Advertisement

Leprosy in Children

  • Josafá Gonçalves BarretoEmail author
  • Marco Andrey Cipriani Frade
  • Fred Bernardes Filho
  • Moises Batista da Silva
  • John Stewart Spencer
  • Claudio Guedes Salgado
Pediatric Infectious Diseases (I Brook, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Infectious Diseases

Abstract

Purpose of Review

This manuscript aims to review the cutting-edge developments regarding to the diagnosis, management, and prevention of leprosy in children.

Recent Findings

Leprosy transmission still occurs continuously in some endemic areas in the world. Leprosy in children below 15 years old is a robust indicator of active source of infection in the community where they live. A special focus on children to reduce disabilities and reduce transmission is one of the core areas of interventions of the global leprosy strategy 2016–2020. Ongoing research is trying to develop better diagnostic tests and to advance chemoprophylaxis and immunoprophylaxis approaches.

Summary

Early diagnosis in children can be hard because of the wide range of clinical aspects of the skin lesions and mainly due to the difficulty of performing the clinical peripheral nerve evaluation. We must maintain leprosy expertise and improve the health professionals training for leprosy diagnosis, since we still have a long journey to reach leprosy elimination.

Keywords

Leprosy Early diagnosis Children 

Notes

Acknowledgements

We would like to thank the following institutions for their support to the authors: CNPQ, CAPES, CAPES PROAMAZONIA, FAPESPA, SESPA, FAEPA-HCFMRP-USP, The Order of Malta (MALTALEP), The New York Community Trust (The Heiser Program for Research in Leprosy) and the J. William Fulbright Scholar to Brazil award.

Compliance with Ethical Standards

Conflict of Interest

Drs Barreto, Frade, Filho, da Silva, Spencer, and Salgado declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• WHO. Global Leprosy Strategy 2016–2020: Accelerating towards a leprosy-free world. New Delhi (India): World Health Organization, Regional Office for South-East Asia; 2016. This document gives a special focus on early case detection on children before visible disabilities occur. One of the main targets is zero disabilities among new pediatric patients by 2020. Google Scholar
  2. 2.
    WHO. Global leprosy update, 2015: time for action, accountability and inclusion. Wkly Epidemiol Rec. 2016;91:405–20.Google Scholar
  3. 3.
    Barreto JG, Guimarães LS, Frade MAC, Rosa PS, Salgado CG. High rates of undiagnosed leprosy and subclinical infection amongst school children in the Amazon region. Mem Inst Oswaldo Cruz. 2012;107:60–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Kumar MS, Padmavathi S, Shivakumar M, Charles U, Appalanaidu M, Perumal R, et al. Hidden leprosy cases in tribal population groups and how to reach them through a collaborative effort. Lepr Rev. 2015;86:328–34.PubMedGoogle Scholar
  5. 5.
    Liangbin Y, Jianping S, Min Z, Guocheng Z. Survey on child leprosy patients and problems resulted from the disease in China. Lepr Rev. 2015;86:75–9.Google Scholar
  6. 6.
    Singal A, Sonthalia S, Pandhi D. Childhood leprosy in a tertiary-care hospital in Delhi, India: a reappraisal in the post-elimination era. Lepr Rev. 2011;82:259–69.PubMedGoogle Scholar
  7. 7.
    Ramos JM, Reyes F, Lemma D, Tesfamariam A, Belinchón I, Górgolas M. The burden of leprosy in children and adolescents in rural southern Ethiopia. Paediatr Int Child Heal. 2014;34:24–8.CrossRefGoogle Scholar
  8. 8.
    Sethi M, Rao P. Challenges in preventing disabilities among children affected by leprosy: findings from a referral hospital in North India. Lepr Rev. 2015;86:296–7.PubMedGoogle Scholar
  9. 9.
    Abeje T, Negera E, Kebede E, Hailu T, Hassen I, Lema T, et al. Performance of general health workers in leprosy control activities at public health facilities in Amhara and Oromia states. Ethiopia BMC Health Serv Res. 2016;16:122.CrossRefPubMedGoogle Scholar
  10. 10.
    Henry M, GalAn N, Teasdale K, Prado R, Amar H, Rays MS, et al. Factors contributing to the delay in diagnosis and continued transmission of leprosy in Brazil—an explorative, quantitative. Questionnaire Based Study PLoS Negl Trop Dis. 2016;10:e0004542.CrossRefPubMedGoogle Scholar
  11. 11.
    Smith WC, van Brakel W, Gillis T, Saunderson P, Richardus JH. The missing millions: a threat to the elimination of leprosy. PLoS Negl Trop Dis. 2015;9:e0003658.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Romero-Montoya IM, Beltrán-Alzate JC, Ortiz-Marín DC, Diaz-Diaz A, Cardona-Castro N. Leprosy in Colombian children and adolescents. Pediatr Infect Dis J. 2014;33:321–2.CrossRefPubMedGoogle Scholar
  13. 13.
    WHO. Diagnosis of leprosy. World Health Organization. 2017. http://www.who.int/lep/diagnosis/en/. Accessed 31 Jan 2017.
  14. 14.
    Ridley DS, Jopling WH. Classification of leprosy according to immunity. A five-group system. Int J Lepr Other Mycobact Dis. 1966;34:255–73.PubMedGoogle Scholar
  15. 15.
    Fakhouri R, Sotto MN, Manini MI, Margarido LC. Nodular leprosy of childhood and tuberculoid leprosy: a comparative, morphologic, immunopathologic and quantitative study of skin tissue reaction. Int J Lepr Other Mycobact Dis. 2003;71:218–26.CrossRefPubMedGoogle Scholar
  16. 16.
    Villarroel MF, Orsini MB, Lima RC, Antunes CM. Comparative study of the cutaneous sensation of leprosy-suspected lesions using Semmes-Weinstein monofilaments and quantitative thermal testing. Lepr Rev. 2007;78:102–9.PubMedGoogle Scholar
  17. 17.
    Lwin K, Zuiderhoek B. Case detection rates for Central Burma (1962-1972). Int J Lepr Other Mycobact Dis. 1975;43:125–8.PubMedGoogle Scholar
  18. 18.
    Kahawita IP, Lockwood DNJ. Towards understanding the pathology of erythema nodosum leprosum. Trans R Soc Trop Med Hyg. 2008;102:329–37.CrossRefPubMedGoogle Scholar
  19. 19.
    Rotberg A. Fiftieth anniversary of the “N-factor/Hansen-anergic fringe” hypothesis for hanseniasis. Int J Lepr Other Mycobact Dis. 1989;57:864–6.PubMedGoogle Scholar
  20. 20.
    Reja AHH, Biswas N, Biswas S, Dasgupta S, Chowdhury IH, Banerjee S, et al. Fite-Faraco staining in combination with multiplex polymerase chain reaction: a new approach to leprosy diagnosis. Indian J Dermatology Venereol Leprol. 2013;79:693–700.CrossRefGoogle Scholar
  21. 21.
    Spencer JS, Brennan PJ. The role of Mycobacterium leprae phenolic glycolipid I (PGL-I) in serodiagnosis and in the pathogenesis of leprosy. Lepr Rev. 2011;82:344–57.PubMedGoogle Scholar
  22. 22.
    Roset Bahmanyar E, Smith WC, Brennan P, Cummings R, Duthie M, Richardus JH, et al. Leprosy diagnostic test development as a prerequisite towards elimination: requirements from the user’s perspective. PLoS Negl Trop Dis. 2016;10:e0004331.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Corstjens PL, de Dood CJ, van der Ploeg-van Schip JJ, Wiesmeijer KC, Riuttamäki T, van Meijgaarden KE, et al. Lateral flow assay for simultaneous detection of cellular- and humoral immune responses. Clin Biochem. 2011;44:1241–6.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Bobosha K, Tjon Kon Fat EM, van den Eeden SJF, Bekele Y, van der Ploeg-van Schip JJ, de Dood CJ, et al. Field-evaluation of a new lateral flow assay for detection of cellular and humoral immunity against Mycobacterium leprae. PLoS Negl Trop Dis. 2014;8:e2845.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    • Turankar RP, Pandey S, Lavania M, Singh I, Nigam A, Darlong J, et al. Comparative evaluation of PCR amplification of RLEP, 16S rRNA, rpoT and Sod A gene targets for detection of M. leprae DNA from clinical and environmental samples. Int J Mycobacteriol. 2015;4:54–9. This study demonstrates that RLEP amplification in slit skin smear can detect the presence of M. leprae better than other genes (rpoT, Sod A, and 16S rRNA) in leprosy patients and environmental samples. CrossRefPubMedGoogle Scholar
  26. 26.
    Araújo S, Freitas LLO, Goulart LLR, Goulart IMBI, Araujo S, Freitas LLO, et al. Molecular evidence for the aerial route of infection of Mycobacterium leprae and the role of asymptomatic carriers in the persistence of leprosy. Clin Infect Dis. 2016;63:1412–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Al-Mubarak R, Vander Heiden J, Broeckling CD, Balagon M, Brennan PJ, Vissa VD. Serum metabolomics reveals higher levels of polyunsaturated fatty acids in lepromatous leprosy: potential markers for susceptibility and pathogenesis. PLoS Negl Trop Dis. 2011;5:e1303.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Lima E de O, de Macedo CS, Esteves CZ, de Oliveira DN, MCV P, Nery JA da C, et al. Skin imprinting in silica plates: a potential diagnostic methodology for leprosy using high-resolution mass spectrometry. Anal Chem. 2015;87:3585–92.CrossRefGoogle Scholar
  29. 29.
    Smith RL, Rodrigues L, Lockwood D, Hacker M, Sales A, Illarramendi X, et al. Proposing a compartmental model for leprosy and parameterizing using regional incidence in Brazil. PLoS Negl Trop Dis. 2016;10:e0004925.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    de Matos HJ, Blok DJ, de Vlas SJ, Richardus JH. Leprosy new case detection trends and the future effect of preventive interventions in Pará State, Brazil: a modelling study. PLoS Negl Trop Dis. 2016;10(3):e0004507.Google Scholar
  31. 31.
    Salgado CG, Barreto JG, da Silva MB, Frade MAC, Spencer JS, Smith C, et al. What do we actually know about leprosy worldwide? Lancet Infect Dis. 2016;16:778.CrossRefPubMedGoogle Scholar
  32. 32.
    WHO. WHO Multidrug therapy (MDT). World Health Organization. 2017. http://www.who.int/lep/mdt/en/. Accessed 31 Jan 2017.
  33. 33.
    Lal V, Pal S, Haldar NK, Mandal PK, Srinivas G. What parents should know while their child is on MDT: insights from a qualitative study in eastern India. Lepr Rev. 2014;85:81–4.PubMedGoogle Scholar
  34. 34.
    Pamba A, Richardson ND, Carter N, Duparc S, Premji Z, Tiono AB, et al. Clinical spectrum and severity of hemolytic anemia in glucose 6-phosphate dehydrogenase-deficient children receiving dapsone. Blood. 2012;120:4123–33.CrossRefPubMedGoogle Scholar
  35. 35.
    Kaluarachchi SI, Fernandopulle BM, Gunawardane BP. Hepatic and haematological adverse reactions associated with the use of multidrug therapy in leprosy: a five year retrospective study. Indian J Lepr. 2001;73:121–9.PubMedGoogle Scholar
  36. 36.
    Singh H, Nel B, Dey V, Tiwari P, Dulhani N. Adverse effects of multi-drug therapy in leprosy, a two years’ experience (2006-2008) in tertiary health care centre in the tribal region of Chhattisgarh State (Bastar, Jagdalpur). Lepr Rev. 2011;82:17–24.PubMedGoogle Scholar
  37. 37.
    Yang CS, Kim C, Antaya RJ. Review of thalidomide use in the pediatric population. J Am Acad Dermatol. 2015;72:703–11.CrossRefPubMedGoogle Scholar
  38. 38.
    Hassan I, Dorjay K, Anwar P. Thalidomide in dermatology: revisited. Indian J Dermatol. 2015;60:213.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Barreto JG, Bisanzio D. Guimarães L de S, Spencer JS, Vazquez-Prokopec GM, Kitron U, et al. Spatial analysis spotlighting early childhood leprosy transmission in a hyperendemic municipality of the brazilian Amazon region PLoS Negl Trop Dis. 2014;8:e2665.Google Scholar
  40. 40.
    •• Barreto JG, Bisanzio D, Frade MAC, Moraes TMP, Gobbo AR, de Souza GL, et al. Spatial epidemiology and serologic cohorts increase the early detection of leprosy. BMC Infect Dis. 2015;15:527. This study demontrates that targeted screening planned using spatial analysis and serologic data is efficient to increase the early detection of leprosy in children. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Gitte SV, Ramanath SN, Kamble K. Childhood leprosy in an endemic area of central India. Indian Pediatr. 2016;53:221–4.CrossRefPubMedGoogle Scholar
  42. 42.
    Palit A, Inamadar AC. Childhood leprosy in India over the past two decades. Lepr Rev. 2014;85:93–9.PubMedGoogle Scholar
  43. 43.
    Richardus JH, Oskam L. Protecting people against leprosy: chemoprophylaxis and immunoprophylaxis. Clin Dermatol. 2015;33:19–25.CrossRefPubMedGoogle Scholar
  44. 44.
    Duthie MS, Balagon MF. Combination chemoprophylaxis and immunoprophylaxis in reducing the incidence of leprosy. Risk Manag Healthc Policy. 2016;9:43–53.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Richardus RA, Alam K, Pahan D, Feenstra SG, Geluk A, Richardus JH. The combined effect of chemoprophylaxis with single dose rifampicin and immunoprophylaxis with BCG to prevent leprosy in contacts of newly diagnosed leprosy cases: a cluster randomized controlled trial (MALTALEP study). BMC Infect Dis. 2013;13:456.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Josafá Gonçalves Barreto
    • 1
    Email author
  • Marco Andrey Cipriani Frade
    • 2
  • Fred Bernardes Filho
    • 2
  • Moises Batista da Silva
    • 3
  • John Stewart Spencer
    • 4
  • Claudio Guedes Salgado
    • 3
  1. 1.Spatial Epidemiology LaboratoryFederal University of ParáParáBrazil
  2. 2.Divison of Dermatology of Internal Medicine, Department of Ribeirão Preto Medical SchoolUniversity of São PauloRibeirão PretoBrazil
  3. 3.Dermato-Immunology LaboratoryFederal University of ParáMaritubaBrazil
  4. 4.Department of Microbiology, Immunology and PathologyColorado State UniversityFort CollinsUSA

Personalised recommendations