbai. Presently, he is working as Executive Director of Maharashtra Lokahita Seva Mandal (MLSM), a NGO operating on National Leprosy Eradication Program (NLEP) in 3 Municipal Wards in Mumbai since 1975. He has contributed to Leprosy Review and International Journal on Leprosy by writing several articles on Leprosy Vaccine, clinical leprosy and epidemiological situation in Mumbai. He is also a secretary of Acworth Leprosy Hospital Research Society (e mail – acworthleprosyrre@yahoo.co.in ).

* Leelamma Joseph is working as Para Medical Worker at MLSM for over 25 years.