This is an interesting comparison between the types of leprosy seen among Chinese, Malays and Indians in Malaya, based on a large experience. The disease is most virulent among Chinese and least so among Indians, three-fourths of the cases among the latter being of mild tuberculoid disease with a tendency to self-healing, but among the Chinese only one-third are of the tuberculoid type. The climate of Malaya is of the hot humid type, in which leprosy flourishes. On the other hand, a higher standard of living than in India tends to hinder the spread of the disease. The age incidence is important. Among, the Chinese, early macules are commonly found in children of 5 to 15 years of age, most of which tend to clear up, but in about one-fourth tuberculoid lesions develop and may go on to the lepromatous condition, especially if the onset of the tuberculoid stage occurs early. When a reliable history is obtained in Chinese, in nearly every lepromatous case a tuberculoid stage was first observed, commonly in the age group 16-40. In a smaller number of persons of over 40 years of age, the proportion of tuberculoid cases is very much higher, but the tendency to become lepromatous is very much less. Major tuberculoid cases are more liable than minor to become lepromatous, but nerve thickening in tuberculoid leprosy is less evident in Chinese than in Indians and it is rare in children and in those over 40. In view of the foregoing peculiarity of the evolution of leprosy in tuberculoid cases in Chinese subjects, active treatment is necessary, in order to prevent them becoming lepromatous. For this purpose, intradermal injections are of little value and they tend to obscure any evolutionary changes. Hydnocarpus oil or esters (deep subcutaneous injections) should therefore be pushed to the limit of tolerance in doses of 1 cc. per 10 pounds body weight twice weekly, or 30 cc. per week, for a patient of 150 Ibs. as a minimum and increased by at least fifty per cent, in acute or reacting cases, when improvement may be expected within three months. Some years' experience of this intensive treatment as compared with weekly injections of 1-5 cc. has shown much more marked improvement and much less incidence of lepromatous change with the high doses. In lepromatous cases, reactions should be avoided, but dosage should be as high as possible short of producing increased erythrocyte sedimentation and plantar pain on heavy stroking. Surveys of school children are of great importance in finding the early macular stage and their discovery may lead to the detection of infective adults who require to be segregated. L. Rogers.
In Sarawak, some tribes stay in communal longhouses whilst others live in villages of single dwellings. The present study looks into the question of whether there is an association between the prevalence of leprosy and tuberculosis with the quantum of social contact that occurs in these two types of settlement patterns. It was found that the prevalence of leprosy and tuberculosis is significantly higher among longhouse dwellers compared with single house dwellers. It was also noted that social groups tended to be larger and to persist for much longer among longhouse dwellers than among those in single dwellings. This lends support to the evidence that social contact in longhouses is more extensive and contributes towards a higher prevalence of leprosy and tuberculosis.
OBJECTIVES: Leprosy remains a public health concern in Malaysia and globally. We aim to review the characteristics of leprosy patients in a tertiary institution in urban Malaysia.
DESIGN: This is a case series of 27 leprosy patients who presented between 2008 and 2013.
RESULTS: The majority of our patients consisted of male (74.1%), Malaysian (63.0%), blue collar workers (51.9%) and married (59.3%) patients; 48.1% had lepromatous leprosy. All except one of the patients presented with skin lesions, 25.9% had nerve involvement and 33.3% developed lepra reactions. Forty-four point four percent (44.4%) of the cases seen initially in the primary care setup were misdiagnosed.
CONCLUSIONS: Doctors need to have a high index of suspicion for leprosy when patients present with suggestive skin, nerve or musculoskeletal lesions. Immigrants accounted for 37% of cases and these patients may become a reservoir of infection, thus accounting for the rise in incidence. An increasing trend in multibacillary cases may be attributed to the spread from migrants from countries with a high burden of leprosy.
The objectives in this epidemiology review are to measure and report the extent of morbidity and mortality due to tuberculosis (TB), the proportion of new sputum smear positive cases in districts and the status of cohort analysis as of 1999. As for leprosy, the main objective is to determine morbidity and the treatment outcomes of Multiple Drug Therapy (MDT). Based on the results obtained, a comprehensive action plan for prevention, control and monitoring of tuberculosis and leprosy cases and patients is being produced and implemented throughout the state. The analysis concentrated on patients diagnosed at all out-patient units and admitted in all of the state's hospitals. The patient particulars were recorded using a standardized format based on TB and Leprosy Health Management Information System (TB HMIS). TB was the second highest by notification of communicable diseases in Malaysia in 2001. 29% or about one-third of the national TB cases are from Sabah. However, it has been noted that there was an average decline of 2.6% in annual notification since 10 years ago to date. There was also a reduction of 11.4% in 2001 as compared to annual notification in 2000. Immigrants contribute more than 24% in detection of new cases since 1990. Treatment success rate in term of completion of treatment to date is 82%. Mortality rate has steadily declined from 14 deaths to 7 deaths per 100,000 population. Leprosy in Sabah also contributes to 30% of the yearly total caseload of Malaysia and has the highest notification rate of 2 per every 100,000 population as compared to other states. The average registered leprosy cases over the past 5 years are 239 cases and the prevalence rate is 0.7/10,000 population. The state has successfully achieved its goal to decrease leprosy as per the World Health Organization (WHO) goal of yearly overall prevalence rate of less than 1 case for every 10,000 population. However, the districts of Kudat, Tawau, Lahad Datu, Kota Kinabalu and Semporna are still within the prevalence rate of more than one per 10,000 population. This review highlights some interesting findings which can be incorporated into the State and Districts action plans and strategies. It is also noted that in order to translate National Plans and Strategies into effective action at the community level, health workers need relevant up-to-date knowledge of the pattern of health and disease, and of their determinants, in each district. The Sabah Health Department continues to organize and support programs related to management and control of tuberculosis and leprosy to progressively reduce the incidence of these diseases in the community by breaking the chain of transmission of Mycobacterium tuberculosis and M. leprae, respectively.
Study site: outpatient clinics, inpatients, hospitals, Sabah, Malaysia
Congo red screening of routine biopsies at the University Hospital Kuala Lumpur revealed the following categories of amyloidosis: systemic AL (5.9%); systemic AA (3.2%); isolated atrial (14%); primary localized cutaneous (7.5%); other primary localized deposits (3.2%); localized intratumour (58%); and dystrophic (8.6%). Unlike in the West, AA amyloidosis in this population was usually secondary to leprosy or tuberculosis. Liver involvement in AL amyloidosis was shown to exhibit a sinusoidal pattern and differed from the vascular pattern of AA amyloidosis. Within the category of AA amyloidosis, there were two patterns of renal involvement--glomerular and vascular, with the glomerular pattern carrying a more ominous clinical picture. Notable among the localized amyloidoses were isolated atrial amyloidosis complicating chronic rheumatic heart disease, intratumour amyloidosis within nasopharyngeal carcinomas and dystrophic amyloidosis which occurred in fibrotic tissues.
Leprosy is a chronic infectious disease and is still a public health problem in Malaysia. In 1926, the Leper Enactment Act was established which required compulsory notification and isolation of leprosy patients. As a result, the National Leprosy Control Centre (NLCC) was built in Sungai Buloh, Selangor. In 1969, the National Leprosy Control programme was launched with the objective of early case finding and decentralisation of treatment of leprosy. The treatment of leprosy patients is integrated with basic Medical and Health services in Malaysia. With the implementation of multiple drug therapy in 1985, the National prevalence rate of leprosy has reduced from 5.7 per 10,000 in 1983 to 1.7 per 10,000 in 1992. The Research Unit in NLCC was established in 1950, where cultivation of Mycobacterium leprae using mouse foot-pad technique is done. This technique is used for assessment of efficacy of chemotherapeutic agents in leprosy. Research activites are also done in collaboration with the Institute for Medical Research in Kuala Lumpur such as isolation of Mycobacterium leprae antigen using T cell clones and phenolic glycolipid antigen.