A critical appraisal on pure neuritic leprosy from India after achieving WHO global target of leprosy elimination

Background: Clinical data on pure-neuritic leprosy (PNL) is limited. Objective: To study the clinical and epidemiological features of PNL in the leprosy post-elimination era. Methods: This was a retrospective analysis of the clinic records of leprosy patients from January 2006 to June 2013. Data regarding age, sex, disease duration, presenting complaints, nerves affected, complications and treatment received were extracted from PNL cases. Results: Among 906 registered leprosy cases, 48 (5.3%) were found to have PNL. The mean age was 36.9 +/- 16.2 years and predominantly males were affected (85.4%). The mean delay between onset of symptoms and diagnosis was 2.1 +/- 2.2 years. Multiple nerves were affected in 36 patients (75%) and 12 (25%) had only one nerve involved. Visible deformities at presentation were noted in 32 (66.7%) patients. Forty patients (83.3%) were treated with multi drug therapy-multibacillary (MDT-MB) regimen and three (6.25%) were treated with MDT-paucibacillary regimen. Twenty-one patients (43.8%) were considered positive responders to treatment. There was no correlation between the duration of NFL and treatment outcome. Conclusion: PNL continues to occur in the post-elimination era. Grade 2 deformities are common in PNL compared to other leprosy patients because of delayed diagnosis and treatment. Distinct diagnosis and treatment guidelines and sensitisation of health care workers and physicians to the occurrence of PNL is the need of the day.