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      Leprosy in Elderly and Children among New Cases – A 3-Year Retrospective Study

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          Abstract

          Background:

          Leprosy occurs in all age groups, with adults constituting the majority. However, leprosy in children always drew the attention of epidemiologists as a guide to transmission of leprosy. With increasing life expectancy and decreasing prevalence of leprosy, there is going to be a significant rise of leprosy among elderly in India. In elderly leprosy patients, clinical signs are often quiet, which makes it a hidden source of infection. The detection of leprosy in elderly is of epidemiological importance, hence it is critical that due attention be given to leprosy in elderly as a possible contributor to hidden leprosy in India.

          Aim:

          To analyze leprosy in elderly and in children from the records of new patients seen over the past 3-year period.

          Methods:

          Analysis of details of “leprosy in elderly” and “leprosy in children'” from the records of new leprosy patients seen at a dermatology OPD of a teaching hospital over a period of 3 years.

          Results:

          Out of 157 patients, 34 (21.6%) were above 45 years, while 18 (11.4%) were below 15 years, the difference being statistically significant ( P > 0.05). Bacteriological Index (BI) values in elderly were higher compared to children. In addition, elderly had a higher percentage of multibacillary (MB) leprosy compared to children both clinically (35% vs 22%) and histopathologically (38% vs 22%).

          Conclusion:

          Leprosy in elderly is an important entity, and there is a need to study it as a distinct group. It will provide information on hidden leprosy load and apprise us on sources of infection in the community.

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          Most cited references18

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          T cell replicative senescence in human aging.

          The decline of the immune system appears to be an intractable consequence of aging, leading to increased susceptibility to infections, reduced effectiveness of vaccination and higher incidences of many diseases including osteoporosis and cancer in the elderly. These outcomes can be attributed, at least in part, to a phenomenon known as T cell replicative senescence, a terminal state characterized by dysregulated immune function, loss of the CD28 costimulatory molecule, shortened telomeres and elevated production of proinflammatory cytokines. Senescent CD8 T cells, which accumulate in the elderly, have been shown to frequently bear antigen specificity against cytomegalovirus (CMV), suggesting that this common and persistent infection may drive immune senescence and result in functional and phenotypic changes to the T cell repertoire. Senescent T cells have also been identified in patients with certain cancers, autoimmune diseases and chronic infections, such as HIV. This review discusses the in vivo and in vitro evidence for the contribution of CD8 T cell replicative senescence to a plethora of age-related pathologies and a few possible therapeutic avenues to delay or prevent this differentiative end-state in T cells. The age-associated remodeling of the immune system, through accumulation of senescent T cells has farreaching consequences on the individual and society alike, for the current healthcare system needs to meet the urgent demands of the increasing proportions of the elderly in the US and abroad.
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            Does tuberculosis threaten our ageing populations?

            Background The global population is ageing quickly and our understanding of age-related changes in the immune system suggest that the elderly will have less immunological protection from active tuberculosis (TB). Discussion Ongoing global surveillance of TB notifications shows increasing age of patients with active TB. This effect of age is compounded by changes to clinical manifestations of disease, confounding of diagnostic tests and increased rates of adverse reactions to antimicrobial treatment of TB. Future epidemiological surveillance, development of diagnostic tests and trials of treatment shortening should all include a focus on ageing people. Summary More detailed surveillance of TB notifications in elderly people should be undertaken and carefully evaluated. Risk stratification will help target care for those in greatest need, particularly those with comorbidities or on immunosuppressive therapies. Novel diagnostics and treatment regimes should be designed specifically to be used in this cohort.
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              Multibacillary leprosy by population groups in Brazil: Lessons from an observational study

              Background Leprosy remains an important public health problem in Brazil where 28,761 new cases were diagnosed in 2015, the second highest number of new cases detected globally. The disease is caused by Mycobacterium leprae, a pathogen spread by patients with multibacillary (MB) leprosy. This study was designed to identify population groups most at risk for MB disease in Brazil, contributing to new ideas for early diagnosis and leprosy control. Methods A national databank of cases reported in Brazil (2001–2013) was used to evaluate epidemiological characteristics of MB leprosy. Additionally, the databank of a leprosy reference center was used to determine factors associated with higher bacillary loads. Results A total of 541,090 cases were analyzed. New case detection rates (NCDRs) increased with age, especially for men with MB leprosy, reaching 44.8 new cases/100,000 population in 65–69 year olds. Males and subjects older than 59 years had twice the odds of MB leprosy than females and younger cases (OR = 2.36, CI95% = 2.33–2.38; OR = 1.99, CI95% = 1.96–2.02, respectively). Bacillary load was higher in male and in patients aged 20–39 and 40–59 years compared to females and other age groups. From 2003 to 2013, there was a progressive reduction in annual NCDRs and an increase in the percentage of MB cases and of elderly patients in Brazil. These data suggest reduction of leprosy transmission in the country. Conclusion Public health policies for leprosy control in endemic areas in Brazil should include activities especially addressed to men and to the elderly in order to further reduce M. leprae transmission.
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                Author and article information

                Journal
                Indian Dermatol Online J
                Indian Dermatol Online J
                IDOJ
                Indian Dermatology Online Journal
                Wolters Kluwer - Medknow (India )
                2229-5178
                2249-5673
                Mar-Apr 2021
                02 March 2021
                : 12
                : 2
                : 294-297
                Affiliations
                [1] Department of Dermatology, Deccan Medical College, Hyderabad, Telangana, India
                [1 ] Department of Dermatology, Navodaya Medical College, Raichur, Karnataka, India
                Author notes
                Address for correspondence: Dr. Potharaju Arunraghav, Department of Dermatology, Deccan Medical College, Hyderabad, Telangana, India. E-mail: arunraghav.potharaju@ 123456gmail.com
                Article
                IDOJ-12-294
                10.4103/idoj.IDOJ_177_18
                8088175
                33959528
                bc5d9a0f-05ae-4c1c-ae24-ce315d823ea1
                Copyright: © 2021 Indian Dermatology Online Journal

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 22 June 2018
                : 20 November 2020
                : 14 December 2020
                Categories
                Brief Report

                Dermatology
                child leprosy,hidden leprosy,leprosy in elderly
                Dermatology
                child leprosy, hidden leprosy, leprosy in elderly

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