Borderline Tuberculoid Leprosy Research Articles

G6PD deficiency in childhood borderline tuberculoid leprosy: A rare case

G6PD deficiency in childhood borderline tuberculoid leprosy: A rare case

Neurological features of Hansen disease: a retrospective, multicenter cohort study

To elucidate the neurological features of Hansen disease. The medical records of patients with confirmed Hansen disease transferred from the neurology department were reviewed, and all medical and neurological manifestations of Hansen disease were assessed. Eleven patients with confirmed Hansen disease, 10 with newly detected Hansen disease and 1 with relapsed Hansen disease, who visited neurology departments were enrolled. The newly detected patients with Hansen disease were classified as having lepromatous leprosy (LL, n = 1), borderline lepromatous leprosy (BL, n = 2), borderline leprosy (BB, n = 2), borderline tuberculoid leprosy (BT, n = 1), tuberculoid leprosy (TT, n = 2), or pure neural leprosy (PNL, n = 2). All of the patients with confirmed Hansen were diagnosed with peripheral neuropathy (100.00%, 11/11). The symptoms and signs presented were mainly limb numbness (100.00%, 11/11), sensory and motor dysfunction (100.00%, 11/11), decreased muscle strength (90.90%, 10/11), and skin lesions (81.81%, 9/11). Nerve morphological features in nerve ultrasonography (US) included peripheral nerve asymmetry and segmental thickening (100.00%, 9/9). For neuro-electrophysiology feature, the frequency of no response of sensory nerves was significantly higher than those of motor nerves [(51.21% 42/82) vs (24.70%, 21/85)(P = 0.0183*)] by electrodiagnostic (EDX) studies. Nerve histological features in nerve biopsy analysis included demyelination (100.00%, 5/5) and axonal damage (60.00%, 3/5). In addition to confirmed diagnoses by acid-fast bacteria (AFB) staining (54.54%, 6/11) and skin pathology analysis (100.00%, 8/8), serology and molecular technology were positive in 36.36% (4/11) and 100.00% (11/11) of confirmed patients of Hansen disease, respectively. It is not uncommon for patients of Hansen disease to visit neurology departments due to peripheral neuropathy. The main pathological features of affected nerves are demyelination and axonal damage. The combination of nerve US, EDX studies, nerve biopsy, and serological and molecular tests can improve the diagnosis of Hansen disease.

Assessment of Clinical, Histopathological, and Bacteriological Findings in Treated Leprosy Patients with Persistent Skin Lesions: A Retrospective Cohort Study.

Since the introduction of multidrug therapy (MDT), various disabilities/morbidities due to leprosy have been prevented. However, there is a subset of patients in whom the skin lesions do not resolve completely or remain unchanged despite a full course of MDT, which is a great source of anxiety to the patient and their family members. Hence, we tried to ascertain the putative causes and risk factors of persistent skin lesions (PSLs) by analyzing the clinical, histopathological, bacteriological, and drug resistance patterns. This is a retrospective, cohort study wherein 35 patients who had PSLs after completion of MDT were included. The majority of the patients were 18 to 30 years of age, with males predominating. Borderline tuberculoid leprosy was the most common clinical spectrum observed (71.4%). The majority had PSLs distributed predominantly over photo-exposed sites (upper limbs > trunk > face). Eight patients (22.8%) had a history of contact with leprosy patients in their family, and six patients (17.1%) had associated comorbidities. Improvement in histopathological parameters such as a decrease in granuloma fraction was observed in 22 patients (62.8%) with PSLs after release from treatment in comparison with baseline. Four patients (11.4%) were noted to have drug resistance (three to rifampicin and one to dapsone). Thus, our study emphasizes that leprosy patients with PSLs after completion of MDT should undergo histopathological evaluation and drug resistance studies.

Our Experience on Unusual Manifestations of Hansen’s Disease - A Case Series

Abstract Hansen’s disease is caused by an acid–fast bacillus – Mycobacterium leprae. Diagnosis of Hansen’s disease is mainly clinical. Hence, it is crucial to be aware of its diverse manifestations. We hereby report three such cases of Hansen’s disease with uncommon presentation. Case 1: A 26-year-old male presented with progressive numbness and multiple skin lesions over both upper and lower limbs in the past 3 years. Case 2: A 26-year-old male presented with tingling sensation of both upper limbs and lower limbs along with multiple skin lesions all over the body in the past 10 months. Case 3: A 39-year-old male presented with multiple joint pain, electric shock-like sensation of both upper limbs, and weakness of both hands along with skin rashes all over the body in the past 1 month. Skin examination of all these patients revealed multiple hypoanesthetic erythematous patches in the involved areas. Nerve conduction study was suggestive of asymmetric sensory motor axonal polyneuropathy. Skin biopsy from the lesions of the first patient revealed epithelioid granulomas suggesting borderline tuberculoid leprosy. Ziehl–Neelsen stain was positive for both fragmented and intact bacilli in the second and third cases, suggesting lepromatous leprosy. All of them were treated successfully with antileprosy drugs. It is essential to consider leprosy as a differential diagnosis in all patients presenting with symptoms of peripheral neuropathy, so that an early diagnosis and treatment is possible.

COVID-19 vaccination and leprosy-A UK hospital-based retrospective cohort study.

Individuals with leprosy are at risk of leprosy reactions, T-cell mediated immunological complications, which lead to nerve function impairment. Leprosy reactions require systemic immunosuppression which is a risk factor for severe COVID-19. Vaccination for SARS-CoV-2 infection is recommended in the UK and became widely available in 2021 with individuals at increased risk of severe disease, including the immunosuppressed, prioritised. Vaccines for SARS-CoV-2 may provoke a T cell response. The latter poses a theoretical risk of provoking an immunological response to latent Mycobacterium leprae infection leading to clinical disease or in those with clinical disease triggering a leprosy reaction. BCG vaccination is associated with the development of leprosy in a small proportion of healthy contacts of people with leprosy within twelve weeks of administration. BCG causes a Th1 immune response. We performed a retrospective cohort study to determine the SARS-CoV-2 vaccination status of individuals diagnosed with leprosy attending the Leprosy Clinic in 2021 and whether any had developed leprosy or experienced a new leprosy reaction within twelve weeks of receiving a dose of a SARS-CoV-2 vaccine. The electronic patient records were used to retrieve data. Fifty-two individuals with leprosy attended the clinic in 2021 of which five people were newly diagnosed with leprosy. Thirty-seven (71%) were male and the median age was 48.5 years old (Range 27-85 years). Eight (15.4%) individuals were taking multi-drug therapy (MDT) and eight (15.4%) had completed MDT within three years of the study. Twenty-two (41.5%) individuals were prescribed a systemic immunosuppressant drug during 2021. Ten (18.9%) individuals have one or more risk factors for severe COVID-19. The SARS-CoV-2 vaccination status of fifty (96%) were recorded of which forty-nine were vaccinated (98%). One individual had declined vaccination. One individual was diagnosed with borderline tuberculoid (BT) leprosy having developed red skin lesions with reduced sensation (which increased in size and number) and thickened peripheral nerves one week after a second dose of BNT162b2 vaccine. Another individual who had completed MDT more than three years earlier developed red plaques and tender thickened nerves consistent with a leprosy Type 1 reaction eight weeks after a single dose of BNT162b2 vaccine (having received two doses of CoronaVac vaccine three months earlier). The development of BT leprosy and a Type 1 reaction in another individual shortly after a dose of BNT162b2 vaccine may be associated with vaccine mediated T cell responses. The benefits of vaccination to reduce the risk of severe COVID-19 outweigh these unwanted events but data from leprosy endemic countries may provide further information about potential adverse effects of augmented T cell responses in individuals with leprosy or latent M. leprae infection.

Quantitative Real-Time Polymerase Chain Reaction for Detection of Mycobacterium leprae DNA in Tissue Specimens from Patients with Leprosy.

In leprosy, early diagnosis is crucial to prevent transmission and onset of disabilities of the disease. The purpose of this study was to determine usefulness of quantitative real-time polymerase chain reaction (PCR) in clinically diagnosed cases of leprosy. Thirty-two leprosy cases were included. The real-time PCR was performed using commercial kit targeting Mycobacterium leprae-specific insertion sequence element. The slit skin smear was positive in two (22.2%) borderline tuberculoid (BT) patients, five (83.3%) borderline lepromatous (BL) patients, and seven (50%) lepromatous leprosy (LL). The positivity of quantitative real-time PCR in BT, BL, LL, and pure neuritic leprosy were 77.8%, 83.3%, 100%, and 33.3%, respectively. Using histopathology as the gold standard, sensitivity of quantitative real-time PCR was 93.1%, and specificity was 100%. The DNA load was higher in LL (3,854.29/106 cells), followed by BL (140.37/106 cells), and BT (2.69/106 cells). Because of the high sensitivity and specificity of real-time PCR, our study strongly suggests the use of real-time PCR as a diagnostic tool for leprosy.

Dendritic Cell Activation in Leprosy Using CD1a and Factor XIIIa Markers.

Leprosy is manifested in varied forms based on the immune status of the patient giving rise to the polar and borderline spectrum of tuberculoid (TT) and lepromatous leprosy (LL). The present study was conducted to assess the macrophage activation in the spectrum of leprosy using CD1a and Factor XIIIa immunohistochemical markers and to correlate the macrophage expression with the morphological spectrum and bacillary index. The present study was an observational study. The present study consisted of 40 biopsy-proven leprosy cases, in which a majority were males, and the most common age group was 20-40 years. The most common type encountered was borderline tuberculoid (BT) leprosy. Expression of epidermal dendritic cells and intensity of staining by CD1a was higher in TT (seven of 10 cases (70%)) when compared to LL (one of three cases (33%)). Similarly, Factor XIIIa showed higher expression of dermal dendritic cells in 90% of TT when compared to LL which was seen in 66%. The increased number and strong intensity of dendritic cells in the tuberculoid spectrum may indirectly indicate macrophage activation and possibly account for the low bacillary index.

Comparison of Serum Levels of Interleukin 17 and Interleukin 9 in Leprosy Patients with and without Lepra Reaction: A Cross-Sectional Analytical Study from Central India.

New pathways of host defence have emerged in leprosy, such as T helper (Th) -17, Th-9, T regulatory cells, and other factors like transforming growth factor-beta, etc. Interleukin (IL) 17 produced by Th17 cells has been found to be elevated in lepra reaction, especially type 2 lepra reaction (T2R). Role of IL-9 has not been studied widely in leprosy reactions so far. The study aimed to compare serum levels of IL-17 and IL-9 in leprosy patients with and without lepra reaction. This was a cross-sectional analytical study including untreated adult leprosy patients with and without lepra reaction. A total of 65 patients were included in the study with 30 leprosy patients without reaction and 35 with lepra reaction. Serum levels of IL-17 and IL-9 were measured in these patients using direct enzyme-linked immunosorbent assay and were compared. Borderline tuberculoid (BT) leprosy with type 1 and Lepromatous (LL) leprosy with T2R patients showed significantly higher levels of IL-17 than BT and LL leprosy patients without lepra reaction, respectively. LL patients with T2R showed significantly lower levels of IL-9 than lepromatous cases without reaction. IL-9 levels were higher in BT patients with T1R as compared to BT patients without reaction but the difference was not significant. We found evidence in support of role of IL-17 in the pathogenesis of T2R, which might serve as useful serum markers for the same. IL-17 might have a role in BT leprosy with T1R. IL-9 seems to have a protective role in T2R as opposed to IL-17, working in synergism with Th1 cytokines.

To Study Utility and Practicality of High-Frequency Ultrasonography to Demonstrate Nerve Involvement in Leprosy

ABSTRACT Background: Nerve examination in leprosy is subjective. There is a paucity of literature on objective methods to evaluate nerve involvement in Leprosy. Aims and Objectives: (1) To measure cross-sectional area (CSA) of nerves and identify echotexural changes in nerves in patients of leprosy by high-frequency ultrasonography (HFUS). (2) To compare HFUS findings in CSA and echotexture of nerves at baseline and after treatment. (3) To compare clinical grading and HFUS grading of nerves before and after treatment. Methods: Both newly diagnosed and treated patients of leprosy were included in the study. Nerve examination was done clinically and clinical grading of nerve thickening was done. Then, thickened nerves were subjected to HUFS to examine CSA (CSA) and echotextural changes. Nerves were also graded by HFUS grading. Parameters such as CSA, echotextural changes, and clinical and HFUS grading were compared before and after completion of treatment. Observations: Sixty-four leprosy patients were studied. Most of the patients in our study were in the third and fourth decade with a male preponderance and the mean age of presentation is 35.75 years. A total of 154 peripheral nerves were studied in 64 leprosy patients. Borderline tuberculoid leprosy (BTH) was the most common type of leprosy. The ulnar nerve was the most commonly imaged nerve followed by the greater auricular nerve. There was a statistically significant difference in CSA of nerves before and after treatment. Only 7 of 23 patients, who were found to have features of neuritis on USG, were clinically symptomatic. Three patients were diagnosed to have nerve abscesses. Conclusion: HFUS appears to be an objective, simple method to evaluate nerve involvement in leprosy. It is also useful to diagnose silent neuritis and nerve abscess. Limitations: All the peripheral nerves were not examined in healthy controls and leprosy patients.

Histopathological Evaluation of Skin Biopsies of Leprosy at a Tertiary Care Centre of Western Rajasthan, India: A Cross-sectional Study

Introduction: Leprosy is a slowly progressive chronic granulomatous disease caused by Mycobacterium Leprae (M. leprae) and predominantly affects skin and peripheral nerves. Leprosy is a leading cause of physical disability in India and poses a major public health challenge for the country. Histopathological evaluation and demonstration of Lepra bacilli by special stain is gold standard for definitive diagnosis and subtyping of leprosy. Aim: To study the common histological subtypes of leprosy on the basis of microscopic features and bacteriological index. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Dr. S.N. Medical College, Jodhpur, Rajasthan, India. The duration of the study was two years and 11 months, from January 2019 to December 2021. A total of 55 skin biopsies which were histologically diagnosed as different types of leprosy were included. Patients data of age, gender, skin examination and other investigations were collected from the requisition forms and analysed. After proper fixation and processing of biopsy samples, Haematoxylin and Eosin (H&E) stained sections were examined for epidermal atrophy, presence of grenz zone, granulomas, infiltrates of lymphocytes, histiocytes, foam cells, infiltration of nerves and adnexa. The sections stained with Fite-Faraco stain were studied for the assessment of bacteriological index. On the basis of microscopic features, cases were categorised into tuberculoid leprosy, borderline tuberculoid leprosy, indeterminate leprosy, borderline leprosy, lepromatous leprosy and histoid leprosy as per Ridley-Jopling classification and percentage is calculated for each category. Data was entered and analysed by using Microsoft Excel version 2008 and Statistical Package for Social Sciences (SPSS) version 23.0. Results: The mean age of the study participants was 39.6 years. Male to female ratio was 2.92:1. There were 33 (60%) cases with erythematous lesions followed by 15 (27.27%) hypopigmented lesions and 7 (12.73%) nodules. Out of 55 there were 21 (38.18%) cases of tuberculoid leprosy followed by 11 (20%) cases of borderline tuberculoid leprosy, 8 (14.55%) cases of indeterminate leprosy, 6 (10.91%) cases of borderline leprosy, 5 (9.09%) cases of lepromatous leprosy and 4 (7.27%) cases of histoid leprosy. Bacteriological index was negative in 35 (63.64%) cases followed by 2+ in 6 (10.91%) cases, 5 (9.09%) had index of 4+, 4 (7.27%) cases had index of 3+, 3 (5.45%) had index of 1+, and 1 (1.82%) case had index of 5+ and 6+ each. Conclusion: Skin biopsy is easy, simple, inexpensive and outpatient procedure which provides adequate material for confirmation of the clinical diagnosis and further management. Histopathological examination including microscopic features of H&E stained sections, along with assessment of bacteriological index on Fite-Faraco stained sections remain the gold standard for diagnosis and subtyping of leprosy cases.

External Jugular Veinous Thrombosis: A Rare Presentation of Hansen’s Disease

Veinous thrombosis is a rare manifestation of leprosy (Hansen’s disease). In this case report, we bring to notice this extremely rare presentation and challenges faced during management. A 26-year-old young healthy individual presented with painless cord-like swellings on both sides of the neck for 1 month. This was evaluated to be external jugular vein (EJV) thrombosis on ultrasonography Doppler. Trying to evaluate the cause of the thrombosis, there was no specific etiology found. On further detailed evaluation, it was found that he had hypopigmented skin patches. This led to the diagnosis of borderline tuberculoid leprosy downgrading to borderline lepromatous in type 1 lepra reaction. He responded to rifampicin, clofazimine, and dapsone with progressive resolution of skin lesions. Simultaneous treatment with apixaban caused complete resolution of EJV thrombosis. Further evaluation revealed heterozygous methylenetetrahydrofolate reductase mutation and beta-2-glycoprotein immunoglobulin M positivity. An extensive literature review suggested that intimal damage caused by lepra bacilli can lead to veinous thrombosis in Hansen’s disease. However, the interplay of genetic procoagulant predispositions in phenotypic presentation is yet to be determined.

1427. Correlation of Dermoscopic and Histopathologic Patterns in Leprosy-a Pilot Study

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. It is diagnosed based on clinical features and confirmed on the histological findings and peripheral slit skin smear staining. Dermoscopy is a handy easily accessible tool to diagnose this granulomatous disease and classify patients based on the immunological and clinical response. Methods A total of 50 patients in different poles of leprosy were evaluated as a single spot observational analysis. The clinical and histological findings were correlated with the characteristic dermoscopy findings. A Lepromatous leprosy showing xerosis and scaling along leg as part of glove and stocking distribution of lesions Dermoscopic pattern in lepromatous leprosy showing partial loss of hair follicles, dry xerotic skin, and white characteristic scaling (Heine Delta® 20 T dermatoscope; 16×; polarizing) Results The dermoscopy findings correlated with the clinical and histological findings. Tuberculoid poles of leprosy classically showed loss of hair and skin pigment along with absence of white dots as sweat glands in dermoscopy. Lack of blood vessel changes ruled out any lepra reaction. Lepromatous pole of leprosy on the other hand showed characteristic xerosis and white scaling on dermoscopy in the background of hypotrichosis and hypopigmentation. leprosy reactions were characterized by blood vessel changes and arborizing blood vessels were characteristic in erythema nodosum leprosum and a diffuse erythema was a clue towards diagnosing type I lepra reaction. Interestingly clofazimine induced pigmentation was picked up characteristically on dermoscopy as a ‘honey comb pattern’. Borderline tuberculoid leprosy with a hypoaesthetic patch on the left side of face with a thickened greater auricular nerve Dermoscopic pattern in borderline tuberculoid leprosy showing white areas with loss of hair follicles. In between yellow globules can be seen which was the hallmark apart from white areas demonstrating hypopigmentation. Absence of blood vessels rules out lepra reaction (Heine Delta® 20 T dermatoscope; 16×; polarizing) Conclusion Dermoscopy is certainly a handy tool in aiding the diagnosis of leprosy, lepra reactions and course of therapy. Characteristic patterns during the course of leprosy would certainly facilitate a quick and definitive diagnosis of patients suffering from leprosy. Also patient drug compliance particularly to Clofazimine can also be picked up objectively on Clofazimine. Multiple erythematous plaques on the back depicting type 1 lepra reaction Dermoscopic features of type I lepra reaction showing characteristic diffuse erythematous background and branching telangiectatic vessels along with sparse hair follicles and scaling (Heine Delta®20 T dermatoscope; 16×; polarizing) Disclosures All Authors: No reported disclosures.

The scenario of lepra reactions in a tertiary care hospital in Central Karnataka

<p class="abstract"><strong>Background:</strong> Leprosy is a chronic disease with a benign course. Even though it is a curable disease, due to presence of bacilli in tissue hypersensitivity reaction may develop called lepra reactions. This study is conducted to see the number of patients with reactions, their onset, presentation, course and response to treatment.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study conducted over the period of 2 years from January 2017 to December 2019 in a tertiary care hospital of JJM Medical College at Davanagere. All confirmed cases after doing biopsy were included in the study. All the cases were classified according to Ridley-Jopling classification. Treatment was started based on World Health Organization (WHO) criteria for paucibacillary and multibacillary, for the duration of 6 months and 12 months accordingly.<strong></strong></p><p class="abstract"><strong>Results:</strong> Over the period of 2 years 178 cases of leprosy were registered. The majority of patients were seen in borderline tuberculoid leprosy spectrum (BT) that is in 29.2% of the patients, followed by in lepromatous leprosy (LL) seen in 26.4% of the patients. Lepra reactions were seen in 41 (23.03%) patients. Type 2 reaction (T2R) were more commonly observed that is in 27 patients (65.8%), type 1 reaction (T1R) is seen in 14 patients (34.1%). T2R were observed more commonly in LL spectrum.</p><p class="abstract"><strong>Conclusions:</strong> Reactions are more damaging than the disease itself. Hence, early diagnosis and proper management is important to prevent further reactions. This is can be done by good clinical knowledge about the disease and reactions and proper follow up of cases.</p>

Diagnosing and treating leprosy in a non-endemic setting in a national centre, London, United Kingdom 1995-2018.

Leprosy is rare in the United Kingdom (UK), but migration from endemic countries results in new cases being diagnosed each year. We documented the clinical presentation of leprosy in a non-endemic setting. Demographic and clinical data on all new cases of leprosy managed in the Leprosy Clinic at the Hospital for Tropical Diseases, London between 1995 and 2018 were analysed. 157 individuals with a median age of 34 (range 13-85) years were included. 67.5% were male. Patients came from 34 different countries and most contracted leprosy before migrating to the UK. Eighty-two (51.6%) acquired the infection in India, Sri Lanka, Bangladesh, Nepal and Pakistan. 30 patients (19.1%) acquired leprosy in Africa, including 11 from Nigeria. Seven patients were born in Europe; three acquired their leprosy infection in Africa, three in South East Asia, and one in Europe. The mean interval between arrival in the UK and symptom onset was 5.87 years (SD 10.33), the longest time to diagnosis was 20 years. Borderline tuberculoid leprosy (n = 71, 42.0%), and lepromatous leprosy (n =, 53 33.1%) were the commonest Ridley Jopling types. Dermatologists were the specialists diagnosing leprosy most often. Individuals were treated with World Health Organization recommended drug regimens (rifampicin, dapsone and clofazimine). Leprosy is not a disease of travellers but develops after residence in an leprosy endemic area. The number of individuals from a leprosy endemic country reflect both the leprosy prevalence and the migration rates to the United Kingdom. There are challenges in diagnosing leprosy in non-endemic areas and clinicians need to recognise the symptoms and signs of leprosy.

Morphea overlapping borderline leprosy: An unusual association

Leprosy, or Hansen’s disease, is a chronic infectious disease with a low transmission rate, affecting the skin, peripheral nerves, eyes, and mucous membranes of the upper respiratory tract, yet it may also be systemic. Cases of borderline leprosy are the acute or subacute stages of the disease. They are immunologically unstable and reflect the gradual variation in resistance against the etiological agent. Localized scleroderma or morphea is a fibrosing disease of the skin and underlying tissues that results from the disrupted function of growth factors (platelet-derived growth factor, i.e., PDGF) and receptor expression (as in the case of transforming growth factor b, i.e., TGF-b). Herein, we report a female patient with borderline tuberculoid leprosy (BT) who, during multidrug treatment (MDT), developed an indurated lesion of morphea exactly on the surface of an infiltrated patch.

EXPRESSION OF S100 PROTEIN AND CD1A MARKER IN LESIONS OF LEPROSY

Background: Leprosy rst described in ancient Indian texts is a nonfatal, chronic infectious disease caused by Mycobacterium leprae. Histological diagnosis is deemed the gold standard for diagnosis of leprosy. Immunohistochemical markers play an important role in monitoring of progression of the disease and effect of treatment. SlOO protein was produced robustly and continuously in macrophages from Lepromatous leprosy patients' lesions. Distinguishing characteristics of LCs suggested that their expression of langerin may enable them to capture certain antigens when they reach the epidermal layers, and that at least some of these antigens might be delivered to CD1a-restricted T cells. In the present study, both S100 protein and CD1a expression has been studied on 38 cases of leprosy cases for assessing the hypothesis. Objectives: Histopathological differentiation of types of leprosy and correlate the expression of S100 protein and CD1a antibody. This study Methodology: was conducted in Department of Pathology, Gandhi Medical College, & Associated Hospitals, Bhopal between 1st January 2020 to 30th June 2021. Skin biopsies received in Department of Pathology, Gandhi Medical College and Hamidia Hospital, Bhopal. Information was taken from requisition forms received in Department of Pathology. History of cases was also taken through case les and interview. The samples were processed for histopathology evaluation and immunohistochemistry staining for S100 and Cd1a. In Results: our study, out of 38, 52.63% cases were diagnosed to be Indeterminate leprosy followed by 23.68 cases of Tuberculoid leprosy , Borderline tuberculoid and Lepromatous leprosy cases were 13.16% and 10.53% in numbers respectively. Cross tabulation for S100 positivity as per histological diagnosis showing that all Lepromatous leprosy cases gave positive expression for this IHC marker whereas all Tuberculoid leprosy cases were negative. Out of 5 cases of BT, 3 were S100 positive and 2 out of 20 cases of IL gave positivity. All Tuberculoid cases (except 1) gave positivity for CD1a and all Lepromatous cases were negative. Out of 20 IL cases, 9 gave positivity. All 5 BT cases gave positivity. Owing to treatment, early or late presentations, Summary: immunological status of the host, histo-morphology may vary as well, however, it remains to be the gold standard of diagnosis. Our study evaluated the role IHC markers namely S100 and CD1a as an ancillary technique to support histopathological diagnosis and guide early and more specic diagnosis in early leprosy cases, assess host's immune status as well as hint towards transition through the spectrum.

A study of histopathological analysis and clinico-pathological correlation of leprosy in urban industrial area

Leprosy is a chronic infectious granulomatous disease caused by Mycobacterium leprae, with a prevalence rate corresponded to 0.2/10000. Skin and peripheral nerves are mainly affected exhibiting spectrum of clinical and histopathological features based on the immunological status of the individual. The diagnosis is made from adequate clinical information combined with histopathology. The aim of study to asses the clinical and histopathological features and there correlation in diagnosing the cases of leprosy.A cross-sectional study of 2 years was conducted on 99 cases of skin biopsies histopathologically diagnosed with leprosy. Adequate clinical history was obtained and biopsies were stained with hematoxylin and eosin and modified Fite Faraco stain. A clinicopathological correlation was then attempted along with statistical analysis. Out of the total 99 leprosy cases, maximum cases (34.34%) belonged to third decade of life with Male to Female ratio of 1.75:1. About 58.59% of the total cases of leprosy showed decreased sensations and nerve thickening was seen in 79.80% cases. Clinically, 45.46% lesions were erythematous plaques. Borderline tuberculoid leprosy (31.68%) was the most frequently diagnosed subtype of leprosy. Evaluation of agreement and correlation between clinical and histopathological classification of leprosy showed an overall agreement of 57.57%. Correlation was more in stable poles i.e. TT tuberculoid pole (TT) and lepromatous pole (LL). Leprosy is still a prevalent disease which raises the concern about therapeutic approaches and various health programmes. It may not have a classical clinical picture always. Many factors contribute in clinicopathological discordance. Hence, diagnostic efficacy can be improved by clinic- histopathological corroboration which includes morphological examination of the skin lesion along with proper clinical history and correlation of these findings with histopathological examination findings.

DAPSONE HYPERSENSITIVITY SYNDROME - A CASE REPORT AT TERTIARY CARE HOSPITAL

Dapsone a sulfonamide drug used mainly in the treatment of Leprosy and various other several bacterial infections. Rarely Dapsone can lead to hypersensitive reaction characterised by fever, yellowish sclera and other systems involved. We report a 17 year old patient presented with fever, jaundice and generalised edema with a history of borderline tuberculoid leprosy receiving Dapsone, clofizamine and Rifampicin. After confirming Dapsone Hypersensitivity Syndrome, Dapsone is stopped and treated with corticosteroids, antibiotics, Glutathione and patient recovered gradually.

Leprosy as immune reconstitution inflammatory syndrome in patients living with HIV: Description of French Guiana's cases over 20 years and systematic review of the literature.

HIV infection is highly prevalent in French Guiana, a territory where leprosy is also endemic. Since the introduction of Highly Active Antiretroviral Treatment (HAART) in the management of HIV, leprosy has been reported as part of the immune reconstitution inflammatory syndrome (IRIS). We aimed to present a general description of these forms of leprosy as IRIS, highlighting clinical and therapeutic specificities. A retrospective study was conducted in French Guiana, including patients living with HIV (PLHIV) with advanced infection (CD4 < 200/mm3) and developing leprosy or a leprosy reaction within six months of HAART initiation, from 2000 to 2020. Clinical, histological and biological data were collected for all these patients. Six patients were reported in French Guiana. A systematic review of the literature was conducted, and its results were added to an overall analysis. Overall, seventy-three PLHIV were included. They were mainly men (74%), aged 22-54 years (median 36 years), mainly from Brazil (46.5%) and India (32.8%). Most leprosy cases (56.2%) were borderline tuberculoid (BT). Leprosy reactions were frequent (74%), mainly type 1 reaction (T1R) (68.5%), sometimes intense with ulceration of skin lesions (22%). Neuritis was observed in 30.1% of patients. The outcome was always favorable under multidrug therapy (MDT), continuation of HAART and additional corticosteroid therapy in case of neuritis or ulceration. There was no relapse. Leprosy as IRIS in PLHIV mainly presents as a BT leprosy in a T1R state, sometimes with ulcerated skin lesions. Response to MDT is usually good. Systemic corticosteroids are necessary and efficient in case of neuritis.

Clinical and epidemiological trends in childhood leprosy: A 20-year retrospective analysis from a tertiary care hospital in Jammu, North India.

Background Slightly more than half the total number of childhood leprosy cases worldwide are from India. Aim To analyze the clinical and epidemiological trends of childhood leprosy over 20 years in a tertiary care hospital. Methods We retrieved the medical records of all children less than 15 years of age registered in the leprosy clinic between April 1998 and March 2018. We tabulated and analyzed data pertaining to demographic details along with clinical findings such as cutaneous lesions, nerves involved, sensory loss, deformities, reactions, smear status, histopathology and treatment. Results Out of total 1548 leprosy cases registered during the study period, 55 (3.55%) cases of childhood leprosy were diagnosed. Thirty five (63.6%) children were in the age group of 11-15 years and 83.7% were migrants from other states. Thirteen (23.6%) children reported contact with a diagnosed case of leprosy, mainly in close contacts. Fifty three (96.4%) children presented with cutaneous lesions while 2 (3.6%) had pure neural involvement. Borderline tuberculoid leprosy was the most common clinical presentation in 27 (49.1%) followed by borderline lepromatous leprosy in 11 (18%). Thickened peripheral nerve trunks were detected in 42 (76.4%), most commonly the ulnar nerve. Reactional episodes occurred in 12 (21.8%) cases (Type 1 reaction, 10 (18.2%); Type 2 reaction, 2 (3.6%)). Grade 2 disability was detected in 4 (7.3%). Multidrug therapy was started in all patients, multibacillary (MB) regimen in 42 (76.3%) patients and paucibacillary (PB) regimen in 13 (23.7%). Twenty five (45.4%) children defaulted from the treatment. On comparing the data of 2008-18 with that of the previous decade (1998-2007), there was a higher proportion of migrant cases as compared to local cases (3:1-11:1) and MB cases as compared to PB cases (2:1-6:1). The proportion of treatment defaulters declined from 60% to 36%. Limitations Relapse rate could not be calculated due to inadequate follow-up period. As it is a hospital-based retrospective study with no active surveys, these findings may not reflect trends in the community. Conclusion Childhood leprosy continues to be a significant problem. There is a clear need to strengthen early detection, treatment and regular follow-up of these cases in both high and low endemic settings.