Lepromatous Leprosy Research Articles

Lucio Phenomenon mimicking with Vasculo necrotic Erithema Nodosum Leprosum: A Case Report

Clinical features of Lucio’s phenomenon (LP), shows a nectorizing erythema, may mimicking Erythema Nodosum leprosum with vasculonecrotic. A 46 years old man presented with diagnosis lepromatous leprosy with Lucio’s phenomenon and diferential diagnosis borderline lepromatous (BL) with vasculonecrotic erithema nodosum leprosum. The patients complained there were painless ulcers on his lower limbs and scrotum, with surrounded by purpuric patches which subsequently became gangrenes and ulcerated for 3 weeks. There was numbness of both hands and feet, the eyelashes, eyebrows baldness since 5 years ago. Patient never got the treatment before. Bacteriological examination showed bacterial index 6+ Histopathology: there were Flattened epidermis by narrow grenz zone, and lymphocyte in perivascular with macrophage. There was endothelial proliferation of capiller. Fite faraco stain showed macrophage infiltration around the perivasculer, with colonization of the endothelial cell by acid fast bacilli and epidermal necrosis and diagnosis as Lepromatous leprosy with Lucio phenomenon. This patient is given adult multiple drug therapy (MDT) therapy, methylprednisolone, neurotrophic vitamins. Lucio’s phenomenon most commonly affects patients with untreated leprosy. Clinically, it may be difficult to differentiate Lucio phenomenon from Erythema nodosum leprosum with vasculonecrotic. In this case, the histopathological examination were colonization of endothelial cell by acid fast bacilli, epidermal necrosis and endothelial proliferation of the vessel.

Histomorphological Study of Leprosy with Clinical Correlation in Kumaon Region

Background: Leprosy is a leading cause of permanent physical disability. Approx 60% of global burden of leprosy is represented by India. Histopathological examination is still considered gold standard for accurate categorization of leprosy so that timely treatment can be started.
 Objectives: To categorize and correlate types of leprosy clinically and histomorphologically in Kumaon region.
 Methods: The present cross-sectional study of 62 cases was conducted in the Department of Pathology & Skin and V.D in a tertiary care centre of Kumaon region from August 2016 to April 2018. The cases were clinically examined and categorized according to Ridley-Jopling classification. Skin Biopsy and Slit-Skin Smear (SSS) were taken for accurate histomorphogical categorization of leprosy and assessment of bacterial index, followed by clinico-histomorphological correlation. Statistical analysis was done in term of chi-square test. Kappa test was used as agreement test for clinical versus histological classification of different type of leprosy.
 Results: A total of 62 clinically diagnosed leprosy cases evaluated histopathologically. Clinically, lepromatous leprosy (LL) was the most common type of leprosy (38.70%), followed by borderline tuberculoid (30.64%). On histopathological examination, indeterminate leprosy (IL) (21 cases; 33.90%) was the most common followed by lepromatous leprosy (16 cases; 25.80%). Overall clinico-histopathological correlation was seen in 36 cases (58. 06%) with maximum correlation seen in indeterminate leprosy (100%) and tuberculoid leprosy (TT) (100%). Conclusion: This study concludes that correlation of clinical and histopathological features along with bacterial index is more useful for accurate typing of leprosy than considering any of the single parameter alone so that early and appropriate treatment could be started.

Clinical and histopathological profile of a patient with localized lepromatous leprosy

Lepromatous leprosy is a polar form of the disease characterized by very low to absent cell mediated immunity, resulting in unrestricted multiplication of the leprosy bacilli. This leads to infiltration and papulo-nodular lesions, which initially favor the cooler areas of the body and later become generalized. However, lepromatous leprosy may rarely be localized to a single or limited sites. Routine skin smears are negative but a skin smear and histopathology from the affected sites are confirmatory. These cases may be misdiagnosed as paucibacillary leprosy with subsequent under-treatment of the patient. Clinicians should be aware of this entity as a simple skin smear from the site can confirm the diagnosis. A 57-year old man presented with an erythematous plaque surrounded by a few satellite papules on the right hand, right ulnar paralysis and partial anaesthesia of the right hand and both feet, for one year. Slit skin smears from routine sites were negative for acid fast bacilli. However, a skin smear from the satellite lesions revealed a bacillary index of 4+. Histopathology of the skin was consistent with lepromatous leprosy. He was initiated on the WHO multibacillary multidrug therapy (MB-MDT).

Melioidosis complicating lepromatous leprosy with type 2 lepra reaction: A rare case report from India

Melioidosis is an infection caused by Burkholderia pseudomallei, occurring in patients with underlying medical conditions. An extensive literature search did not reveal any reports of Burkholderia in association with Hansen’s disease. We present here a case of a 34 year male with lepromatous leprosy with recurrent type 2 reaction presenting with right iliopsoas abscess due to Burkholderia pseudomallei; he was treated successfully with meropenem and doxycycline. This is the first case report of Burkholderia pseudomallei abscess coexisting with Hansen’s disease.

Bullous erythema nodosum leprosum: a rare case series

Bullous erythema nodosum leprosum (Bullous ENL) is the severe form of Type 2 lepra reaction. There are only a handful of reports of bullous ENL cases in English literature. We hereby report five cases of lepromatous leprosy with bullous erythema nodosum leprosum, of whom cases 1, 3, 4 and 5 had bullous ENL at initial presentation, while case 2 developed bullous lesions during the fourth episode of ENL. The diagnosis was based on clinical features and histopathology. All cases had a bacillary index more than 4+. None of the patients had a history of previous anti-leprosy treatment. A history of contact with another person with leprosy was present in two cases. All five cases were successfully treated with multidrug therapy, oral steroids and thalidomide. This case series on bullous ENL emphasises that a high bacillary index and delay in diagnosis and treatment can lead to the more severe form of bullous Type 2 lepra reaction.

Hematological alterations in lepromatous leprosy: A cross-sectional observational study

BackgroundDapsone has been the mainstay for the treatment of leprosy since its discovery in the 1940s. However, hematological disturbances are not uncommon in leprosy patients on daily dapsone therapy. Hence, the present study was conducted to document the hematologic alterations observed in lepromatous leprosy patients treated with Dapsone 100 mg daily. MethodologyA cross-sectional observational study was conducted amongst 32 lepromatous leprosy patients treated with Dapsone 100 mg daily. A complete hemogram was conducted for all the study recruits. The test results were compared against the standard average values for adults for the given variables. The one sample t-test was employed to compare the difference between the study values and the standard normal values for adults. The statistical significance was considered at p < 0.05. ResultsThe study reveals a marked decrease in hemoglobin concentration in patients on dapsone, 100 mg daily. Other hematological alterations found were reduced platelet count, reduced mean platelet volume, reduced Hematocrit, reduced Mean Corpuscular hemoglobin, reduced Mean Corpuscular hemoglobin concentration. (p < 0.05). ConclusionTreatment of lepromatous leprosy with 100 mg daily Dapsone therapy may lead to hematological alterations. These findings are suggestive of dapsone-induced hemolysis.

Oral candida prevalence and species specificity in leprosy

BackgroundLeprosy represents a chronic progressive debilitating disease. The severe morbidity associated with leprosy predisposes the patients to opportunistic infections. To assess the oral candida prevalence and species specificity in lepromatous leprosy patients. MethodsThe cross-sectional study included 70 lepromatous leprosy patients under a multi-drug regimen for less than 1 year (group 1) and 70 healthy volunteers (group 2). Both group 1 and 2 were matched for potential confounding factors including age, gender, ethnicity, absence of HIV co-infection. Oral swab samples obtained from both groups were subjected to a series of conventional and molecular diagnostic modalities. ResultsYeast growth was statistically higher (0.0006) in group 1 (45.7%) than in group 2 (18.5%). 28 of the 32 yeast growth in group 1 and all 13 yeast growth in group 2 were identified as candida. Among the 28 candida species in group 1, 23 (71.88%) were Candida albicans, 3 (9.37%) were Candida parapsilosis, 1 (3.13%) was Candida lusitaniae and 1 (3.13%) was Candida nivariensis. Among group 2, 11 (84.6%) were Candida albicans, 1 (7.7%) was Candida parapsilosis and 1 was Candida tropicalis. ConclusionOral candida prevalence is higher in leprosy patients than in healthy individuals, indicating a predisposition towards opportunistic infections. The increasing prevalence of the non-candida albicans species in leprosy is a major concern as they have shown to possess inherent resistant towards common anti-fungal agents.

Neoplastic cells parasitized by Mycobacterium leprae: report of two cases of melanocytic nevus and one of basal cell carcinoma

BackgroundLeprosy is a major public health concern in many developing countries. Mycobacterium leprae (M. leprae), the causative agent of leprosy, has the ability to parasitize different types of human cells and tissues. In this article, the uncommon parasitism of nevus and neoplastic and epithelial cells by M. leprae are described using histological sections doubly stained by Fite-Faraco (FF) and immunohistochemistry (IHC), respectively.Case presentationThree patients with borderline-lepromatous and lepromatous leprosy underwent excision of melanocytic nevi (cases 1–2) and basal cell carcinoma (case 3). Histological sections confirmed the clinical diagnosis of melanocytic nevus and basal cell carcinoma, but leprosy lesions were evident in adjacent tissues. FF staining and IHC (CD68, Melan A, and 34βE12) demonstrated the presence of bacilli within the nevus cells and also in the epithelial cells of the basal cell carcinoma.ConclusionsM. leprae has the ability to parasitize different types of cells, including neoplastic cells. Pathologists working in settings where leprosy is endemic should be aware that some cutaneous biopsy specimens may also present with leprosy findings.

Isolation of Mycobacterium lepromatosis and Development of Molecular Diagnostic Assays to Distinguish Mycobacterium leprae and M. lepromatosis.

Mycobacterium leprae was thought to be the exclusive causative agent of leprosy until Mycobacterium lepromatosis was identified in a rare form of leprosy known as diffuse lepromatous leprosy (DLL). We isolated M. lepromatosis from a patient with DLL and propagated it in athymic nude mouse footpads. Genomic analysis of this strain (NHDP-385) identified a unique repetitive element, RLPM, on which a specific real-time quantitative polymerase chain reaction assay was developed. The RLPM assay, and a previously developed RLEP quantitative polymerase chain reaction assay for M. leprae, were validated as clinical diagnostic assays according to Clinical Laboratory Improvement Amendments guidelines. We tested DNA from archived histological sections, patient specimens from the United States, Philippines, and Mexico, and US wild armadillos. The limit of detection for the RLEP and RLPM assays is 30 M. leprae per specimen (0.76 bacilli per reaction; coefficient of variation, 0.65%-2.44%) and 122 M. lepromatosis per specimen (3.05 bacilli per reaction; 0.84%-2.9%), respectively. In histological sections (n = 10), 1 lepromatous leprosy (LL), 1 DLL, and 3 Lucio reactions contained M. lepromatosis; 2 LL and 2 Lucio reactions contained M. leprae; and 1 LL reaction contained both species. M. lepromatosis was detected in 3 of 218 US biopsy specimens (1.38%). All Philippines specimens (n = 180) were M. lepromatosis negative and M. leprae positive. Conversely, 15 of 47 Mexican specimens (31.91%) were positive for M. lepromatosis, 19 of 47 (40.43%) were positive for M. leprae, and 2 of 47 (4.26%) contained both organisms. All armadillos were M. lepromatosis negative. The RLPM and RLEP assays will aid healthcare providers in the clinical diagnosis and surveillance of leprosy.

A unique case of borderline lepromatous leprosy with psoriasis-like lesions all over the body and mycosis fungoides-like lesions on the face

sClinical manifestations of leprosy are various and may resemble other skin diseases. Skin lesions of leprosy mimicking psoriasis and mycosis fungoides (MF) that simultaneously occurs in one patient are rare. We reported a unique case of borderline lepromatous (BL) leprosy with severe reversal reaction manifested as psoriasis-like lesions and MF-like lesions in a 43-year-old-man. Psoriasis-like lesions all over the body accompanied by plaques and tumor-like lesions mimicking MF on the face could be found in this patient. Histopathological examination on an MF-like lesion from the face and psoriasis-like lesions from the posterior trunk and lower extremities revealed granulomatous reaction with epithelioid cells, Langhans giant cells, and foam cells which supported the diagnosis of BL leprosy. The patient was treated with multidrug therapy multibacillary (MDT-MB) regimen and 40 mg prednisone daily which was tapered off. Clinical improvement was observed on the 32nd day of observation as psoriasis-like and MF-like lesions became hyperpigmented macules and plaques, respectively. Due to the rarity of the multitype skin lesions of leprosy in one patient, a diagnosis of leprosy should be suspected by the clinicians in any patients with previously described skin disorders, especially in an endemic area.

Histopathological study of non-neoplastic skin lesions-A retrospective approach

Histopathological study of non-neoplastic skin lesions-A retrospective approach - IJPO- Print ISSN No: - 2394-6784 Online ISSN No:- 2394-6792 Article DOI No:- 10.18231/j.ijpo.2019.108, Indian Journal of Pathology and Oncology-Indian J Pathol Oncol

Case Report: Nodular colloid degeneration of the skin

In this report, we described a 58-year-old man, presenting with multiple plaques and nodules over the nose and forehead resembling sarcoidosis or lepromatous leprosy. The histologic study revealed deposition of the mass of amorphous, eosinophilic-cleaved, colloid materials in the papillary dermis and deep dermis. The periodic acid-Schiff (PAS) stain was positive, whereas the Congo red stain was negative. Based on the clinical and pathologic findings, the patient was diagnosed with nodular colloid degeneration(NCD). To treat the patient, lesions were flattened using a Co2 laser. The patient did not return for follow-up. NCD is a rare disease, with only 12 cases having been previously reported. Here, we present a case of NCD that occurred on the face and discuss the topic of how to discriminate between NCD and other similar entities, emphasizing that nodular colloid degeneration should be considered in the differential diagnosis of asymptomatic facial plaques and nodules.

Osteoarcheological and biomolecular evidence of leprosy from an 11-13th century CE Muslim cemetery in Europe (Orosháza, Southeast Hungary).

Orosháza site no. 10 (Southeast Hungary) contains the partially excavated archaeological remains of an 11-13th century CE Muslim merchant village and its cemetery located in close proximity to Christian villages of the same era. The skeleton of a young woman (grave no. 16) from the last phase of the cemetery use was identified with rhinomaxillary lesions associated with lepromatous leprosy. The right parietal bone also exhibited signs of cranial trauma, possibly caused by symbolic trepanation, a well-known ritual practice in the 9-11th century CE Carpathian Basin. The retrospective diagnosis of the disease was supported by ancient DNA analysis, as the samples were positive for Mycobacterium leprae aDNA, shown to be of genotype 3. Contrary to the general practice of the era, the body of the young female with severe signs of leprosy was interred among the regular graves of the Muslim cemetery in Orosháza, which may reflect the unique cultural background of the community.

A clinico pathological correlation in leprosy in a tertiary care teaching institution

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Leprosy is a chronic infectious granulomatous disease caused by &lt;em&gt;Mycobacterium leprae&lt;/em&gt;. The disease primarily affects peripheral nervous system, the skin and certain other tissues. It is a spectral disease which is classified into five groups based on clinical, histopathological and bacteriological and immunological criteria as tuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), lepromatous (LL) according to Ridley-Jopling classification. Adequate clinical information combined with histopathology and bacteriological index is helpful not only in classification of different types of leprosy, but also useful for management of cases.The objective of the study was to correlate clinical diagnosis with histopathological findings of leprosy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective study was conducted for one year from January to December 2018 in Leprosy clinic, Department of Dermatology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai. The histopathological findings were compared with clinical diagnosis.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total number of cases attended leprosy clinic from January 2018 to December 2018 was 167 cases, among those 49 clinically diagnosed cases were included in the study. Out of 49 cases, maximum number of patients belonged to 30-50 years age group. Male to female ratio was 3.9: 1. Hypopigmented, hypoaesthetic patches were commonly seen. Clinically as well as histopathologically BT leprosy was common.The maximum histological correlation seen in lepromatous leprosy (100%) followed by BT (80%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study emphasises the role of skin biopsy in confirming the clinical diagnosis of leprosy and also as a therapeutic guide.&lt;/p&gt;

De novo histoid leprosy in an immunocompetent male: a rare case report from North east India

Histoid leprosy is a rare form of lepromatous (multibacillary) leprosy. This form of leprosy is fairly common in patients on dapsone monotherapy and irregular treatment. Sometimes it can arise de novo as well. Very few cases have been reported in immunocompetent individuals from India. I report a case of de novo histoid leprosy in a 22 year old male from north east India.

The impact of KIR/HLA genes on the risk of developing multibacillary leprosy.

BackgroundKiller-cell immunoglobulin-like receptors (KIRs) are a group of regulatory molecules able to activate or inhibit natural killer cells upon interaction with human leukocyte antigen (HLA) class I molecules. Combinations of KIR and HLA may contribute to the occurrence of different immunological and clinical responses to infectious diseases. Leprosy is a chronic neglected disease, both disabling and disfiguring, caused mainly by Mycobacterium leprae. In this case–control study, we examined the influence of KIRs and HLA ligands on the development of multibacillary leprosy.Methodology/Principal findingsGenotyping of KIR and HLA genes was performed in 264 multibacillary leprosy patients and 518 healthy unrelated controls (238 healthy household contacts and 280 healthy subjects). These are unprecedented results in which KIR2DL2/KIR2DL2/C1/C2 and KIR2DL3/2DL3/C1/C1 indicated a risk for developing lepromatous and borderline leprosy, respectively. Concerning to 3DL2/A3/A11+, our study demonstrated that independent of control group (contacts or healthy subjects), this KIR receptor and its ligand act as a risk factor for the borderline clinical form.Conclusions/SignificanceOur finding suggests that synergetic associations of activating and inhibitory KIR genes may alter the balance between these receptors and thus interfere in the progression of multibacillary leprosy.

A vasculonecrotic Type 2 Lepra Reaction Mimicking Lucio Phenomenon

Multibacillary, lepromatous or borderline leprosy patients may present two types Vasculonecrotic reactions: Erythema Nodosum Leprosum (ENL) with vasculitis and Lucio Phenomenon. ENL is Type 2 Lepra Reaction while Lucio Phenomenon commonly seen in nonnodular diffuse leprosy patients, mainly reported from Mexico. Here we reported a case of 20 year old male, RFT (Relief From Treatment) leprosy patient presented with fever, malaise, joint pain, edema over hands and feet and red tender elevated nodules. Interestingly, within 3 days of admission he developed multiple vesicular erythema multiforme like eruption on chest, back and upper extremity, which broken down to form necrotic ulcer in following 4 days. Biopsy showed leucocytoclastic vasculitis and fibrin deposition in vessel walls. Furthermore, USG of both ulnar nerves showed thickening. These clinical and histopathological features helped us to arrive at the diagnosis of the ENL with vasculonecrotic phenomenon. J Microbiol Infect Dis 2019; 9(3):133-136.

Leprosy \u2013 eliminated and forgotten: a case report

BackgroundLeprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual.Case presentationIn this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication.ConclusionAn unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.

Lepromatous leprosy and human immunodeficiency virus: A rare coinfection

Lepromatous leprosy and human immunodeficiency virus: A rare coinfection

Oro-facial manifestations in lepromatous leprosy patients in Central India: clinical findings from a cross-sectional study.

To clinically evaluate the oro-facial manifestations in lepromatous leprosy patients undergoing multidrug therapy in Central India. Two hundred patients from 2 leprosy treatment centers in Central India who satisfied the diagnostic criteria set by the WHO (2006-2010) committee on leprosy were included in the study. To avoid bias, only patients who started the multi-drug treatment regimen less than 1year ago were included. All the patients were examined for the presence of oral and facial manifestations. To confirm that the oro-facial manifestations were not due to HIV co-infection, serological diagnostic tests including ELISA, Immunocomb, and Tri-dot were performed. Majority of the patients (n = 189) exhibited oral (n = 145) and/or facial (n = 147) manifestations. The most common oral lesions were found to be fissuring and depapillation of the tongue followed by fibrosis and loss of uvula. Among the facial manifestations, facial skin lesions and loss of eyebrows were most prevalent followed by sagging of facial skin and facies leonine. The facial manifestations of leprosy are quite common, readily recognizable, and relatively specific to the disease. Thus, the presence of facial manifestations, especially with co-existing oral lesions must prompt the clinician to mandate further investigations to confirm the diagnosis. As evidenced by the present study, facial manifestations and oral lesions are an integral part of leprosy. In addition to being a diagnostic parameter, facial manifestations and oral lesions could potentially be used to monitor the disease progression and treatment outcome.