Leprosy in Children [antikvár]

INTRODUCTION G. Browne ^ The cursory references to leprosy in standard texts on paediatrics, even in those written in tropical countries and intended for medical students and practitioners in those countries, give the impression that leprosy is very rare in children and does not enter into the differential diagnosis of chronic dermatoses or the peripheral neuropathies. This is far from being the case, and the illustrated text prepared by Dr F. M. Noussitou is therefore very welcome. , Dermatologists practising in departments attached to the central hospitals in capital cities in the tropics may gain a totally erroneous impression of the prevalence of skin disease in general and of leprosy in particular if they confine their professional interests to the highly selected population that presents in the average children's clinic. Nor, for that matter, does the practitioner in a peripheral hospital fare much better. And unless the doctor or medical auxiliary sees every little patient in his catchment area who is suffering from some persistent abnormality of the skin or peripheral nerves, he too might be deluded into thinking that leprosy is a rare condition among children. As Dr Noussitou is at pains to point out, a thorough inspection of the skin is all-important. A history of a family contact may help, especially of contact with a patient known to be suffering from a multibacillary form of leprosy, but the supposedly innocuous " closed " or non-contagious forms are often apparently the source of infection, and the general level of child infection in a community may reflect a kind of background or threshold exposure of all children, irrespective of household contact. The epidemiological implications of this deduction are obvious. The observant and thoughtful clinician embarking on a serious study of leprosy in children will soon find himself questioning accepted definitions of " exposure " and "contact" and "proximity", and will be forced willy-nilly to use all his professional wits in the search for "index cases" and "viable bacilli" and "portals of exit". From regular and thorough examination of contacts of known leprosy sufferers—always with an eye to avoiding the creation of stigma and alarm—he will proceed to school surveys and whole population surveys in order to ascertain the baselines for the therapeutic and preventive measures he recommends and implements. » Director, The Leprosy Study Centre, London, United Kingdom.