Date Published: May 17, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Jason Samona, Scott Samona, Cameron Samona, S. Gopalakrishnan, P. Shekhar, D. Kubern, P. S. Mohan Kumar, Reza Nassiri.
No other research paper has ever been written about leprosy in this manner. The orthopedic and surgical implications, as well as the functional debility caused by the disease, have not been previously explained by past research as they have in such a comprehensive manner in this paper. The results of this study have regional and global implications as they pertain to disease pathology, risk factor recognition/disease prevention, and treatment. This paper is a unique, in that it also serves as a combination of a review of the current medical literature, as well as an epidemiological survey of the disease in a region of the world which has never been researched in the past. Clinical data points to the possibility of a new strain of the disease. This information is of significance because it effects prevention and improved treatment of the disease, which leads to devastating sequela. This was a cross-sectional study involving subjects diagnosed with leprosy in the Chengalpet region of the Kancheepuram District, of the Tamil Nadu state of India. The study was performed at the Tamil Nadu Medical College Teaching Hospital and Research Center. This study included various physical examinations, observation and survey of lesions, questionnaires in regard the debilitating orthopedic and medical effects of the disease, as well as treatment options.
This paper is a unique, in that it is a combination of a review of the current medical literature, as well as an epidemiological review and survey of the disease in a region of the world which has never been researched in the past. The review of the literature presents information discovered in recently performed clinical studies, government and health care run epidemiological reviews, as well as historical facts about the disease. In order to gain a full understanding of the disease process, the investigation also reviewed epidemiological factors. India is home to the largest number of leprosy patients on earth. Although leprosy research has been conducted in India in the past, the Chengalpet region completely lacks any previous investigations. This paper also serves as a research paper revealing unique clinical information. No other paper has ever been written about leprosy and its orthopedic effects in this manner, ever before. This is a comprehensive study of the disease, especially focusing on the orthopedic considerations, risk factors, and treatments. The results of this study have regional and global implications as they pertain to disease pathology, risk factor recognition/disease prevention, and treatment. This disease rarely receives orthopedic attention, and it is a unique topic of discussion.
In this observational cross-sectional study, we have examined diagnosed leprosy patients at a medical college hospital and research center located in the Chengalpet region of Kancheepuram District, Tamil Nadu state of India. The hospital is located in a rural area and it is the only medical facility within a 16-mile radius. The facility serves a population of 15,000 individuals where over 100 individuals are confirmed to suffer from the disease of leprosy. The study was conducted on patients attending the outpatient department. All the subjects were of Indian descent and were born in India. Data was collected over a 60-day period at the hospital/research center, from approximately the months of January of 2011 until March of 2011. The subjects of this study were lifelong residents of the region and regular patients of this medical facility. They received all of their medical treatment from this hospital, as confirmed by questioning of the patient, the medical staff who were familiar with the patients, and review of medical records. Therefore we can claim that the vast majority of the treatment and disease progression was supervised at this one hospital. All leprosy patients who came to the hospital during the 60-day study were asked if they would be willing to participate in this study, therefore no specific selection process used. Therefore this avoids bias as to who was chosen as subjects in the study and also displays an accurate representation of the overall leprosy population in this region via random selection process.
The lesions and their distribution are displayed in Table 1. The vast majority of the lesions were found to be located on the extremities, attributing to the devastating orthopedic effects of this disease. The upper extremity lesions accounted for 32.5%, and the lower extremity lesions were 37.7%. For the anatomical region of the first noted lesion the extremities were the most numerous as well, upper extremity with 33% and the lower extremity with 25%.
Hansen’s disease affects both men and woman in different proportions, but in most regions there is a strong male preponderance of infected individuals. The difference in distribution between the sexes is so drastic that it is very common to have a male-to-female ratio of 2 : 1 in the regions of the world including India, the Philippines, Hawaii, Venezuela, and Cameroon. There is occasionally a larger prevalence among females, as observed in Uganda, Nigeria, Malawi, Gambia, Burkina Faso, Zambia, Thailand, and Japan . This study revealed that 57% of the patients were male, and 43% were female. This is clearly not the 2 : 1 ratio that is known to occur in the country of India. Genotyping of 475 strains of mycobacterium leprae from six different countries has already been completed as most recent studies have shown . There lacks sufficient research as to how many different strains of mycobacterium lepromatosis exist. Each strain of the disease will present with signs and symptoms we collectively call “leprosy,” but each strain has its own unique characteristics in terms of age and sex distribution, and so forth . Due to the fact there is less research in this region of India, the discordance from the 2 : 1 ratio may be due a new undiscovered strain predominating in this region as compared to the rest of India.
The demographic factors like age and sex distribution of the leprosy patients in this region of the world are in conflict with previously stated rates and figures. The degree of neurological deficits is also different from those found in previous studies. The authors of this paper claim a new undiscovered strain of bacterium to be the causative agent of these differences. It is a well known fact that different parts of the world have different causative agents leading to the varying clinical presentation known as leprosy. This is a very unique and substantial proposal. Clinical data points to the possibility of a new strain of the disease. The authors call on future research to identify this unique strain. This information is of significance because it effects prevention and improved treatment of the disease, which leads to devastating orthopedic implications as quantified and displayed in the paper by lesions, functional and neurological sequela, disability ratings, and the need for surgical intervention.