Lepromatous Leprosy Research Articles

Exhausted CD8 T cells and anti-inflammatory macrophages characterize lepromatous leprosy lesions

Exhausted CD8 T cells and anti-inflammatory macrophages characterize lepromatous leprosy lesions

Clinically Suspicious Cases of Hansen's Disease at a Tertiary Care Hospital in South India: A Clinicopathological Study.

Background and objective Hansen's disease, also known as leprosy, is a chronic granulomatous condition caused by Mycobacterium leprae, primarily affecting the skin and peripheral nerves. The disease has a wide spectrum of clinical and histopathological manifestations, often mimicking other inflammatory and infectious conditions. This variability poses significant challenges in its early diagnosis and management. Aligning clinical suspicion with histopathological evidence is critical for effective treatment and control of transmission. This study was designed to explore the concordance between clinical impressions and histopathological diagnoses and to understand the diagnostic utility of various histopathological techniques. We aimed to establish and correlate the histopathological types of leprosy with clinical presentations. We also sought to determine the extent to which different histopathological techniques, including special stains, can corroborate with clinical types, thereby enhancing diagnostic precision. Materials and methods This was a hospital-based, retrospective study of clinically suspicious cases of leprosy at a tertiary care hospital in South India. A total of 100 cases of various age groups were identified and included in the study. All cases underwent skin biopsy with samples subjected to routine hematoxylin and eosin (H&E) staining and acid-fast bacilli (AFB) staining for the detection oflepra bacilli. Results Among the 100 clinically suspicious cases of leprosy, 50were histopathologically confirmed as leprosy and 50were categorized as non-specific dermatitis. Among the 50 histologically confirmed cases of leprosy, the most common type was lepromatous leprosy (LL) (38%) followed by borderline tuberculoid (BT) (30%) leprosy.Modified AFBstain was positive in 21 cases and was instrumental in confirming the suspected cases of leprosy. The overall correlation between the clinical and histopathological diagnosis was significant, with the highest correlation noted in LL cases. Conclusions Our findings underscorethe complexity of diagnosing leprosy due to its varied clinical and pathological presentations. Despite a high overall concordance rate, the discrepancies between clinical impressions and histopathological findings observed highlight the need for a multidimensional diagnostic approach. Incorporating a combination of clinical assessment, routine histology, and special staining can enhance diagnostic accuracy, leading to better patient management and outcomes.

Diffuse Lepromatous Leprosy with Lucio Phenomenon Caused by Mycobacterium leprae

Mycobacterium lepromatosis is the primary cause of diffuse lepromatous leprosy and has previously been linked to the Lucio phenomenon in Mexico. In this study, we demonstrate that M. leprae and M. lepromatosis are responsible for many of the leprosy infections in which the Lucio phenomenon occurs. A 47-year-old female presented with chief complaints of erythematous and purpuric lesions on her left lower extremity and bilateral upper extremities. Over the past month, she had experienced recurrent tingling sensations in both legs. The patient had widespread infiltration, no nodules, madarosis (eyelash loss), and thickening in both ears. An acid-fast bacilli analysis revealed a bacterial index of 4+ and a microscopy index of 7%. Biopsy tissue was lacking the epidermal layer, and there was a dermal layer of dilated blood vessels, an area of bleeding, and infiltration of neutrophil inflammatory cells, perivascular plasma cells, foam cells, histiocytes, lymphocytes, the endothelium, and perivascular regions by acid-fast bacilli. A polymerase chain reaction identified the presence of both M. leprae and M. lepromatosis. The patient's symptoms worsened rapidly and she developed ulcers on both hands and both legs, extending to the soles of the feet. She was admitted to the hospital 3 days after presentation. Based on the clinical symptoms, examination of tissue samples, and the polymerase chain reaction identification of coinfection with M. leprae and M. lepromatosis, a diagnosis of diffuse lepromatous leprosy was made. The M. leprae bacteria were verified by DNA sequencing.

Concomitance of lepromatous leprosy and squamous cell carcinoma

Introduction: leprosy is an endemic disease in Brazil, ranking second worldwide for the number of new cases diagnosed yearly. However, late diagnosis of this disease is still common. Objective: to alert health professionals to the importance of recognizing the insidious signs of leprosy, both clinical and histopathological, even in the presence of other, more apparent alterations. Presentation and discussion of the case: a man with skin lesions suggestive of squamous cell carcinoma. On histological examination, besides the carcinoma, there were aggregates of foamy macrophages full of acidfast bacilli compatible with lepromatous leprosy. A more detailed physical examination by a multidisciplinary team from a national reference center also revealed skin with a diffuse infiltrated appearance and supraciliary madarosis, alterations not noticed in the first evaluation at another service. Final considerations: this case can help clinical professionals and pathologists pay attention to skin alterations that can make it challenging to diagnose leprosy, especially in endemic regions, to enable early diagnosis and reduce the disabilities related to the disease.

“Histopthological Spectrum Of Leprosy In A Tertiary Care Centre”

Background: Leprosy affects skin and peripheral nerves, muscles, eyes, bones, testis and internal organs. Histopathology and demonstration of lepra bacilli is a vital role to supplement clinical examination and diagnosis for correct classification and therefore for patients treatment. Aim- To study the Histopathology spectrum of Leprosy in a tertiary care centre. Materials &Methods: All the skin biopsy with clinically suscipious of leprosy and sent for histopathological examination during the year Jan 2020 to Dec 2024 were included in the study. Results: A total of 60 cases were studied out of them 61% are male and 39% are female. With M:F ratio1.56: 1, majority of them belongs to 41-50 age group. The commonest histological type was borderline TB leprosy followed by Borderline lepromatous leprosy, least common cases were of lepromatous leprosy and histoid leprosy. Conclusion: Histopathological examination is the important investigation for accurate diagnosing and typing of leprosy

Bridging dermatology and hematology: a case of lepromatous leprosy with bone marrow involvement and pancytopenia.

Leprosy, caused by Mycobacterium leprae (M. leprae), primarily manifestswith cutaneous and peripheral nerve involvement. Systemic involvement, particularly in the bone marrow, is exceedingly rare. This report presents a case of lepromatous leprosy with bone marrow involvement, emphasizing the systemic nature of the disease and the importance of comprehensive diagnostic and management approaches. We aim to present a case of lepromatous leprosy with bone marrow involvement, detailing the clinical presentation, diagnostic evaluation, and management approach. A 65-year-old male with lepromatous leprosy and severe erythema nodosum leprosum developed pancytopenia. After undergoing comprehensive clinical evaluation, including history taking, physical examination, and laboratory investigations, bone marrow examination and molecular diagnostics using polymerase chain reaction (PCR) were performed to confirm the presence of M. leprae as an etiology for his pancytopenia. The bone marrow aspirate revealed hypercellularity with erythropoiesis and thrombopoiesis within normal limits. Foamy histiocytes with erythrophagocytosis were observed, along with the presence of M. leprae on Modified Ziehl-Neelsen stain. Molecular analysis confirmed M. leprae DNA in the bone marrow aspirate. Treatment with multi-drug therapy (MDT) and thalidomide resulted in normalization of blood counts and healing of skin lesions. This case underscores the systemic nature of leprosy and the rarity of bone marrow involvement, highlighting the importance of thorough evaluation in cases of persistent symptoms. Comprehensive diagnostic approaches, including bone marrow examination and molecular diagnostics, are essential for accurate diagnosis and timely initiation of appropriate treatment, ultimately improving patient outcomes and minimizing disease complications.

Erythema nodosum leprosum in a patient with lepromatous leprosy: A case report

Rationale: Lepromatous leprosy is a skin condition. Erythema nodosum leprosum (ENL) aids in its diagnosis. ENL is a type- 2 immune response, whereas lepra ENL is characterized by a hypersensitivity reaction and an exaggerated immune response through a different pathway. Patient's Concern: A 40-year-old male patient, previously diagnosed with lepromatous leprosy, displayed painful skin lesions on his extremities. Diagnosis: Type-2 lepra reaction, specifically erythema nodosum leprosum. Interventions: The patient was initially treated with 100 mg dapsone daily and then with fusidic acid, prednisone, and other MDT agents, after development of dapsone resisitance. After type- 2 lepra reaction was lessened in just two weeks, the regimen was adjusted to prednisolone (up to 2 g daily), thalidomide (300 mg daily), minocycline (1.5 g daily), ofloxacin (1 g twice daily), and pentoxifylline (400 mg three times daily) over a six-month period. Outcomes: The treatment effectively reduced the type-2 lepra reaction and improved the patient's skin lesions and overall health. Lessons: Healthcare providers should maintain a high level of awareness regarding the symptoms and medical history associated with ENL to facilitate timely diagnosis and appropriate management strategies. It is critical to tailor treatment to each patient’s symptoms and responses for successful management. Consistent monitoring of inflammatory markers and regular follow-up appointments play vital roles in preventing complications and ensuring positive outcomes for patients with ENL.

A glimpse into the past of Hansen's disease – Re-evaluation and comparative analysis of cases with leprosy from the Avar period of the Trans-Tisza region, Hungary

Our knowledge of how society viewed leprosy and treated its victims in the past is still scarce, especially in geographical regions and archaeological periods from where no written sources are available. To fill in some research gaps, we provide the comparative analysis of five previously described, probable cases with leprosy from the Avar-period Trans-Tisza region (Hungary). The five skeletons were subject to a detailed macromorphological (re-)evaluation. Where possible, the biological and social consequences of having leprosy were reconstructed based on the observed bony changes and mortuary treatment, respectively. The retrospective, macromorphology-based diagnosis of leprosy could be established in three cases only. Based on the detected skeletal lesions, all of them suffered from near-lepromatous or lepromatous leprosy. The disease resulted in aesthetic repercussions and functional implications, which would have been disadvantageous for these individuals, and limited or changed their possibilities to participate in social situations. They could have even required heavy time investment from their respective communities. The analysis of the mortuary treatment of the confirmed leprosy cases revealed no evidence of a social stigma. These findings indicate that the afflicted have not been systematically expulsed or segregated, at least in death, in the Early Middle Ages of the Carpathian Basin.

LEPROMATOUS LEPROSY REVEALED BY PALMOPLANTAR NODULAR LESIONS

Leprosy is a chronic debilitating disorder caused by the acid-fast bacilli Mycobacterium leprae (M. leprae).This bacilli exhibit a distinctive predilection for the skin and peripheral nerves, although they can potentially impact any system in the body.Palmoplantar involvement has been infrequently reported in leprosy and is an easily misdiagnosed entity.We report a case of a young female presented with a palmo plantar nodular lesions for wich a skin biopsy showed histological signs consistent with lepromatous leprosy.

A case report of de novo histoid leprosy in a Nigerian male: A diagnostic dilemma.

Histoid leprosy is an uncommon variant of lepromatous leprosy. It poses a diagnostic challenge because of its distinctive clinical and histopathological features. It presents as smooth papules and nodules that rarely ulcerate. We present the case of a 22-year-old Nigerian man with a 2-year history of multiple, dome-shaped papules and nodules on the skin with necrotic centres. General examination showed right axillary lymphadenopathy, non-pitting oedema, foot ulcer, and glove and stocking sensation loss. Despite previous misdiagnoses, histopathological examination showed dermal expansion by histiocytes arranged in a storiform pattern. Slit skin smear yielded abundant bacilli. The patient was started on WHO multidrug treatment, resulting in the improvement of his lesions. This case emphasises the importance of increased awareness of this rare presentation of leprosy.

A retrospective analysis thyroid function and ultrasonography in a group of subjects with lepramatous leprosy in Turkey.

There are several studies on thyroid functions and thyroid gland features in patients with leprosy in the literature. The relationship between them have not been clarified yet. These studies are time-expired and don't contain ultrasonography examination. The purpose of the study is to investigate thyroid functions and gland characteristics in leprosy patients by ultrasonography (US) and current laboratory techniques. This retrospective study was conducted by collecting the data of patients with lepramatous leprosy. Serum thyroid-stimulating hormone, free triiodothyronine, free thyroxine, anti-thyroid peroxidase, antithyroglobulin, and thyroglobulin values and thyroid ultrasonography reports were collected from previous records. The mean age is 75.12±9.89 years of total 17 subjects and 10 patients (58.8%) were male. Thyroid US was performed on 14 of the patients, nodules were detected in a total of 7 (50%) patients. The mean FT3, FT4, TSH, Anti-Tpo, Anti-TG, and TG values of the patients were found to be within normal limits. In the present study, no changes were detected in the thyroid functions and structures of the patients with Lepromatous Leprosy. We consider that prospective randomized studies that will include larger sample sizes are needed to determine whether there is a relationship between leprosy and thyroid disease.

Borderline lepromatous leprosy: A case report

Rationale: Lepromatous leprosy can have many atypical presentations, obscuring early diagnosis. We present a case of lepromatous leprosy, presenting with atypical features, which made a diagnostic dilemma. Patient concerns: A 48-year-old man presented with bilateral lower limb oedema and scaly “ichthyosis like” skin rash in both hands and feet, hepatosplenomegaly and pancytopenia, over a course of three months, without any classical features of leprosy. A skin biopsy revealed an unexpected diagnosis of borderline lepromatous leprosy. Diagnosis: Lepromatous leprosy. Interventions: Multi-drug regimen treatment with rifampicin, dapsone and clofazimine for lepromatous leprosy. Outcomes: The patient made a good clinical recovery. Lessons: In endemic settings, clinicians should be aware of similar atypical manifestations of leprosy to face the global challenge of eradicating this chronic deforming disease.

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.

Ulnar nerve abscess in lepromatous leprosy: Insights from three cases confirmed via ultrasound imaging

Ulnar nerve abscess in lepromatous leprosy: Insights from three cases confirmed via ultrasound imaging

Association of polymorphisms in the TNFA, TNFRSF1A and TNFRSF1B genes with lepromatous leprosy in Western Mexican patients.

Studies in different populations have shown that single-nucleotide polymorphisms (SNPs) of tumor necrosis factor-alpha (TNFα) and TNF receptors 1 and 2 (TNFR1 and TNFR2) may be involved in the pathogenesis of lepromatous leprosy (LL). To further explore the results in a Mexican population, we compared the frequencies of the polymorphisms in - 308 G>A TNFA (rs1800629), - 383 A>C TNFRS1A (rs2234649), and + 196 T >G TNFSR1B (rs1061622) genes in LL patients (n = 133) and healthy subjects (n = 198). The genotyping was performed with the polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP) technique. Statistical analysis was performed using the χ2 test, within the 95% confidence interval. Odds ratios (OR) were calculated and Hardy-Weinberg equilibrium was verified for all control subjects and patients. We found an association between the TNFSR1 -383 A>C genotype and the risk of lepromatous leprosy when leprosy patients were compared to controls (OR = 1.71, CI: 1.08-2.69, p = 0.02). Furthermore, it was also associated with the risk of LL in a dominant model (AC + CC vs AA, OR: 1.65, 95% CI: 1.05-2.057, p = 0.02). Similar genotype and allele frequencies for the SNPs TNFA - 308 G>A and TNFSR2 + 196 T>G were observed between leprosy patients and healthy subjects. The TNFSR1 -383 A>C could be a potential marker for the identification of high-risk populations. However, additional studies, using larger samples of different ethnic populations, are required.

Vitiligo after borderline lepromatous leprosy: common immunological implications

Vitiligo after borderline lepromatous leprosy: common immunological implications

Lepromatous Leprosy in an Immunosuppressed Patient Due to Renal Transplantation Associated with Glucose-6-Phosphate Dehydrogenase Deficiency: A Diagnostic and Therapeutic Challenge.

Lepromatous Leprosy in an Immunosuppressed Patient Due to Renal Transplantation Associated with Glucose-6-Phosphate Dehydrogenase Deficiency: A Diagnostic and Therapeutic Challenge.

Leprosy: Comprehensive insights into pathology, immunology, and cutting-edge treatment strategies, integrating nanoparticles and ethnomedicinal plants.

Mycobacterium leprae is the causative agent responsible for the chronic disease known as leprosy. This condition is characterized by dermal involvement, often leading to peripheral nerve damage, sensory-motor loss, and related abnormalities. Both innate and acquired immunological responses play a role in the disease, and even in individuals with lepromatous leprosy, there can be a transient increase in T cell immunity during lepromatous reactions. Diagnosing of early-stage leprosy poses significant challenges. In this context, nanoparticles have emerged as a promising avenue for addressing various crucial issues related to leprosy. These include combatting drug resistance, mitigating adverse effects of conventional medications, and enhancing targeted drug delivery. This review serves as a comprehensive compilation, encompassing aspects of pathology, immunology, and adverse effects of multidrug delivery systems in the context of leprosy treatment. Furthermore, the review underscores the significance of ethnomedicinal plants, bioactive secondary metabolites, and nanotherapeutics in the management of leprosy. It emphasizes the potential to bridge the gap between existing literature and ongoing research efforts, with a profound scope for validating traditional claims, developing herbal medicines, and formulating nanoscale drug delivery systems that are safe, effective, and widely accepted.

Multibacillary lepromatous leprosy detected in Olmedo, Ecuador. Case report

Introduction: hansen's disease or leprosy is an infectious disease caused by Mycobacterium leprae, which mainly affects the skin, peripheral nerves and mucosa of the upper respiratory tract. It has a chronic course as old as humanity itself.Clinical case: the clinical case of a 51-year-old male patient, native and from the Olmedo canton, province of Manabí, with a farmer occupation, who began to present in November 2008 with macular, hyperchromic skin lesions, which progressed, is presented. to multiple nodules, located in the lower limbs and then spreading to the upper limbs, thorax and abdomen, neck and face. The set of clinical parameters and positive biopsy results allowed the case to be classified as Lepromatous Leprosy (multibacillary). Triple multitherapy (Dapsone, Rifampicin, Clofazimine) was prescribed, showing an improvement in the number and size of the lesions at the end of therapy.Discussion: this is the first clinical case of lepromatous leprosy detected in the Olmedo canton, Manabí province, Ecuador. Due to the novelty in the territory, the patient had this condition for years without being diagnosed or treated adequately and even once under treatment, there were delays in acquiring the medications that extended their application from 12 months to a period of 25 months.Conclusions: the clinical case presented highlights that Hansen's Disease is an emerging health problem in the Olmedo canton, highlighting the need to make sustained efforts for its identification, treatment and prevention in the territory

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.