Borderline Tuberculoid Research Articles

Diagnostic And Post-Therapeutic Histopathology Of Hansen’s Disease in a Man With Rheumatoid Arthritis

Abstract Introduction/Objective Hansen’s Disease (leprosy), caused by Mycobacterium leprae, is a chronic infectious disease primarily affecting the skin and peripheral nerves. In the United States, leprosy remains rare, with less than 200 cases per year reported to the CDC. Diagnosis is often delayed, due to low clinical suspicion and lack of experience among healthcare providers, leading to potentially severe complications and increased transmission risk. Methods/Case Report A 71-year-old man presented to dermatology with a progressive, non-tender erythematous rash involving the arms and chest. He denied any travel history, or exposure to armadillos, and had no family history of a similar rash. His medical history was significant for rheumatoid arthritis, for which he was receiving methotrexate. The clinical differential included drug eruption, tinea infection, or sarcoidosis. Skin biopsy revealed extensive infiltration of the dermis by noncaseating granulomas surrounding cutaneous nerves, and AFB stain highlighted numerous bacilli consistent with Mycobacterium leprae, leading to the diagnosis of Hansen’s disease. The WHO classification was multibacillary leprosy, and the Ridley-Jopling classification was borderline tuberculoid (BT) to perhaps mid borderline (BB), based on clinical and histologic features. He was started on triple therapy, and biopsies performed during treatment, as well as at three years follow up showed marked improvement, with some remaining disease detected in unresolved rash. Results (if a Case Study enter NA) NA Conclusion This case presents a diagnostic challenge given the absence of typical risk factors for Mycobacterium leprae transmission. The patient’s immunocompromised status due to methotrexate therapy may have predisposed him to the disease. Documented cases of Hansen’s disease have more than doubled in the southeastern states since 2013, with concern for endemic regions emerging in Florida. Early recognition, classification, and prompt treatment are essential to prevent disease progression and reduce transmission. Increased education and awareness among healthcare providers are crucial to improving diagnostic accuracy and patient outcomes in cases of leprosy.

Hansen’s disease: Is histopathological correlation mandatory for all clinically diagnosed patients? A descriptive study in a tertiary care hospital

Background: Leprosy has been historically associated with social stigma and discrimination. Leprosy, also known as Hansen’s disease, is indeed a chronic infectious disease caused by the bacterium Mycobacterium leprae. Diagnosis of leprosy is usually done by clinically and classified as multibacillary (MB) and paucibacillary (PB). The disease was also classified into different types based on histopathological findings, such as tuberculoid, borderline tuberculoid (BT), mid-borderline, borderline lepromatous, and lepromatous. Aims and Objectives: The aim of the study was the clinicohistopathological correlation of all clinically diagnosed cases of Hansen’s disease. Materials and Methods: The study was done at Bankura Sammilani Medical College and Hospital for a period of 18 months. Ethical approval was taken from the Institutional Ethics committee. All new patients 66 in number clinically diagnosed as leprosy attending the Dermatology Outpatient Department were included in the study. The skin biopsy and staining were done with hematoxylin and eosin staining and Fite-Faraco stain for every patient. The skin biopsy was reported according to the Ridley-Jopling classification. Results: Males were more commonly affected than females. Most of the leprosy cases in the study were classified as MB (86.4%) and the upper extremities were the most commonly affected sites. Bacterial index was observed negative in clinically PB cases. The most common histological subtype of leprosy identified in the study was BT, Regarding bacterial index, all clinically diagnosed MB cases were smear positive and PB cases were smear negative. Out of nine clinically diagnosed PB cases, inflammatory cells were found in 3 (33.4%). Conclusion: In a large country like India where resources are limited, no need for skin biopsy for every patient. Biopsy should do if there is any confusion with other skin lesions.

Nail fold capillaroscopy in leprosy: Unveiling the microvascular changes

BackgroundLeprosy, a chronic infectious disease, is associated with various nail changes. Its etiopathogenesis is multifaceted, with microvascular damage being crucial. Nail fold capillaroscopy (NFC) emerges as a novel tool for detecting early vascular deficits in leprosy. The study aimed to assess and provide a complete clinical characterization of NFC changes in leprosy patients. MethodsIt is an observational cross-sectional study, done over a period of 1.5 year (January 2021 to august 2022) in a tertiary care hospital, encompassing 60 patients diagnosed with leprosy (18–60 years). After obtaining informed consent; detailed history, complete cutaneous and neurological examinations were conducted. All fingernails and toenails were examined for clinical changes. Subsequently, onychoscopy was performed using USB type of video-dermatoscope (Model AM7115MZT Dino-lite), a non-invasive tool. This was followed by NFC which was done for all fingernails and images were recorded by single operator, which were then assessed for quantitative and qualitive changes and statistical analysis was conducted using SPSS v20, with mean capillary density compared using Student's t-test, morphological change frequencies assessed by proportions, and group comparisons made using Chi-square or Fischer exact tests, with a significance threshold of p < 0.05. ResultsAmong the 60 patients, 39 were in the lepromatous group, which included both borderline lepromatous (BL) and lepromatous leprosy (LL) patients, and 17 were in the tuberculoid group, which included borderline tuberculoid (BT) leprosy patients; 23.3 % had Type 1 reactions, and 18.3 % had Type 2 reactions. Nail fold capillaroscopy (NFC) showed microvasculature changes in 93.3 % of patients. The average capillary density was 6.8 ± 1.5 capillaries per mm, with the lepromatous group having a lower density (6.5 ± 1.09) compared to the tuberculoid group (7.0 ± 0.86). The most common NFC changes in the tuberculoid group were tortuous capillaries (70 %), capillary dropouts, and dilated capillaries (both 64.7 %). In the lepromatous group, capillary dropouts (82 %) were most frequent, followed by tortuous (69 %), receding (69 %), and dilated capillaries (66 %). A dilated and prominent subpapillary plexus was more common in the lepromatous group (35 %, p = 0.04). Patients with trophic changes in the lepromatous group had more capillary dropouts and bizarre capillaries. Capillary dropouts, dilated capillaries, and visible subpapillary venous plexus were more prevalent in patients with Type 2 reactions. ConclusionNFC changes are prevalent in both tuberculoid and lepromatous leprosy, which may be an indicator of peripheral vascular compromise and trophic changes, especially in lepromatous leprosy. NFC can be an auxiliary tool for detecting microvascular abnormalities in leprosy patients.

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.

Leprosy in Post-elimination Era: A Study Conducted in Rural Tertiary Settings in North India.

Background Leprosy is an age-old disease caused by Mycobacterium leprae. The disease was declared eradicated in India in 2005. Many new cases are still being identified in the outdoor patient department. This study was undertaken to understand the epidemiological, clinical, and social aspects of leprosy among new patients, and assessthe current situation regarding caseload and presentation. Material and methods This study was designed as an observational study. It was carried out in people newly diagnosed with leprosyattending the outpatient department of Dermatology, Venereology, and Leprology in the tertiary care hospital in Uttar Pradesh University of Medical Sciences from July 2022 to January 2024. A total of 231 people afflicted with leprosy were included in the study. The data collected was statistically analyzed to identify demographic and social patterns, clinical presentations, and features associated with leprosy. Result Out of these 231 patients, 139 (60.17%) were male and 92 (39.83%) were female. Most cases belonged to the age group 40-59 years 87 (37.66%). History of close contact with an afflicted person was present in 34 (14.71%). Clinically, most patients belong to the borderline tuberculoid (BT) type. Only 24 (10.4%) patients were found positive for M. leprae by slit-skin smear examination. The ulnar nerve was the most common nerve involved in 63 (27.27%) cases. Trophic ulcers were the predominant deformity in 34 (14.7%), followed by foot drop in 13 (5.62 %). Conclusion The present study provides an overview of the prevailing trends of Leprosy within a specific region in the post-elimination era. The findings underscore the significance of the ongoing National Leprosy Eradication Program (NLEP) program and stress the importance of aligning them with the common goal of eliminating the burden and stigma of Leprosy from society.

Dermatoscopic evaluation of leprosy: A multi-centre cross-sectional study.

Background Leprosy is known to be a great mimicker. Its dermatoscopic evaluation may be of value in establishing diagnosis. Objective To study the dermatoscopic findings encountered across the leprosy spectrum. Methods This was a multi-centre cross-sectional study of leprosy patients, where after a thorough cutaneous and neurological evaluation, representative skin lesions from the study patients were photographed in standard settings, and the most representative skin lesions were chosen for dermatoscopic evaluation. Data was entered in a structured proforma and a descriptive analysis of dermatoscopic patterns was carried out. Results A total of 53 cases of ages between 14 and 80 years, ranging from tuberculoid to the lepromatous spectrum of disease, with active skin lesions in the form of patches and plaques were included. The spectrum of leprosy as per Ridley-Jopling classification at diagnosis was indeterminate in 1 (1.9%), tuberculoid in 1 (1.9%), borderline tuberculoid in 25 (21.5%), borderline lepromatous in 9 (17%), lepromatous in 14 (26.4%) and histoid in 3 (5.7%). Dermatoscopic features included distorted pigment network in 48 (90.6%), focal white areas in 40 (75.5%), reduced eccrine and follicular openings in 43 (81.1%), widened skin lines in 28 (52.8%), circle hairs in 15 (28.3%) and white shiny streaks in 17 (32.1%). Conclusion Dermatoscopy is a practical, non-invasive device to assess skin lesions of leprosy and provide cues to its diagnosis, spectral classification and differentiating it from other granulomatous disorders. However, dermatoscopy alone cannot reliably differentiate between the various types of leprosy and future large-scale studies are required. Limitations of the study The numbers for each subtype were variable and few in some spectrum of leprosy patients. A dermatoscopic-histologic correlation was not done.

Mitochondrial variants of complex I genes associated with leprosy clinical subtypes.

Leprosy is a chronic bacterial infection mainly caused by Mycobacterium leprae that primarily affects skin and peripheral nerves. Due to its ability to absorb carbon from the host cell, the bacillus became dependent on energy production, mainly through oxidative phosphorylation. In fact, variations in genes of Complex I of oxidative phosphorylation encoded by mtDNA have been associated with several diseases in humans, including bacterial infections, which are possible influencers in the host response to leprosy. Here, we investigated the presence of variants in the mtDNA genes encoding Complex I regarding leprosy, as well as the analysis of their pathogenicity in the studied cohort. We found an association of 74 mitochondrial variants with either of the polar forms, Pole T (Borderline Tuberculoid) or Pole L (Borderline Lepromatous and Lepromatous) of leprosy. Notably, six variants were exclusively found in both clinical poles of leprosy, including m.4158A>G and m.4248T>C in MT-ND1, m.13650C>A, m.13674T>C, m.12705C>T and m.13263A>G in MT-ND5, of which there are no previous reports in the global literature. Our observations reveal a substantial number of mutations among different groups of leprosy, highlighting a diverse range of consequences associated with mutations in genes across these groups. Furthermore, we suggest that the six specific variants exclusively identified in the case group could potentially play a crucial role in leprosy susceptibility and its clinical differentiation. These variants are believed to contribute to the instability and dysregulation of oxidative phosphorylation during the infection, further emphasizing their significance.

A clinicoepidemiological study of leprosy among children and adolescents in a tertiary care centre in the post elimination era

Leprosy amongst younger age indicates active foci of transmission in the community. Our aim is to analyse the epidemiological profile, clinical spectrum, reactions and deformities of leprosy among children and adolescents. This is a prospective observational study conducted on all newly diagnosed leprosy patients under the age of 19 years for one year. Of 113 newly diagnosed leprosy cases, 38 patients were under 19 years of age. Male-female ratio was 5.3:1. Mean age was 16.6 years. Borderline tuberculoid (BT) was the most common type followed by borderline lepromatous (BL) and Indeterminate (I) leprosy most common manifestation was hypopigmented anaesthetic skin lesion over exposed parts. 79% had multiple nerve trunk involvement of which ulnar nerve was the most common. Reaction and deformity were found to be in 21% and 18.3%. Both were seen only in multibacillary cases and predominantly in 15-19years of age. Risk factors for reactions were male sex, increasing age, labourers, borderline spectrum, skin lesion involving the nerve trunk, multiple nerve involvement and smear positivity. Risk factors for deformities were migrants in lower socio-economic status, increased duration of active disease and delayed diagnosis. Leprosy, a disease of long incubation period, among adolescents may indicate missed cases of childhood leprosy. Training through integrated service in early diagnosis and its complication, introduction of an exclusive type of treatment (MB MDT) for all categories for a shortened duration and newer drugs for reactions, sustained commitment to follow-up care and health education among community is a need at this post elimination era.

Clinicohistopathological Concordance of Cutaneous Granulomatous Disorders at a Tertiary Care Hospital in Northern India: A Cross-sectional Study

Introduction: Granulomatous inflammatory pattern is a chronic inflammation with a limited number of possible conditions that cause it. Therefore, for treatment purposes, its diagnosis is mandatory. The overlapping clinical and histological features of granulomatous dermatitis demand a proper system of classification. The aetiology, histopathological granuloma patterns, and the morphology of various skin lesions can be informative and supportive towards their diagnosis. Aim: To determine the distribution of various cutaneous granulomatous disorders in the demographical region and their causative agents. Materials and Methods: This cross-sectional study was conducted in the Histopathology section of the Department of Pathology, Government Medical College, Jammu and Kashmir, India over a period of five years (1st November 2014-31st October 2019) involving a prospective and retrospective analysis of 1,150 skin biopsies. A clinical diagnosis of Infectious Cutaneous Granulomatous Disorders (IGDS) was made in 560 cases included in the study. Out of 560 cases, the histopathological diagnosis of IGDS was confirmed in 361 cases. The aetiology and granuloma histology were studied. A clinicopathological agreement was established with the kappa test. Results: Leprosy was the most common histopathological diagnosis, with 343 out of 361 cases (95.01%), followed by tuberculosis with 9 out of 361 cases (2.49%). Leprosy subtypes included Lepromatous Leprosy (LL) in 75 cases (21.87%), followed by Borderline Tuberculoid (BT) in 71 cases (20.70%). Among the nine cases of cutaneous tuberculosis, Lupus Vulgaris (LV) was found in five cases (55.56%), followed by Scrofuloderma (SD) in three cases (33.33%), and Tuberculosis Cutis Orificialis (TCO) in one case (11.11%). The cases of leprosy showed maximum clinicopathological concordance in 343 cases (68.33%), with the BT type being the most concordant with the clinical diagnosis at 30 out of 64 cases (46.88%). A statistical analysis of kappa was applied to the subtypes of leprosy, and the observed kappa value was 0.3439, indicating agreement between histology and clinical diagnosis. Conclusion: Histopathological examination is the gold standard for diagnosing, categorising, and determining clinicopathological concordance of cutaneous granulomatous lesions. The wide spectrum of clinical differentials can be narrowed down. Although the importance of clinical examination and ancillary techniques for confirming the diagnosis cannot be denied, considering all aspects together can lead to a final conclusive diagnosis.

Whole mitogenome sequencing uncovers a relation between mitochondrial heteroplasmy and leprosy severity

BackgroundIn recent years, the mitochondria/immune system interaction has been proposed, so that variants of mitochondrial genome and levels of heteroplasmy might deregulate important metabolic processes in fighting infections, such as leprosy.MethodsWe sequenced the whole mitochondrial genome to investigate variants and heteroplasmy levels, considering patients with different clinical forms of leprosy and household contacts. After sequencing, a specific pipeline was used for preparation and bioinformatics analysis to select heteroplasmic variants.ResultsWe found 116 variants in at least two of the subtypes of the case group (Borderline Tuberculoid, Borderline Lepromatous, Lepromatous), suggesting a possible clinical significance to these variants. Notably, 15 variants were exclusively found in these three clinical forms, of which five variants stand out for being missense (m.3791T > C in MT-ND1, m.5317C > A in MT-ND2, m.8545G > A in MT-ATP8, m.9044T > C in MT-ATP6 and m.15837T > C in MT-CYB). In addition, we found 26 variants shared only by leprosy poles, of which two are characterized as missense (m.4248T > C in MT-ND1 and m.8027G > A in MT-CO2).ConclusionWe found a significant number of variants and heteroplasmy levels in the leprosy patients from our cohort, as well as six genes that may influence leprosy susceptibility, suggesting for the first time that the mitogenome might be involved with the leprosy process, distinction of clinical forms and severity. Thus, future studies are needed to help understand the genetic consequences of these variants.

Clinicoepidemiologic profile of leprosy in geriatric population in post-elimination era: A retrospective, hospital-based, cross-sectional study from Eastern India.

Geriatric populations are susceptible to leprosy infection with masked clinical signs due to lower immunity in them. Our aim was to analyze the clinicoepidemiologic profile of patients with geriatric leprosy and find out the reasons for delayed diagnosis and treatment. A retrospective, record-based study was conducted in a tertiary care center from May 2019 to May 2022. The clinicodemographic data of biopsy-confirmed leprosy cases aged ≥60 years were obtained from the leprosy clinic record. Various reasons for the delay in treatment were also recorded. Simple statistics was used for analysis. Out of 605 leprosy cases, 50 (7.4%) cases belonged to the geriatric population. Males outnumbered females (M/F = 37/13). The mean age of the patients was 66.28 + 6.5 years. Maximum patients belonged to 60-69 years of age. The mean duration of illness was 35.22 months (range 1-240 months). Most of the patients were illiterate (33.6%), and 56% were farmers by occupation. The ulnar nerve was the most common nerve to be thickened in 90% (45/50) cases, followed by the common peroneal nerve in 54% (27/50) cases, radical cutaneous nerve in 52% (26/50) cases, and posterior tibial nerve in 24% (12/50) cases. Borderline tuberculoid was the most common type in 44% cases, followed by lepromatous leprosy in 22%, borderline lepromatous leprosy in 18% (9/50), and pure neuritic leprosy in 14%. Type 1 and type 2 lepra reactions were found in 18% and 14% cases, respectively. Also, 38% had grade 2 disability. Common reasons for the delay in treatment were financial constraints, lack of family support, and personal superstitious beliefs. The study was limited by its retrospective nature. Geriatric leprosy needs special attention as the elderly are more prone for deformities; also, because of low immunity, there is a high chance of developing multibacillary leprosy, and therefore, they are potential sources of infection to the community.

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.

A study on the multidisciplinary diagnostic approach of leprosy: Can we prevent the recrudescence in the post-elimination Indian scenario?

Leprosy also widely known by the name Hansen's disease is a chronic disease caused by Mycobacterium leprae affecting mankind with various clinico-pathological forms. It remained a major public health issue due to associated case load, morbidity and stigma attached to it. India declared elimination of leprosy in the year 2005. However, it is surprising to see that in some parts of the country, the prevalence is still significant. The objective of the study is to describe the spectrum of histopathological profile of leprosy and compare its correlation with clinical diagnosis in this post elimination era. A 24-months prospective study was conducted with clinically diagnosed leprosy cases in a tertiary care hospital in eastern India. Lesions were graded and the histopathological slides along with its bacteriological index (BI) on slit skin smears where possible was reviewed and analyzed. Agreement of histopathological finding with clinical finding was established. A total of 220 cases were included in the study. On histopathology, borderline category was the most frequently reported with borderline tuberculoid the most common subtype. Most common clinical feature was hypopigmented plaque, followed by erythematous skin lesions, nodules, macules etc. Bacteriological index was studied in 192 slit skin smears. Moderate agreement between clinical and histopathological diagnosis with kappa measure of inter-rater agreement as 0.457 was noted. Clinico-histopathological correlation is pivotal in the accurate diagnosis of leprosy to prevent, treat, and control the resurgence of the disease in the post-elimination era.

Adverse reactions after Covid-19 vaccination in persons affected by leprosy: A scoping review.

Leprosy reactions are the main pathway leading to severe nerve damage and disability. These reactions can occur at any time. The coronavirus disease 2019 (Covid-19) pandemic led to a catastrophic loss of human life and has had a devastating impact on persons affected by leprosy. To achieve deep insight into the subject of adverse reactions acquired after Covid vaccinations in persons affected by leprosy through a literature review. A scoping review was conducted in the studies published between July 2021 and June 2022 using the Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) checklist. Using the search strategy, a total of 130 articles were found, of which five were relevant to the study. The adverse reactions were acquired mostly in males [9 (81.8%)]; the majority of them belong to borderline tuberculoid [4 (36.4%)], and most of them were released from treatment (multi-drug therapy) [7 (63.6%)]. Surveillance and management of adverse events following immunization (AEFI) are essential; even minor AEFI should be reported and documented in a line list.

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.

A RETROSPECTIVE STUDY OF HISTOMORPHOLOGICAL SPECTRUM OF HANSEN’S DISEASE IN A TERTIARY CARE CENTRE OF BARABANKI AREA

Objectives: Hansen’s disease is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Early detection is essential to prevent the disease’s spread and disability. Due to the multitude of morphologies, it may be difficult to accurately diagnose certain cases based solely on clinical signs; therefore, histopathology is crucial for definitive diagnosis. The study aims to investigate the various histological forms of leprosy over a year in a tertiary care hospital. Methods: It was a retrospective study that included 25 leprosy cases that were clinically and histopathologically diagnosed from July 2021 to August 2022 in a tertiary care center. Results: The majority of the cases were from the second decade with the male predominance of the cases (M:F=1.5:1). According to histomorphology, tuberculoid leprosy was the most common type (36%), followed by borderline tuberculoid (24%), borderline lepromatous (16%), lepromatous leprosy (8%), borderline leprosy (8%), histoid leprosy (4%), and indeterminate leprosy (4%). Ziehl–Neelsen staining for acid-fast bacilli demonstrated positivity in 8 cases. Conclusion: As the clinical spectrum of leprosy is diverse, histopathology is the gold standard for the diagnosis and a key tool in obtaining a conclusive diagnosis.

Prevalence of Leprosy in District Buner, Khyber Pakhtunkhwa, Pakistan

Background: Leprosy, commonly referred to as Hansen's disorder, is caused by the obligatory intracellular acid-fast bacilli Mycobacterium leprae and is predominantly transmitted by inhalation macrophages. It causes infection of the skin and nerves, as well as neurological damage due to inflammation. Aim: The current study was conducted to determine the prevalence of leprosy disease in District Buner, Khyber Pakhtunkhwa, Pakistan.During the investigation, we reported different types of leprosy. Methods: The current study investigates 467 patients from 1965-2000 in six Tehsil and 74 from 2000-2021. In the reported five types of Leprosy, Lepromatous Leprosy is more common than other types. Leprosy has five subtypes which 2 are Tuberculoid (TT), Lepromatous Leprosy (LL), and 3 are borderline types Leprosy Borderline tuberculoid (BT), Borderline (BB),borderline lepromatous (BL).

A retrospective study on newly diagnosed Hansen’s disease and its spectrum in a tertiary care hospital

Background: Leprosy, a well known ancient disease caused by the pathogen Mycobacterium leprae. Leprosy became curable with the introduction of multi drug therapy (MDT). But the burden of the disease still continues to make an impact in the present society. India is one of the major contributors to the global leprosy case load even after elimination. The main aim of this study was to assess the clinical pattern of newly diagnosed leprosy patients and to emphasize the need of timely intervention. Methods: This was a hospital based retrospective observational study. The medical records of all the newly diagnosed leprosy patients during the period of January 2022 to December 2022 were collected and various clinical and demographic factors were analyzed. Results: Total 139 newly diagnosed leprosy cases were reported. The most common age group affected was 45-60 years. Males were predominantly affected than females. 128 cases were multibacillary leprosy and 11 were paucibacillary. Borderline tuberculoid (48.2%) was the most common spectrum noted. About 19.4% patients presented with lepra reactions and 25.17% patients presented with deformities. Conclusions: Newly diagnosed leprosy cases show that leprosy is active in the society. Active case detection by household contact survey and timely referral &amp;treatment initiation and follow up by the field staff of health facility will prevent disability and stigma.