Lepromatous Leprosy Research Articles

Histoid leprosy: de novo case with atypical presentation

Histoid leprosy is a rare kind of lepromatous leprosy with specific clinicopathologic manifestations.It usually follows treatment failure especially after dapsone monotherapy. Occasionally it occurs de novo without any history of inadequate or irregular treatment. We hereby report a case of de novo histoid leprosy in a 17 year old boy who presented with atypical features, including involvement of flexures, hypopigmented macules topped with nodules, and de novo occurrence.

A study of clinico pathological spectral correlation in multibacillary leprosy

<p class="abstract"><strong>Background:</strong> Leprosy expresses itself in different clinico-pathological forms, depending on the immune status of the host.The diagnosis and classification of leprosy have traditionally been based on the clinical examination with additional information from skin smears and histopathological examination. Very often, disparities between clinical and histopathological findings are observed. This study was aimed to correlate between clinical and histopathological spectral correlation of newly diagnosed multibacillary leprosy cases for a period of 1 year.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in the Department of Dermatology and Venereology, Government Medical College, Thiruvananthapuram, for a period of 1 year. All newly diagnosed multibacillary leprosy cases were included.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 40 patients with clinically diagnosed multi bacillary leprosy were studied. Maximum numbers of leprosy patients studied were in the age group of 40-49 years. Maximum clinical and histopathological correlation was found in 75% (9/12) in lepromatous leprosy and least correlation of 44.44% was noted in borderline lepromatous (4/9).</p><p class="abstract"><strong>Conclusions:</strong> In this study maximal clinico-histopathological spectral correlation was found in lepromatous spectrum. The percentage of correlation was considerably less in all the other groups.</p>

HANSEN’S DISEASE DIAGNOSED AFTER ANTI-CANCER CHEMOTHERAPY

Background. Leprosy or Hansen’s disease is a chronic granulomatous disease involving predominantly skin, peripheral nerves and nasal mucosa but capable of affecting any tissue or organ. Histoid leprosy is a very rare well-defined clinicopathological variant of multibacillary lepromatous leprosy, which is very difficult to diagnose due to different specific clinical and histopathological findings that mimic a fibromatous disorder. Histoid leprosy occurs generally after treatment failure and sometimes de novo.
 Objective. The aim of the study was to explore histoid leprosy throughout a case report.
 Methods. A case report of histoid leprosy diagnosed after cancer chemotherapy is presented.
 Results. A 25-year-old healthy male presented with multiple skin coloured, discrete, well defined, painless papules and nodules scattered over nape of neck, right side of the trunk and both arms along with numbness as well as tingling sensation over both the arms and trunk. It was a case of non-seminomatous germ cell tumour (NSGCT), left testis, diagnosed and treated with a high inguinal orchidectomy with adjuvant chemotherapy in 2016. Ziehl Neelsen (ZN) stain for Acid Fast Bacilli (Mycobacterium leprae) – a modified Fite stain method showed numerous acid-fast bacilli. Histopathological diagnosis of Hansen’s disease (Histoid) was conducted. The patient was admitted and started on triple drug multi-bacillary multi-drug therapy (MB-MDT). A remarkable improvement was noticed in the lesion status within one month of institution of the therapy.
 Conclusions. Histoid leprosy is a discrete infrequent form of multibacillary leprosy with distinctive clinical, bacteriological and histomorphological features. Histopathologic examination with modified Fite stain is still the mainstay of diagnosis.

An unusual presentation of De-novo Histoid leprosy clinically mimicking as neurofibromatosis

Histoid leprosy is a rare and uncommon variant of lepromatous leprosy which generally occurs following resistance to dapsone therapy or relapse after dapsonemonotherapy or multidrug therapy. Rarely, it can occur de novo without any history of treatment. We present one such rare case of histoid leprosy mimicking neurofibromatosis presented in a 43 year old male.

Serological evidence of Toxoplasma gondii infection as potential risk for the development of lepromatous leprosy in an endemic area for both neglected tropical diseases in Brazil

BackgroundMycobacterium leprae and Toxoplasma gondii infections are both neglected tropical diseases highly prevalent in Brazil. Infection with certain parasite species can significantly alter susceptibility to other important pathogens, and/or influence the development of pathology. Here we investigated the possible influence of M. leprae/T. gondii co-parasitism on the manifestation of leprosy and its clinical forms.MethodsParticipants (n = 291) were recruited in Campos dos Goytacazes city, Rio de Janeiro state, southeast Brazil, from August 2015 to December 2019 and clinically diagnosed for leprosy. Participants were selected based on the presence (patients) or absence (healthy controls) of the leprosy disease. Contacts of patients were also recruited for this study. Serum samples from patients (n = 199) with leprosy, contacts (n = 40) and healthy controls (n = 52) were investigated for levels of IgM and IgG anti-phenolic glycolipid-1 (PGL-1) by ELISA. Additionally, IgG antibody against soluble Toxoplasma antigen (STAg) was measured in sera samples from leprosy patients, contacts and healthy controls for Toxoplasma gondii serology by ELISA. Anti-PGL-1 IgG and IgM levels were compared using one-way ANOVA Kruskal-Wallis or Mann-Whitney, while Spearman test was used to correlate levels of IgG anti-STAg and IgM/IgG anti-PGL-1 from seropositive and seronegative individuals for T. gondii infection. The risk of T. gondii infection for leprosy disease was assessed using Fisher’s test.ResultsLevels of IgM anti-PGL-1 antibodies were significantly higher in multibacillary (MB) patients compared to paucibacillary (PB) patients (P = 0.0068). Higher IgM and IgG levels anti-PGL-1 were detected in patients with the lepromatous forms. The serologic prevalence for T. gondii infection was 74.9%. We detected increased anti-STAg antibody levels in leprosy patients (79.4%), reaching 88.8% within those with lepromatous form of this disease. The leprosy risk increase in T. gondii seropositive individuals was two-fold (odds ratio [OR] = 2.055; 95% confidence intervals [95% CI]: 1.18–3.51) higher than those seronegative, and considering the lepromatous leprosy risk this increase was even dramatic (OR = 4.33; 95% CI: 1.76–9.69) in T. gondii seropositive individuals. Moreover the leprosy risk in T. gondii seropositive individuals was weakly correlated to the levels of IgG anti-STAg and IgM/IgG anti-PGL-1.ConclusionsAltogether, our results suggest that T. gondii infection may exert immunomodulatory properties that influence to the susceptibility of leprosy, mainly on its more severe clinical form. A better understanding of parasite immunomodulation can ultimately contribute to the development of medical applications.

Demographics of new diagnoses of leprosy in the UK over 23 years: a retrospective study of cases at the Hospital for Tropical Diseases, London

BACKGROUND: Leprosy is rare in the UK, but migration from endemic countries results in new diagnoses annually. Early recognition, diagnosis and treatment can prevent harmful stigma and disability. METHODS: We conducted retrospective analysis from a database of new cases of leprosy seen at the Hospital for Tropical Diseases, London from 1995 to 2018. We aimed to identify typical demographics of patients presenting with leprosy and identify causes and consequences of delayed diagnosis. RESULTS: 157 cases were included. A large proportion were male (67.5%) with a median age of 34 years. Most were non-UK born and migrated in adulthood. 41.3% of cases were acquired in India, Sri Lanka or Bangladesh. Borderline tuberculoid (43.9%) was the most common type, followed by lepromatous leprosy (33.8%). The mean time between arrival in the UK and symptom onset was 5.87 years (SD 10.33). It took over 5 years for 12.8% of patients to be diagnosed. 93.6% of patients completed multidrug treatment following diagnosis. CONCLUSION: Male predominance and age at diagnosis reflects global epidemiology of leprosy. Patterns of acquisition reflect trends in UK migration from endemic countries. The typical patient presenting to the clinician is a young male who has migrated as an adult and developed symptoms in the years surrounding migration. Many patients may have developed disability before treatment commences as the time to diagnosis can be prolonged. Once diagnosed in the UK, treatment is of high quality, readily available, and effective: earlier recognition by clinicians can prevent disability and reduce the risk of transmission.

Lepromatous palate perforation and its surgical repair: a case report

<p class="abstract">Involvement of oral cavity in lepromatous leprosy has been observed in 19-60% cases and has been described as late manifestation of disease. About 75% of oral lesions have been observed in the anterior part of hard palate which may result in debilitating complications like perforation of hard palate. We present a case of lepromatous perforation of hard palate that was effectively treated by multidrug therapy for the primary disease. The patient was declared disease free by slit skin smear method and reparative surgery of perforation was done with good results.</p>

Study of histomorphological variants of leprosy in correlation with bacilloscopy index in tertiary care hospital

Introduction: Leprosy is an infectious and contagious chronic disease, caused by Mycobacterium leprae, an obligate intracellular bacillus, that affects mainly the skin, nerves and mucous membranes. It can also affect the eye, nose, joints, lymph nodes, internal organs and bone marrow, especially in multibacillary patients (MB). In the majority of cases, it is transmitted from person to person through contact with patients having a high bacillary index and haven't been treated. Materials and Methods: This is an observational retrospective study of 52 cases conducted in histopathology section of Pathology department, Government Medical college, Bhavnagar, Gujarat. In this study, cases were included whose biopsy samples were received in the department with clinical suspicion of leprosy. All the case diagnosed as leprosy were evaluated by Fite Faraco stain and reported for bacilloscopy index. Results: Out of 52 cases, 40 were histomorphologically confirmed as leprosy. Maximum number of cases were observed in the age group of 31 to 40 years (47.5%). Among various anatomical site for cutaneous presentation of leprosy in maximum number of cases, the lesions were observed in upper extremity (50%). Higher number of type of leprosy observed were borderline tuberculoid leprosy (35%) followed by tuberculoid leprosy (30%). It is observed, mean bacilloscopic index is higher in cases of lepromatous leprosy whereas lower in tuberculoid leprosy. Conclusion: In our study, borderline tuberculoid and tuberculoid cases were reported with higher incidence. Bacteriological examination and bacilloscopy index add onto the morphological diagnosis and help to categorise multibacillary and paucibacillary leprosy. Keywords: Leprosy, Bacilloscopy index, Fite Faraco.

Disability and Deformity in Patients of Hansen’s Disease Attending a Tertiary Care Center in Nepal


 
 
 
 Introduction: Leprosy is responsible for disability and deformity among patients. Nerve damage is one of the main features of leprosy and it is the main cause of disability in the patients. Developing deformity leads to restriction in professional work and hence reduced income as well as it also acts adversely on social wellbeing. The aim of this study was to study the spectrum of Grade 2 disability among all leprosy patients attending outpatient and inpatient according to WHO grading and to find the association with Ridley Joplingclassification.
 Methods: It was an observational cross sectional hospital based study. All the inpatients and outpatients of leprosy getting treatment and were on follow up in the Department of Dermatology between December 2017 to November 2019 were included. Details of disability and deformity were recorded and were Classified as per WHO grading and Ridley Jopling classification. Cross tab was used in descriptive analysis to compare between different variables and data was analysed in percentage.
 Results: A total of 88 patients were included in the study. Maximum number of patients 41 (46.7%) belonged to 30 to 50 years of age group. Various degrees of loss of sensation was seen in all patients and total number of patients with Grade 1 disability were 68 (77.3%) and Grade 2 disability were 20 (22.7%). Maximum number of patients 11 (12.5%) with Grade 2 disability was seen in Lepromatous Leprosy.
 Conclusions: Disability and deformity can occur in any spectrum of disease and intervention as early as possible will help reduce the incidence.
 
 
 

Reação Hanseniásica Persistente 8 Anos Após Conclusão da Terapêutica: Desafio para Médicos e Pacientes


 
 
 
 Introdução: Para além da infecção pelo Mycobacterium leprae, as reações tipo 1 e 2 representam eventos inflama- tórios agudos, no curso crónico da hanseníase multibacilar, mas que podem ser recorrentes e tardias.
 Caso Clínico: Jovem com quadro de reação tipo 2 no contexto de hanseníase borderline lepromatosa, persistente e de difícil condução clínica.
 Discussão: O caso ilustra o desafio diagnóstico na hanseníase com resposta inflamatória sistémica, mais expressiva que o quadro dermato – neurológico. São discutidas as implicações clínicas, histopatológicas e terapêuticas, além de fatores de risco para reação e a positividade da reação em cadeia da polimerase 8 anos após a alta da poliquimioterapia
 
 
 

Endocrinological Testicular Dysfunction in Patients with Lepromatous Leprosy and the Impact of Disease on Patient's Quality of Life.

Introduction:Leprosy or Hansen's disease poses a drastic impact on the quality of life in affected patients even after successful completion of treatment. The involvement of the endocrine system in leprosy is usually insidious, silent, and under-reported, especially the testicular dysfunction.Aims and Objectives:The present study was aimed at evaluating the abnormalities of the primary testicular hormone testosterone and the gonadotrophins LH and FSH in male patients affected with lepromatous leprosy and assessing the impact of the disease on quality of life (QOL).Materials and Methods:The study included 43 married male patients diagnosed with lepromatous leprosy. Careful history taking and examination for symptoms of testicular dysfunction were done. Serum concentrations of total testosterone, FSH, and LH were noted. The QOL was evaluated using the WHO Quality of Life-BREF (WHOQoL-BREF).Results:The most common clinical manifestation of testicular dysfunction was reduced or loss of libido reported in 12 (27.9%) patients followed by gynaecomastia in 7 (16.3%). Ultrasonographic (USG) analysis revealed reduced testicular volume in 31 (72.1%) patients, and average testicular volume was 11.9 ± 4.9 mL each. Seventeen (39.5%) patients had low serum testosterone levels, 9 (20.9%) had high serum FSH level, and 11 (25.6%) high LH levels. There was a significant negative correlation between testosterone level and FSH as well as LH. There was also a significantly positive correlation between testicular volume and testosterone level. Symptomatic patients with gynaecomastia/gynaecothelia had higher hormonal derangement than those who had other symptoms. On QOL, most patients scored lowest on the domain of “social relationships” (including sexual wellbeing) followed by “psychological health”.Conclusion:We found a high rate of USG diagnosed testicular atrophy in lepromatous leprosy patients. Therefore, every leprosy patient should be thoroughly examined clinically to rule out features of testicular dysfunction. Testicular function tests should be routinely carried out in all leprosy patients to arrive at an early diagnosis. Leprosy is found to affect all domains of a patient's quality of life.

Expression of annexin-A1 in blood and tissue leukocytes of leprosy patients.

INTRODUCTION In leprosy, immune system mediators that regulate the infectious process act in a complex manner and can lead to several clinical outcomes. To understand the behavior of these mediators we quantified the expression of annexin-A1 (ANXA1) in the peripheral blood and plasma as well as tissue leukocytes in all clinical forms of leprosy and compared with healthy controls. METHODS Seventy healthy controls and 70 patients with leprosy, tuberculoid (TT) (n = 13), borderline tuberculoid (BT) (n = 15), borderline borderline (BB) (n = 13), borderline lepromatous (BL) (n = 15), and lepromatous leprosy (LL) (n = 14), were selected. Phenotyping of the lymphocyte cells and the intracellular expression of ANXA1 in leukocytes was performed by immunofluorescence. Plasma protein levels were determined by enzyme-linked immunosorbent assay. RESULTS Histiocytes and CD4+ and CD8+ T cells in the skin of BL and LL patients had higher ANXA1 expression. ANXA1 expression was also high in circulating polymorphonuclear, monocytes, and CD4+ and CD8+ T cells in the blood of LL patients compared to those of TT, BT, BB, and BL patients, and these levels were similar to those in healthy controls. Plasma ANXA1 levels indicate an increase in paracrine release in patients with LL. CONCLUSIONS The data indicate that ANXA1 expression is enhanced in the leukocytes and plasma of patients with LL, and may contribute to the inhibition of leukocyte action, leading to inadequate functioning of the immune system and thus contributing to the spread of M. leprae infection.

Histopathological changes in leprosy and its correlation with IHC markers

Leprosy is a chronic granulomatous disease. It involves the psychological, socioeconomic dimensions of an individual. Histopathology is considered as an accurate method for diagnosing leprosy. Immunity is largely T-cell mediated, whereas deficiency of T-cells causes lepromatous leprosy. The relative proportion of T and B lymphocytes were studied using CD3 and CD20 immunohistochemistry markers (IHC). A Retrospective, prospective and observational study was carried from August 2016 to July 2019. The cases were divided based on histopathological findings. IHC markers CD3 was used to study T cell whereas CD20 was used to study B-cells. As per Ridley Jopling classification maximum cases belonged to indeterminate forms. Bacillary load of 4+ and above was seen in lepromatous leprosy. CD3 showed strong positivity in all types whereas CD20 showed more focal positive staining for lepromatous leprosy than tuberculoid and indeterminate forms.

Lepromatous leprosy presenting with type II reaction before and type I reaction after treatment

Lepromatous leprosy is associated with a high bacillary load and poor cellular immune response. Early dermatologic manifestations include erythematous macules, papules, nodules, and plaques with a symmetrical distribution. Leprosy also shows two major reaction states including type I (reversal reaction) and type II (vasculitis). These reactions are usually seen in some patients who are undergoing treatment. Herein, we report an interesting patient with lepromatous leprosy who presented with skin lesions of type II reaction without receiving any anti-leprosy treatment and surprisingly showed a type I reaction eight months after the beginning of the treatment.

Plasma and salivary irisin levels in lepramatous leprosy patients

Aim: We aimed to investigate the plasma and salivary irisin levels in leprosy patients, as well as to evaluate the role of the irisin in the leprosy pathogenesis. Leprosy is a granulomatous disease with the peripheral nerves, mucous membrane, and skin involvement primarily. Irisin, a novel protein, has been associated with several inflammatory diseases and demonstrated in the peripheral nerve cells, deep sebaceous glands, and saliva excessively. To our knowledge, there is no study investigating the irisin levels in patients with leprosy. Material and Methods: We conducted a case-control study on 20 patients with lepromatous leprosy and 20 healthy controls between January 2016 and January 2017. Of the participants, the demographic data and disease history including duration of the disease, any current treatments, and presence of any other family members with leprosy were recorded. The plasma and salivary irisin levels of the participants were measured by enzyme-linked immunosorbent assay (ELISA). Additionally, the serum levels of C-reactive protein (CRP), glucose, hemoglobin A1c (HbA1C), triglyceride, cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were evaluated in both groups.Results: The plasma and salivary irisin levels were significantly lower in the patient group than those in the control group (P = 0.001 and P = 0.03, respectively). In patients with leprosy, the serum and salivary irisin levels had a positive correlation (r: 576, p: 0.008). In addition, there was a negative correlation between the plasma irisin and CRP levels (r: −468, p: 0.037).Conclusion: The irisin may act an immunomodulatory role in leprosy. The irisin production is probably suppressed by the increased inflammatory markers in leprosy or the bacillus to reach the temperature for its reproduction. Further studies are needed to clarify the role and prognostic value of the irisin in leprosy with a large number of patients examined before and after the treatments.

Histopathology of Post Kala-azar Dermal Leishmaniasis.

The various lesions seen in the clinical presentation of post kala-azar dermal leishmaniasis (PKDL) are reflected in the histopathology of the type of lesion biopsied. The cells that form the dermal infiltrate include lymphocytes, histiocytes, and plasma cells in varying proportions. The infiltrate, which is mild and confined to the superficial dermis in macular lesion becomes denser with the increasing severity of the lesion. Leishman–Donovan bodies (LDB) in general are rarely demonstrable in macules and somewhat infrequently in the rest, though at times they may be numerous; mucosal lesions offer a greater chance of visualizing LDB than biopsies from the skin. A characteristic histomorphology in nodules is prominent follicular plugging with a dense plasma cell-rich lymphohistiocytic dermal infiltrate that shows an abrupt cut-off in the lower dermis, an appearance highly suggestive of PKDL even in the absence of LDB. Russell bodies within plasma cells, vascular changes, and xanthoma-like hue have been seen in plaques from chronic PKDL. The histopathologic picture in some may also mimic that seen in tuberculoid and lepromatous leprosy, and other granulomatous dermatoses. In contrast to Indian PKDL, epithelioid cell granulomas with giant cells are more common in African PKDL, and vascular changes are rare though neuritis showing LDB has been described.

Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by SIG Leprosy (IADVL Academy).

Management of Leprosy in the Context of COVID-19 Pandemic: Recommendations by SIG Leprosy (IADVL Academy).

What is New in the Pathogenesis and Management of Erythema Nodosum Leprosum.

Erythema nodosum leprosum (ENL) is a manifestation of type II lepra reaction, seen in lepromatous or borderline lepromatous leprosy. Although it is a common reaction encountered in clinical practice, there are an increasingly large number of newer updates in the pathophysiology and management of this condition. The treatment options have expanded far beyond just thalidomide and steroids and now extends to TNF-α inhibitors, thalidomide analogs, tenidap, cyclosporine A, plasma exchange, and even IVIG amongst others. These updates and the current knowledge of ENL are summarized in this review.

Diagnostic difficulty-an elusive case of Hansen’s disease mimicking sarcoidosis

Hansen´s disease (leprosy) is caused by a slow-growing type of bacteria called Mycobacterium leprae (M. leprae). It is an age-old disease that has been around since biblical times yet cases still occur especially in Asia and Africa, despite concerted global efforts to eradicate the disease. Chemotherapeutic agents are available and effective once administered appropriately and adequately. We report an elusive case of Hansen’s disease wherein the only symptom was a nodule on the nasal bridge in an otherwise healthy woman for over one year. Repeated examinations and investigations in different centers were suggestive of sarcoidosis and she was left untreated for leprosy for the period. A skin biopsy was carried out for histopathology diagnosis. Histology confirmed borderline lepromatous leprosy. This case demonstrates the need for a definitive diagnosis of leprosy to reduce the spread of this contagious disease especially in tune with the concerted global efforts.

Anterior chamber angle granuloma: A rare ocular manifestation of histoid lepromatous leprosy

Leprosy is a chronic multisystem disease caused by Mycobacterium leprae with frequent ocular manifestations such as madarosis, lagophthalmos, lid abnormalities, impaired corneal sensations, chronic uveitis, and cataract. Granulomas are characteristic lesion of lepromatous leprosy commonly seen as conjunctival and iris granulomas. We report a case of leprosy with a rare ocular manifestation in the form of angle mass lesion or suspected granuloma which has not been reported before and its successful management following treatment with favorable outcome. The index case also highlights the anterior segment fluorescein angiography features of the lesion and study of its vascular pattern.