Lepromatous Leprosy Research Articles

Concurrent pulmonary tuberculosis and lepromatous leprosy in a newly diagnosed HIV positive patient: a case report

BackgroundThe leprosy-tuberculosis (TB) co-infection is rarely reported in recent times. However, this dual comorbidity is associated with high mortality and major morbidity. Unrecognised leprosy-TB co-infection may predispose affected patients to rifampicin monotherapy and subsequent drug resistance.Case presentationA 35 year old migrant, human immunodeficiency virus (HIV) positive male worker presented with 6 month history of symmetric infiltrative nodular plaques of the face and distal, upper extremities. A few days after initial dermatology presentation, a sputum positive pulmonary tuberculosis diagnosis was made at his base hospital. Subsequent dermatology investigations revealed histology confirmed lepromatous leprosy and a weakly reactive rapid plasma reagin test. The presenting clinical features and laboratory results were suggestive of lepromatous leprosy coexisting with pulmonary tuberculosis in an HIV positive patient.ConclusionsThis case illustrates the occurrence of leprosy with pulmonary tuberculosis in an HIV infected patient and the difficulties in interpreting non-treponemal syphilis tests in these patients. This case also highlights the need for a high index of suspicion for co-infection and the need to exclude PTB prior to initiation of rifampicin containing multi-drug therapy (MDT). Interdisciplinary management and social support are crucial in these patients.

The cellular architecture of the antimicrobial response network in human leprosy granulomas.

Granulomas are complex cellular structures composed predominantly of macrophages and lymphocytes that function to contain and kill invading pathogens. Here, we investigated the single-cell phenotypes associated with antimicrobial responses in human leprosy granulomas by applying single-cell and spatial sequencing to leprosy biopsy specimens. We focused on reversal reactions (RRs), a dynamic process whereby some patients with disseminated lepromatous leprosy (L-lep) transition toward self-limiting tuberculoid leprosy (T-lep), mounting effective antimicrobial responses. We identified a set of genes encoding proteins involved in antimicrobial responses that are differentially expressed in RR versus L-lep lesions and regulated by interferon-γ and interleukin-1β. By integrating the spatial coordinates of the key cell types and antimicrobial gene expression in RR and T-lep lesions, we constructed a map revealing the organized architecture of granulomas depicting compositional and functional layers by which macrophages, T cells, keratinocytes and fibroblasts can each contribute to the antimicrobial response.

Lepromatous leprosy mimicking systemic lupus erythematosus

We describe a case of a 36-year-old woman who presented with bilateral symmetrical polyarthritis of the hands, malar rash, and discoid rash over three months. She was initially diagnosed and treated as systemic lupus erythematosus but later proven to have lepromatous leprosy. The patient showed a remarkable improvement after the administration of steroids. Due to typical features of a connectivetissue disorder, a positive serological marker, photosensitivity, typical age of onset and initial response to treatment led to the confusion and delay in diagnosis of lepromatous leprosy. Further, this case emphasizes the importance of obtaining a detailed contact history and taking a skin biopsy even in a typical connective tissue lesion. Our case illustrates an unusual presentation of lepromatous leprosy mimicking systemic lupus erythematosus.

Chronic macrocheilia: a clinico-etiological series of 47 cases.

Macrocheilia is an inflammatory disfiguring condition responsible for the swelling of the lips. This multi-etiological entity represents a diagnostic and therapeutic challenge. Published data on macrocheilia is scarce, often limited to granulomatous cheilitis. We conducted a retrospective study, including all patients presenting with chronic macrocheilia (CM) for nineteen years. CM was defined as a persistent enlargement of one or both lips for at least eight weeks. Both descriptive and analytical analyses were performed. Of the 47 patients identified, 20 (43%) had cutaneous leishmaniasis, 10 (21%) had Miescher's cheilitis, five (11%) had Melkersson-Rosenthal syndrome, five (11%) had sarcoidosis, one (2%) had lepromatous leprosy, one (2%) had systemic amyloidosis, and one (2%) had Crohn's disease. In four cases, the CM was unlabeled. Ulcerations were significantly associated with leishmaniasis (P < 0.05). Histological study showed a granulomatous infiltrate in 72% of cases. Medical treatment was adapted to the etiology of CM. Surgery was performed in two cases. Improvement of CM secondary to leishmaniasis was seen in all cases. In patients with idiopathic orofacial granulomatosis, partial improvement was noted in four cases and a total improvement in one case. Recurrences were noted in three cases after complete regression. Macrocheilia is a rare and disfiguring condition that requires an etiological investigation, considering that it can reveal a serious underlying systemic disease. We identified several factors that could help recognize the cause of CM, including age, history of intermittent swelling, the extent of lip enlargement, the existence of ulceration, and systemic symptoms.

Clinical findings in patients with leprosy who are infected with COVID-19: a case series from Elazığ, Turkey

Background: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae that can be self-limiting or progressive according to the immunological status of the host organism. Aim and objectives: We present the demographic and clinical characteristics of lepromatous leprosy (LL) patients who had Covid-19 infection. Materials and methods: This study recruited patients hospitalized in Elazığ Leprosy Hospital. Details of the patients were collected as follows: age, gender, presence of comorbidity, leprosy classification, clinical presentation, presence of leprosy reactions and complaints at the time of admission; laboratory and computed tomography (CT) findings and treatments applied. Results: This study included 9 patients with lepromatous leprosy (LL classification). Six patients were PCR positive for SARS-CoV-2, 7 patients had thoracic CT involvement. The mean age was 78.7 years (range 65–95). Complaints on admission included fatigue (n:7), cough (n:4) and fever (n:3) followed by sore throat (n:1), headache (n:1) and dysphonia (n:1). Two patients were asymptomatic, PCR positivity was detected in one and CT positivity was detected in another during screening. All patients received treatment with favipiravir and enoxaparin. No leprosy reactions occurred. All patients were discharged with recovery after completion of treatment. Conclusion: We expected that the risk for catching COVID-19 may be higher in LL patients who have a cellular immunity deficiency, and that the course of the infection may be more severe in COVID-19-infected LL patients, for the same reason. However, we have seen a decrease in the clinical severity of the COVID-19 and no patient losses. We conclude that this situation may be due to the drugs used for leprosy treatment. These immune-modulating drugs may cause a decrease in the clinical severity of the COVID-19, but we need larger studies on this subject.

Feeding the sick: An insight into dietary composition at a Medieval leper hospital using dental wear pattern analysis

In the Middle Ages, palliative dietary regimens were fundamental to the treatment of disease. It was believed that the foods eaten were central to bringing balance to the human body. Alleviating the symptoms of leprosy required the consumption of foods considered moist and mild, which included certain kinds of meat. Medieval lepers were housed and treated in leprosaria (leper hospitals), often located on the outskirts of towns and cities. The quality of the food consumed at each institution, however, varied considerably according to its financial situation. The extent to which the diet of lepers corresponded to that advised by Medieval physicians, therefore, remains largely uncertain. Here, a method of 3D dental wear pattern analysis, called Occlusal Fingerprint Analysis, is used to infer the dietary composition of individuals interred at the cemetery associated with the medieval leprosarium and later almshouse of St James and St Mary Magdalene, Chichester (n = 24). It was found that the dental wear pattern of individuals with osseous changes consistent with lepromatous leprosy showed an enlargement of buccal phase I wear when compared to the rest of the cemetery and a comparative group interred at St Michael’s Litten lay cemetery, Chichester (n = 17). Differences in dental wear patterns suggest that the lepers at this cemetery had regular access to meat beyond the quantities consumed by the majority of the lower social strata of Medieval society and more consistent with the palliative care recommended by Medieval medical theory.

P.137 A case of leprosy in the UK

Introduction: Leprosy is a multi-system disease caused by Mycobacterium leprae. Whilst uncommon in the developed world, cases continue to rise in developing nations with up to 200,000 new cases reported annually. 1We report a case of lepromatous leprosy in a parturient residing in Scotland. Case Report: A 26-year-old primigravida presented in early pregnancy following a history of nosebleeds and widespread rash. The patient was a sickle-cell carrier but was otherwise well with no allergies. A diagnosis of lepromatous leprosy with erythema nodosum reaction was made and treatment commenced with prednisolone and combination therapy with rifampicin, clofazimine and dapsone. The pregnancy was complicated by anaemia and thrombocytopaenia with mild splenomegaly. Anaemia was thought to be secondary to Dapsone-related haemolysis, and thrombocytopaenia was thought most likely to be gestational. She developed neuropathic leg pain and hypoaesthesia but this resolved during the pregnancy. Renal and liver function remained normal and there were no symptoms or signs of autonomic dysfunction with normal postural blood pressure readings and normal ECG. After multi-disciplinary discussion, induction of labour was planned due to concerns over fetal growth. The patient was screened for SARS-CoV-2 and this was positive, though the patient remained asymptomatic. The patient was not considered to be infectious and standard infection control procedures were observed. Anaesthetic options for analgesia in labour and anaesthesia for potential operative delivery were discussed at several occasions during pregnancy and ”OAA Labour Pains” translated information sheets were given to the patient. Following induction of labour, the patient had a spontaneous vaginal delivery with no anaesthetic intervention required. Discussion: Leprosy is uncommon in developed nations but may occur in the UK as the population becomes more diverse. Leprosy raises many potential challenges for the anaesthetist including;cutaneous changes (which may be of particular significance if occurring over sites of intravenous access or lower lumbar region), neuropathies, myopathies, autonomic dysfunction, haematological derangements (including anaemia, thrombocytopaenia and agranulocytosis) and liver and renal impairment. Drug therapies for leprosy may in themselves be associated with blood dyscrasias, hepatitis, psychosis, and peripheral neuropathies. Anaesthetic management should be informed by the presence of any complications, most notable thrombocytopaenia or peripheral neuropathies. The possibility of autonomic dysfunction should be considered regardless of which anaesthetic modality is chosen and care taken to actively manage hypotension. The patient’s SARS-CoV-2 status was a further factor influencing the risk-benefit assessment of anaesthetic options in this case.

Sonographic pattern of median nerve enlargement in Hansen's neuropathy.

Median nerve enlargement in leprosy seems to be more proximal than in carpal tunnel syndrome (CTS), but this feature has not been studied systematically. The aim of the study was to compare the sites of median nerve enlargement in patients with leprosy with that of patients with CTS. Transverse sections of the median nerve were recorded from wrist to the mid-forearm (at distal wrist crease and at 2-cm: M1, 4-cm: M2, 6-cm: M3, 8-cm: M4 and 10-cm: M5, proximal to the distal wrist crease in the forearm) in patients with leprosy, CTS and healthy subjects using high-resolution ultrasound. Twenty-six patients each with leprosy and CTS were compared with healthy controls. Patients with leprosy included 6 (23.1%), 7 (26.9%), 7 (26.9%) and 6 (23.1%) patients with borderline tuberculoid, borderline-borderline, borderline lepromatous and lepromatous leprosy, respectively. Cross-sectional area (CSA) of median nerve was increased in all patients with leprosy as compared to healthy controls at all points of measurement. CSA was higher among patients with leprosy as compared to CTS at all points except at the wrist. In patients with leprosy, the maximal enlargement was noted 2-cm (M1) proximal to the wrist crease with gradual tapering of the CSA proximally (p<.05). In contrast, in patients with CTS the median nerve was maximally enlarged at the distal wrist crease (p<.05). Median nerve enlargement 2-cm proximal to the distal wrist crease distinguishes leprosy from CTS. This important discriminating sign can be used at point-of-care to identify patients with leprosy.

Dermoscopy in Leprosy: A Clinical and Histopathological Correlation Study

Leprosy, an insidious infectious granulomatous disease, is diagnosed traditionally through clinical examination coupled with skin smears and histopathology. It has myriad clinical presentations that pose diagnostic challenges. Lately, dermoscopy has emerged as a rapid, noninvasive diagnostic modality for many dermatoses. We evaluated the dermoscopic findings of various manifestations of leprosy and correlated them with clinical and histopathological features. This prospective, cross-sectional study was conducted in our skin outpatient department for a period of 1 year. Patients newly diagnosed as having leprosy or those undergoing leprosy treatment for less than 6 months were included. The most representative lesion was dermoscopically evaluated and later biopsied. We included 73 patients in the study. Results indicated an obvious correlation between dermoscopic findings and histopathology. We noted orangish yellow and white structureless areas, steadily throughout the spectrum, depicting dermal granuloma. Additionally, we observed focal vascular structures such as branching, linear, and crown vessels that result from the pressure of granuloma pushing the dilated vessels upwards. The relative absence of skin appendages aided in differentiating leprosy from other granulomatous disorders. Novel findings of our study were the detection of a branch-like pattern of clofazimine-induced pigmentation on dermoscopy and orange globules on onychoscopy. Other unique findings included violaceous structureless areas, characteristic large telangiectatic vessels, follicular plugging, star-shaped silvery-white scaling, and white globules in type 1 reaction; white shiny steaks were observed in patients with borderline lepromatous leprosy, and central white dots and keratotic plugs were observed in patients with histoid leprosy. Dermoscopy, as a noninvasive modality, could aid in the quick diagnosis of leprosy and should be used as a handy tool to complement other investigative tools for this disease.

Mycobacterium leprae promotes triacylglycerol de novo synthesis through induction of GPAT3 expression in human premonocytic THP-1 cells.

Mycobacterium leprae (M. leprae) is the etiological agent of leprosy, and the skin lesions of lepromatous leprosy are filled with numerous foamy or xanthomatous histiocytes that are parasitized by M. leprae. Lipids are an important nutrient for the intracellular survival of M. leprae. In this study, we attempted to determine the intracellular lipid composition and underlying mechanisms for changes in host cell lipid metabolism induced by M. leprae infection. Using high-performance thin-layer chromatography (HPTLC), we demonstrated specific induction of triacylglycerol (TAG) production in human macrophage THP-1 cells following M. leprae infection. We then used [14C] stearic acid tracing to show incorporation of this newly synthesized host cell TAG into M. leprae. In parallel with TAG accumulation, expression of host glycerol-3-phosphate acyltransferase 3 (GPAT3), a key enzyme in de novo TAG synthesis, was significantly increased in M. leprae-infected cells. CRISPR/Cas9 genome editing of GPAT3 in THP-1 cells (GPAT3 KO) dramatically reduced accumulation of TAG following M. leprae infection, intracellular mycobacterial load, and bacteria viability. These results together suggest that M. leprae induces host GPAT3 expression to facilitate TAG accumulation within macrophages to maintain a suitable environment that is crucial for intracellular survival of these bacilli.

Clinicopathological study of lepromatous leprosy and histoid leprosy in a tertiary care institute

Background: Lepromatous leprosy is a clinical course seen in patients with inefficient cellular immunity against Mycobacterium leprae, resulting in anergy. A highly bacilliferrous type of lepromatous leprosy is histoid leprosy. Histoid leprosy was initially reported to manifest after the failure of long-term dapsone monotherapy, irregular therapy, or inadequate therapy. However, it is now well known that histoid leprosy develops de-novo as well. This study was undertaken to know the incidence and clinicopathological characteristics of lepromatous leprosy and histoid leprosy.Materials and Methods: This was a combined (both retrospective and prospective) study of lepromatous and histoid Leprosy, undertaken in the Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi, over 42 months from January 2013 to June 2016.Results: Out of the 16 clinically diagnosed lepromatous leprosy cases, only 5 were histologically proven to be the same. Of the seven clinically diagnosed histoid leprosy cases, 4 were histoid leprosy on histopathology and the remaining 3 were lepromatous leprosy. All 4 patients of histoid leprosy were cases of De- Novo histoid leprosy. The commonest skin lesion encountered were erythematous patches (9/16) in lepromatous leprosy and nodules (5/7) in histoid leprosy.Conclusions: Lepromatous leprosy when diagnosed in an early stage, interrupts the epidemiological chain and avoids the associated disabilities and psychological effects for the patient and family. Histoid leprosy is a rare entity that can also present with no history of prior anti-leprosy treatment, the diagnosis of “de-novo histoid leprosy” should be kept in mind.

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients.

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley-Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes - spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.

Role of Urinary Calcium and Creatinine Ratio in Assessing Bone Resorption in Lepromatous Leprosy

Bony changes in lepromatous leprosy are one of the causes of deformity and disability. Fasting calcium and creatinine ratio in urine is used as a bone resorption marker in a number of diseases such as hyperthyroidism, osteoporosis, multiple myeloma, paget’s disease and sarcodosis. In lepromatous leprosy assessment of bone resorption might be done with that marker. To assess the role of fasting urinary calcium and creatinine ratio as a marker of bone resorption in patients with lepromatous leprosy. A case control study was conducted on 28 patients diagnosed as lepromatous leprosy and 28 age-matched healthy control. The participants who fulfilled all inclusion and exclusion criteria were studied by measuring fasting urinary calcium and creatinine level as well as observing X-rays of both hands and feet of affected individuals. The mean age of cases 38.1±14.2 years and 38.9±12.9 years was in control group. Male - female ratio was 3.6: 1. It was observed that 10.7% leprosy patients showed urinary Ca/Cr ratio &gt;0.20 (0.13±0.12) and 10.7% healthy control showed urinary Ca/Cr ratio ratio&gt;0.20 (mean ±SD 0.11±0.7). the difference was not statistically significant (p&gt;0.05). X-ray finding was positive in 14.3% leprosy patients and none of the control group. That difference was not significant statistically (p&gt;0.05). there was no relation between raised urinary Ca/Cr ratio and positive findings of bone resorption on x-rays among the leprosy cases.&#x0D; Bangladesh Med J. 2019 Sep; 48 (3): 28-33

Clinical, histopathological, and molecular characterization of leprosy in an endemic area of the colombian caribbean.

Mycobacterium leprae was considered the only causal agent of leprosy until Mycobacterium lepromatosis was identified' which it has been suggested has greater pathogenicity and is linked to diffuse lepromatous leprosy (DLL) and Lucio's phenomenon (LPh). Our objective is to identify Mycobacterium spp. in an endemic area of leprosy in Colombia. The study included cases with a diagnosis of leprosy by clinical and histopathological analysis. DNA extraction and two specific rounds of semi-nested polymerase chain reaction (PCR) were performed in paraffin biopsies skin to identify M. leprae and M. lepromatosis. Demographic, clinical, and histopathological data were extracted and tabulated for analysis. Forty-one cases of leprosy were analyzed. The most frequent clinical diagnosis was lepromatous leprosy (36.6%); there was one case with DLL and two with LPh. The most common histopathological finding was tuberculoid leprosy (36.59%); three cases had negative histopathology. M. lepromatosis was not detected; all cases corresponded to M. leprae including cases with negative histopathology' DLL, and LPh. In this study, M. leprae was the causative agent of leprosy, encompassing even its most severe phenotypic forms. It is appropriate to consider PCR as an indispensable tool for the diagnosis of leprosy and to continue to carry out the active search for M. lepromatosis.

An unusual ocular presentation of histoid leprosy

Leprosy is a chronic granulomatous infection caused by mycobacterium leprae, mainly affecting the skin and peripheral nerve. Histoid type of leprosy, which is considered as an extremely rare variant of lepromatous leprosy. We report a case of a 50/year old male presented to our institute with chief complain of conjunctival swelling in both eyes, encroaching over cornea and involving limbus and sclera, associated with painless blurring of vision. An incisional biopsy of the right eye was performed under local anesthesia. Histopathology of right eye biopsy revealed spindle shaped cells having bland looking nuclei and variable amount of cytoplasm which was suggestive of histoid leprosy. A dermatology consultation was sought and patient was diagnosed to have leprosy. Consequent to which he was started on MBALD (multibacillary anti leprosy drug), and showed improvement in patient`s visual acuity as well as regression of right eye swelling and disappearance of left eye swelling.

Association of Testosterone Level among Lepromatous and Borderline Leprosy Male Patients: Experience of 30 Cases in Bangladesh

Background: Hormonal dysfunction is reported among the leprosy patients.&#x0D; Objective: The purpose of the present study was to see the association of testosterone level among male patients presented with lepromatous and borderline leprosy.&#x0D; Methodology: This cross-sectional study was conducted in the Leprosy Hospital, Dhaka, Bangladesh from January to December 2016 for a period of one year. All patients with a known diagnosis of leprosy under follow up at the hospital were included in the study. The serum concentration of testosterone was measured using an enzyme immunoassay technique (ELISA) (DiaMetra, Spello, Italy).&#x0D; Result: A total number of 30 cases of leprosy were recruited for this study. The mean with SD of the study population was 39.20±9.065 years. Among 30 cases of study population 26 cases were lepromatous leprosy patents and the rest 4 cases were Borderline Leprosy patients. The mean with the standard deviation of testosterone level in serum was 6.41±4.756 mg/dL and 4.71±2.396 mg/L in lepromatous leprosy and borderline leprosy respectively (p=0.497).&#x0D; Conclusion: In conclusion there is no statistically significant relationship between leprosy and testosterone; however, lower level of testosterone is found among the study population&#x0D; Bangladesh Journal of Infectious Diseases 2020;7(2):36-39

Pathogenesis and Host Immune Response in Leprosy.

Leprosy is an ancient insidious disease caused by Mycobacterium leprae, where the skin and peripheral nerves undergo chronic granulomatous infections, leading to sensory and motor impairment with characteristic deformities. Susceptibility to leprosy and its disease state are determined by the manifestation of innate immune resistance mediated by cells of monocyte lineage. Due to insufficient innate resistance, granulomatous infection is established, influencing the specific cellular immunity. The clinical presentation of leprosy ranges between two stable polar forms (tuberculoid to lepromatous) and three unstable borderline forms. The tuberculoid form involves Th1 response, characterized by a well demarcated granuloma, infiltrated by CD4+ T lymphocytes, containing epitheloid and multinucleated giant cells. In the lepromatous leprosy, there is no characteristic granuloma but only unstructured accumulation of ineffective macrophages containing engulfed pathogens. Th1 response, characterised by IFN-γ and IL-2 production, activates macrophages in order to kill intracellular pathogens. Conversely, a Th2 response, characterized by the production of IL-4, IL-5 and IL-10, helps in antibody production and consequently downregulates the cell-mediated immunity induced by the Th1 response. M. lepare has a long generation time and its inability to grow in culture under laboratory conditions makes its study challenging. The nine-banded armadillo still remains the best clinical and immunological model to study host-pathogen interaction in leprosy. In this chapter, we present cellular morphology and the genomic uniqueness of M. leprae, and how the pathogen shows tropism for Schwann cells, macrophages and dendritic cells.

A Clinicoepidemiological Study of Psychiatric Co-Morbidity in Hansen's Disease.

Introduction:Leprosy is a chronic disease caused by mycobacterium leprae. Chronicity of the disease leads to various psychiatric co-morbidities, which are often undiagnosed and untreated. The main objectives of this study were to evaluate the frequency and nature of psychiatric co-morbidity in patients of Hansen's disease.Materials and Methods:Seventy confirmed cases of Hansen's disease between the ages of 18 and 60 years attending the department of dermatology of Indira Gandhi Medical College and Hospital, Shimla were evaluated for various manifestations of Hansen's disease and screened for psychiatric co-morbidity using GHQ-12 and diagnosed using ICD-10 checklist. Severity of depression and anxiety was assessed with HAM-D and HAM-A scales, respectively.Results:The prevalence of psychiatric co-morbidity was found in 27.14% of enrolled patients. Depression was most prevalent in (20%) mental disorder; followed by anxiety disorder (7.14%). Moderate depressive episode was the commonest seen in 11.42% patients whereas 5.71% patients had mild depression. Generalized anxiety disorder was seen in 1.42% whereas 5.71% patients had mixed anxiety disorder. Patients with higher education status, positive family history of leprosy, lepromatous leprosy, and hand deformities were significantly associated with higher psychiatric co-morbidity.Conclusion:Patients suffering from Hansen's disease have significantly high prevalence of psychiatric co-morbidity complicating the Hansen's disease. High index of suspicion is required to diagnose and treat it.

Magnitude and temporal trends of leprosy relapse in the state of Ceará, Brazil in the period 2001-2018

INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.

Clinico-pathological Study of Leprosy- A Descriptive Study

Introduction: Leprosy is an age old disease affecting mankind with various clinico-pathological forms. Mycobacterium Leprae causes a chronic infectious disease known as Leprosy or Hansen’s disease. It remained a major public health issue due to associated case load, morbidity and stigma attached to it. Clinical and histopathological examination along with demonstration of lepra bacilli in skin smears by Fite-faraco stain and Bacillary Index (BI) is widely used for proper classification and diagnosis of leprosy. Aim: To study the clinico-pathological features of leprosy in skin biopsies and to categorise it into various types of lesions according to Ridley Jopling classification. Materials and Methods: The descriptive study included clinically diagnosed 183 leprosy cases who underwent skin biopsy for histopathological examination from January 2017 to December 2018 at Shri Bhausaheb Hire Government Medical College Dhule, Maharashtra. All sections were stained with Haematoxylin and Eosin (H&amp;E) and Fite-faraco stain. Ridley-Jopling classification was done to classify leprosy. Clinical diagnosis was in concordance with that of histopathological diagnosis. Results: A total of 183 skin biopsies were studied from patients in an age group of 11-76 years. Male to female ratio was 1.5:1 and commonest age group affected was 21-40 years. Clinically, 78 cases (42.6%) were diagnosed as Borderline Tuberculoid (BT) leprosy followed by indeterminate leprosy 34 (18.57%). On histopathological examination maximum cases had BT leprosy 64 (82.05%) followed by Tuberculoid (TT) leprosy 13 (81.25%). Fite- faraco stain was done in 71 cases and was found positive in all cases of Borderline Lepromatous (BL) and Lepromatous Leprosy (LL). Also,concordance between Bacillary Index (BI) and histopathology examination was done. The clinico-histopathological concordance was seen in 127 cases (69.39%). Conclusion: Early and accurate diagnosis by clinical and histopathological examination along with special stain is essential for proper diagnosis and treatment of the patient as well as prevention of its complications.