Leprosy Sequelae Research Articles

Substance P- and insulin-like growth factor 1-derived tetrapeptides for neurotrophic keratopathy related to leprosy: a clinical trial

PurposeNeurotrophic keratopathy is part of the leprosy sequelae and causes progressive deterioration of visual acuity. Although leprosy is bacteriologically curable, there is currently no efficient treatment. Eye drops containing tetrapeptides, Phenylalanine-Glycine-Leucine-Methionine-amide (FGLM-NH2) and Serine-Serine-Serine-Arginine (SSSR), derived from substance P and insulin-like growth factor 1 (IGF-1), are clinically efficacious in the treatment of corneal epithelial disorders caused by neurotrophic keratopathy. To further investigate the effect of this treatment on leprosy sequalae, we evaluated the clinical efficacy of FGLM-NH2+SSSR eye drops for treating neurotrophic keratopathy. DesignClinical trial: Interventional, multicenter, exploratory, single-arm, before and after comparison. ParticipantsThe eyes (12) of 11 patients, aged >60 years, were studied from two leprosy sanatoriums in Japan. MethodsPatients with neurotrophic keratopathy in leprosy sanatorium, specifically those with corneal perception of <40 mm, assessed by the Cochet-Bonnet corneal esthesiometer, and persistent corneal epithelial defects (PEDs) and/or corneal stromal thinning were included in this study. Those treated for infection in the acute phase were excluded from the study. Eye drops containing FGLM-NH2 0.05% and SSSR 5x10-6% were administered four times daily for up to 3 months. Fluorescein staining and optical corneal sections were photographed using a slit-lamp microscope at protocol-set intervals. Where possible, anterior segment optical coherence tomography was performed before and after the intervention. Main outcome measuresThe primary outcome measured was improvement in neurotrophic keratopathy. The patient was judged to have improved when one or more of the following criteria were met: 1) healing epithelial defects or 2) increased thickness in the thin area of the cornea. Secondary endpoints were visual acuity, subjective findings, and time to complete healing for a PED. ResultsNeurotrophic keratopathy on epithelial defects or stromal thickness improved in 83.3% of the patients (90% confidence interval 56.2%–97.0%, P<0.00001). The mean value of corrected visual acuity increased -0.16 by logarithm of the minimum angle of resolution. There were no adverse events reported in association with the treatment. ConclusionsWe confirmed that FGLM-NH2+SSSR eye drops are effective for neurotrophic keratopathy without any adverse reaction in leprosy. These results should be disseminated to any parties who could need this information.

Analysis of Lower-Limb Ulcers in Participants with Leprosy Sequelae Using Metabolomics and 16S Ribosomal DNA Sequencing

Analysis of Lower-Limb Ulcers in Participants with Leprosy Sequelae Using Metabolomics and 16S Ribosomal DNA Sequencing

Vision-related quality of life among released from treatment cases of leprosy evaluated with NEI-VFQ-25: a cross-sectional study

BackgroundPeople with leprosy who have been declared Release From Treatment (RFT) are often not aware of the leprosy sequelae possibility which can decrease their quality of life. This could be because they have been adapting for a long time hence they do not feel the need to see physicians. This study seeks to compare the results of Vision-Related Quality of Life (VR-QoL) among RFT persons based on the National Eye Institute Visual Functioning Questionnaire–25 (NEI-VFQ-25) and WHO grading disability based on physical examination.MethodsA cross-sectional study of 325 RFT subjects from leprosy communities (Singkawang, West Kalimantan and Tangerang, Banten) was conducted between 2018 and 2019. We used the NEI-VFQ-25 questionnaire that had been validated and translated into Indonesian and distributed to the leprosy population. Relationships and comparisons among variables were evaluated using Kruskal–Wallis and Mann–Whitney tests.ResultsThere were three main results: The median composite score of VR-QoL for WHO grade 0, 1, and 2 disabilities has decreased by 13%, 25.5%, and 30% of the maximum value, respectively. Of the total, eleven subscales were statistically significant between WHO grading disability and VR-QoL based on the NEI-VFQ-25 (p < 0.05). The comparison between grade 0 and grade 2 disability in all subscales was statistically significant (p < 0.05).ConclusionsThe grade of disability is related to their VR-QoL assessment using the NEI-VFQ-25 questionnaire. Thus, it can be used as an initial screening in primary healthcare settings to increase awareness of disability before a thorough physical examination.

Epidemiological clinical profile and closure of chronic plantar ulcers in patients with leprosy sequelae undergoing orthopedic surgery in a municipality in western Amazon.

Chronic plantar ulcers in leprosy are lesions resulting from motor and sensory alterations caused by Mycobacterium leprae. They are lesions refractory to conventional dressings and present high recurrence rates. To evaluate the epidemiological clinical profile of patients with chronic plantar ulcers associated with bony prominences in the lesion bed and to evaluate the efficacy of orthopedic surgical treatment of these lesions. This is a descriptive and analytical retrospective study with the evaluation of medical records of patients undergoing surgical treatment of chronic plantar ulcers from 2008 to 2018. The surgical technique applied consisted of corrective resection of bone prominences and the primary closure of the lesion with bipediculated local flap. 234 patients were submitted to surgery, 55.1% male with an average age of 69.5 years old. Of these, 82.9% were illiterate; and 88.5% with open lesions over 10 years. After surgical treatment, total wound healing occurred in an average time of 12 weeks. The variables that contributed to shorter healing time were: Patients' lower age group; regular use of orthopedic shoes and insoles and dressings performed by nurse aides in health units before surgery. Obesity was the factor that correlated with the delay of healing time. A higher incidence was observed in males and male and female illiterate patients. The regular use of shoes and insoles and dressings performed by nurse aides in health units contributed to shorter postoperative healing time. Orthopedic surgical treatment with corrective resection of bony prominences proved to be an efficient therapeutic method for the closure of chronic plantar ulcers. It is a reproducible method, justifying the importance of the orthopedic surgeon in the context of the multidisciplinary team to cope with these complex lesions.

Management Non-healing Trophic Ulcer in a Leprosy Patient with Combination of Injection and Topical Platelet Rich Plasma

Introduction: Trophic ulcer is one of the leprosy sequelae due to peripheral neuropathy. Trophic ulcers in leprosy patients can pose a significant stigma to the patients and remain challenging to clinicians due to the low response to treatment. Recent studies have reported the effectiveness of Platelet-rich plasma (PRP) in the management of chronic ulcers. This study reports a case of non-healing trophic ulcers in leprosy patients treated with a combination of injection and topical PRP. Case Presentation: A 61-year-old female patient referred to complaining of a non-healing wound in her right foot since two months ago. She was a leprosy patient with already finished medication since 19 years ago. She treated the wound with sodium chloride compress and gentamycin ointment without any improvement. The general status was in normal condition. Skin examination on the right plantar pedis showed a solitary ulcer sized 1 × 0.5 × 0.3 cm and linear ulcer sized 2.5 × 3 × 0.3 cm with callus in the surrounding. The sensoric test with Semmes-Weinstein Monofilaments (SWM) showed decreased sensory in magenta monofilament (300 g). The whole blood test, blood glucose, renal function, and kidney function showed no abnormality. Gram examination from the base of the ulcer showed no bacteria. We diagnosed a trophic ulcer and treated it with a combination of injection and topical PRP every week. The clinical result showed that the ulcer completely healed in four weeks of PRP treatment and no side effect appeared during treatment. Conclusions: A combination of injection and topical PRP showed to be promising in the management of non-healing trophic ulcers in leprosy patients. It is a simple, safe, and cost-effective in-office procedure and can improve the patient’s quality of life.

Case Report: Nasal Myiasis in an Elderly Patient with Atrophic Rhinitis and Facial Sequelae of Leprosy.

We describe a case of nasal myiasis in an 89-year-old Brazilian patient affected by leprosy with severe nasal sequelae. An initial treatment comprising sinusectomy combined with nasal endoscopy removed more than 300 larvae, supplemented by systemic treatment using oral and topical ivermectin and levofloxacin. Infestation recurred after 2 months, was treated similarly, and resolved completely. The case could be attributed to severe nasal leprosy sequelae, with a lack of sneezing reflex, painless ulceration, atrophic rhinitis (ozena), and inability to clean the nose properly due to hand and nose impairment. This case illustrates the importance of long-term medical follow-up of patients with leprosy sequelae.

Functional capacity and sociodemographic conditions of older people with leprosy sequelae in the Dr Geraldo da Rocha Hospital, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil

Functional capacity and sociodemographic conditions of older people with leprosy sequelae in the Dr Geraldo da Rocha Hospital, Colônia Antônio Aleixo, Manaus, Amazonas, Brazil

Programa de reabilitação funcional para sujeitos com sequelas de hanseníase.

Este estudo objetiva analisar um programa de reabilitação funcional para sujeitos com sequelas de hanseníase. O estudo tem abordagem qualitativa e abrange a base teórica subjacente à aplicação do programa de reabilitação funcional a um caso típico de paciente com sequelas de hanseníase. O programa engloba técnicas de facilitação neuromuscular proprioceptiva (FNP), cinesioatividade e tecnologia assistiva (TA). Dentre os benefícios do programa, destaca-se que a FNP e a cinesioatividade podem viabilizar fortalecimento muscular, ganho de amplitude de movimento (ADM), resistência muscular e prevenção de deformidades, bem como os dispositivos de TA podem auxiliar no ganho de ADM, prevenção de deformidades e no desempenho das atividades cotidianas. Portanto, o programa terapêutico proposto neste estudo ressalta os benefícios da utilização integrada dos métodos e técnicas para a minimização de déficits funcionais (ADM, força e destreza manual) e ocupacionais em sujeitos com sequelas de hanseníase.

The originality and creativity of leprosy sequelae patients in regard to dental care

Leprosy sequelae patients surmount the inconvenience by the handicap. When people with the handicap are able to do the same act as healthy people, we may not pay attention to the originality and creativity for it. Therefore, we are not able to notice some risks which are hidden. We turned our attention to the denture in the oral region. The methods of putting in and taking out the denture of leprosy sequelae patients are characteristic. Even a partial denture, there are many patients who take out their denture using only their tongue, without touching a clasp with a finger. And they put in the denture by biting. But we had never not announced the details of their methods. So, we investigated how to handle their denture in National Sanatorium Nagashima Aiseien. We explain their methods and show the results. On the other hand, there are a lot of cases of the denture breakage in National Sanatorium Nagashima Aiseien. We think most of these matters occur due to their handicaps. We researched on the cases with dentures broken. In addition, we also describe our countermeasure.

Leprosy neuropathy evaluated by NCS is independent of the patient's infectious state

IntroductionLeprosy causes nerve injury, which mimics clinical and neurophysiological conditions, rendering it an excellent model of peripheral neuropathy. MethodsA retrospective study including 822 nerve conduction studies (NCS) of 509 patients was developed to appraise the electrophysiological pattern of leprosy neuropathy. NCS of motor and sensory nerves performed before, during, and after multidrug therapy (MDT) were analyzed. ResultsDuring the three periods of MDT, while NCS alterations were similar regarding extension, topography, damage severity, and type of lesion, NCS showed that sensory was more frequent (sural nerve) (92–96%) than motor impairment (70–77%) (ulnar nerve). ConclusionOnce axonal loss has been installed, nerve function is little affected by inflammatory, immune and/or bacterial events since chronic neuropathy has been established, inevitably leading to the well-known leprosy sequelae occurring at any time before and/or after leprosy diagnosis.

O uso da tecnologia assistiva no resgate da autonomia de pacientes com sequelas da Hanseníase

This is a study on the approach of occupational therapy at the level of health rehabilitation, which focuses on the autonomy of patients with leprosy sequelae. Are themes of this research: the adoption of assistive technology in the care process, subjectivity, customer autonomy. The goals: to describe the impact of assistive technology in the autonomy of the subject; analyze the relationship between subject and technologies in the care process. A far as a qualitative study was preferred, the techniques used were semi-structured interview and participative observation. Having been made in the University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, the research was performed between November/2014 and February/2015. Eight patients under treatment in the Occupational Therapy Service were interviewed. The kind of analysis chosen was the hermeneutics of the subject. As for the results, three categories were described and discussed. They are: the contribution of the devices in the patients´ routine and in self-care; the feelings and sensations arosen by the use of adapted instruments; and, finally, the patient’s perception about the health professional’s care. It is concluded that assistive technology is a potential tool with transformer in the rescue possibilities, through this; you can equip subject to the exercise of self-care and promote social inclusion. We note also that the study participants perceive the care received in our service as warm, sensitive and competent

Evaluation of surgical treatments for leprosy sequelae using the Salsa and Dash scales

Objectiveto compare the SALSA and risk awareness scales with the DASH scale in assessments on leprosy surgery. Methodbefore the operation and 90 days afterwards, we applied the tests to 14 patients (11 females and three males) of ages from 28 to 67 years, who were operated between November 2011 and May 2012. Resultsthe patients were evaluated after the operation using the SALSA and DASH scales, to measure their relationships and results. Conclusiondespite the small sample, this study showed that there were similar relationships of results between the SALSA/risk awareness and DASH scales.

Exercise capacity and pulmonary function in individuals with leprosy

Introduction In Brazil 23% of leprosy patients have some type of physical disability after discharge. The impact on the respiratory system and correlation with functional exercise capacity is still unknown. Objective To correlate the functional exercise capacity and pulmonary function in individuals with leprosy sequelae. Materials and methods We evaluated 20 subjects and 25 controls by sensory evaluation, muscle strength, graduate the grade of physical disability followed by pulmonary function tests with spirometry and manovacuometry, besides the functional exercise capacity through the six minute walking distance (6MWD). Results The majority (75%) of the subjects showed physical disability grade 1. The mean of the maximal inspiratory pressure were below than normal -71 ± 31 cmH20 and maximal expiratory pressure +89 ± 22 cmH20. Spirometric values presented measures within normal value. The functional exercise capacity found a reduced value with a distance of 404 ± 92m. Positive and statistically significant correlation between the inspiratory pressures with 6MWD (r = 0.49, p = 0.025) and, similarly, expiratory pressure (r = 0.53, p = 0.004). The same evidence is found in maximal respiratory pressures of individuals in grade 1 with significant correlations (r = 0.52, p = 0.036) and (r = 0.51, p = 0.042). Conclusion Individuals with leprosy sequelae had impaired respiratory muscle strength and functional exercise capacity. Maximal respiratory pressures are presented as an independent factor in the change in performance in the functional exercise capacity.

ハンセン病後遺症障害を持つ人々の口腔内状態と歯科治療の特徴

The leprosy sequelae especially the handicap of eyes and hands makes difficult to maintain the oral health status. So, leprosy sequelae patients are controlling themselves by creative and original methods. However even such efforts have hardly reached the level to stop of caries and periodontal disease. More support is required in order for them to maintain the oral health status. Therefore, in National Sanatorium Nagashima Aiseien, we started the periodic preventive system containing oral check-up, mouth cleaning, and early detection early treatment 15 years before. It is the report about this activity. First, the leprosy sequelae handicap which makes oral control difficult is described. Secondly, our periodic preventive system in National Sanatorium Nagashima Aiseien is explained. In order to evaluate this activity, the number of patients and the contents of dental treatment were compared. Furthermore, the number of remaining teeth was compared with the adult Japanese. Our periodic preventive system was received and they have many remaining teeth now. It is sure that this activity for 15 years was successful.

Post-kala-azar dermal leishmaniasis mimicking leprosy relapse: a diagnostic dilemma

Post-kala-azar dermal leishmaniasis (PKDL) is well recognized in the Indian subcontinent and is not infrequently confused with leprosy. The present report describes findings in an unusual case of PKDL. We report an adult male who presented with firm nodules on the face and extremities, along with hypopigmented macules on the neck with deformity and hypoesthesia over the right upper extremity. The patient had experienced similar lesions seven years previously and had used multibacillary multi-drug therapy for leprosy with complete resolution of the nodules. At the current presentation, skin smears from ear lobes and nodules were negative on Ziehl-Neelsen staining. Histopathological examination revealed a dermal lymphohistiocytic infiltrate with plasma cells. Giemsa staining of a tissue smear revealed Leishmania donovani bodies, and an rK39 antigen test was positive. The patient responded well to oral miltefosine. This case is noteworthy because the patient exhibited an unusual combination of healed leprosy sequelae and active PKDL lesions, which caused a diagnostic dilemma.

Quality of life of leprosy sequelae patients living in a former leprosarium under home care: univariate analysis

Quality of life (QoL) is a broad concept that has become more important during the last decades. Despite this fact, few studies have been conducted to evaluate leprosy patients, none of which has specifically addressed patients with leprosy sequels submitted to home care. To evaluate the QoL of leprosy sequel bearers and the factors that may affect their perception of their condition. WHOQoL-BREF, a questionnaire developed by the World Health Organization, was administered to 32 people living in the coverage area of a former leprosarium. Patient socio-demographic and care-related caregiver data were collected. Activities of daily living and Instrumental Activities of Daily Living Scales were used to evaluate autonomy. Mini-Mental Status Examination was used to evaluate cognitive status. Simple linear regression analyses were conducted using SPSS Statistical Software and the non-standardized beta values were presented. The patients were mainly female, widowed, elderly, with bone sequels; all had impairment of at least one Instrumental Daily Living Activity. QoL scores were 12.35 in a 4-20 scale (52.18 %) in the physical domain, 12.95 (55.94 %) in the psychological health domain, 13.18 (57.40 %) in the environment domain, and 16.09 (75.56 %) in the social domain. Univariate analysis suggests that instrumental daily activity "capacity of shopping," marital status, and caregiver age were associated with self-perceived QoL. Data were also compared to those from other studies. Individuals affected by leprosy had low QoL scores in the physical and psychological health domains and high scores in the social domain. The factors that impact their QoL seem to be related to specific conditions found in the leprosarium and the previous isolation practices.

저단계 레이저 치료의 한방안이비인후피부과 활용에 대한 논문 경향 분석

Objective : Low level laser therapy(LLLT) is conjugated many different diseases such as skin disease, nervous system disease, cardiovascular disease, etc. This study was tried to survey the conjugation of LLLT in field of ophthalmology, otolaryngology and dermatology of Korean Medicine. Methods : In this study, LLLT deal with the field of ophthalmology, otolaryngology and dermatology was searched at Pubmed and NDSL. We searched Pubmed and NDSL with the title "Laser Therapy and Low-Level" for the last 10 years and analyzed disease, laser type, sample size, effect, journal and year. Results : Using Pubmed and NDSL, 8 treatises were researched. About 8 treatises, 7 treatises were papers in field of dermatology, 1 treatise was ophthalmology. And about 8 treatises, 6 treatises were foreign papers and 2 treatises were domestic papers on clinical application of laser status. Mainly used type of laser was a He-Ne laser and Diode laser. The diseases were ocular hypertension, acne, ulcers in patients with leprosy sequelae, freckles, segmental-type vitiligo lesions, diabetes-linked skin lesion, facial skin melanin and elasticity, atopic dermatitis symptom. As a result, we found that treat group had more improvement than control group in 7 of the 8 treatises, that treat group had no difference control group on effect significantly only 1 treatise. Conclusions: As therapeutic tool, LLLT's application range is very wide in the field of ophthalmology, otorhinolaryngology, and dermatology. Keep up with the increasing interest of domestic and foreign about laser therapy, clinical tries on the use of laser will be studied steadily. It is necessary to have sustained attention and research on the point of view of the Korean Medicine.

Clinic-epidemiological evaluation of ulcers in patients with leprosy sequelae and the effect of low level laser therapy on wound healing: a randomized clinical trial

BackgroundMycobacterium leprae is the only pathogenic bacteria able to infect peripheral nerves. Neural impairment results in a set of sensitive, motor and autonomic disturbances, with ulcers originating primarily on the hands and feet. The study objectives were to analyze the clinic-epidemiological characteristics of patients attended at one specialized dressing service from a leprosy-endemic region of the Brazilian Amazon and to evaluate the effect of low level laser therapy (LLLT) on wound healing of these patients.MethodsClinic-epidemiological evaluation of patients with leprosy sequelae was performed at the reference unit in sanitary dermatology of the state of Pará in Brazil. We conducted anamnesis, identification of the regions affected by the lesions and measurement of ulcer depth and surface area. After that, we performed a randomized clinical trial. Fifty-one patients with ulcers related to leprosy were evaluated, twenty-five of them were randomly assigned to a low level laser therapy group or a control group. Patients were treated 3 times per week for 12 weeks. Outcome measures were ulcer surface area, ulcer depth and the pressure ulcer scale for healing score (PUSH).ResultsNinety-seven ulcers were identified, with a mean (SD) duration of 97.6 (111.7) months, surface area of 7.3 (11.5) cm2, and depth of 6.0 (6.2) mm. Statistical analysis of the data determined that there were no significant differences in the variables analyzed before and after treatment with low level laser therapy.ConclusionsUlcers in patients with leprosy remain a major source of economic and social losses, even many years after they have been cured of M. leprae infection. Our results indicate that it is necessary to develop new and more effective therapeutic tools, as low level laser therapy did not demonstrate any additional benefits to ulcer healing with the parameters used in this study.Trial RegistrationThe trial was registered at ClinicalTrials.gov as NCT00860717.