Type Of Leprosy Research Articles

Anemia on Chronic Disease in Leprosy Before and After Completing Multi Drug Therapy

Leprosy infection can cause anemia due to chronic disease (ACD). Multidrug therapy (MDT) for leprosy patients can overcome the infection. This study aims to determine the comparison in the incidence of ACD before and three months after MDT to leprosy patients at Prof. Dr. I G.N.G. Ngoerah Central General Hospital. A cross-sectional analytical observational study was conducted using secondary data from medical records of leprosy patients. A total of 142 samples were taken through total sampling. Data taken included gender, domicile, type of leprosy suffered, incidence of ACD, hemoglobin levels, and erythrocyte index before and three months after completing MDT leprosy therapy. Data analysis was carried out with SPSS version 21 using chi-square and paired t tests (dependent t-test), p value <0.05 means significant. The incidence of ACD was significantly higher before leprosy MDT therapy compared to 3 months after completing leprosy MDT therapy (49.3% vs. 16.2%; p value <0.001) with a prevalence ratio of 3.043 (2.021-4.584) CI95%. The mean hemoglobin levels, MCV, MCH, and MCHC levels 3 months after MDT leprosy therapy were significantly higher than before receiving MDT therapy (13.73 ± 1.47 vs. 12.40 ± 2.06 g/dL; p value <0.001), (88.18±7.22 vs. 84.07±9.55 fl; p value<0.001), (28.32±2.76 vs. 26.72±3.17 pg/cell; p value <0.001), (32.03±1.30 vs. 31.69±1.47%; p value<0.001). The incidence of ACD was significantly higher before MDT compared to 3 months after MDT. Mean hemoglobin, MCV, MCH, and MCHC levels were found to be significantly higher 3 months after MDT compared to before receiving MDT.

The Ocular Findings among Patients with Leprosy in South-Eastern Region, Tanzania

Objective: To assess ocular findings among patients with leprosy and ex-leprosy at Nazareth Leprosy Center. Methodology: An analytical cross sectional study was conducted at Nazareth Leprosy Center in Morogoro region, from June to December 2021.All patients with leprosy and ex-leprosy patients who were available at Nazareth during the study period were interviewed and examined. A total of 88 participants were enrolled in the study and their socio-demographics, clinical history and ocular examination findings were analysed. Results: There were 53 (60.2%) males and 38 (43.2%) of participants were between the age of 54 to 70 years with a median age 64 years. Majority, 66 (75%), were unemployed and 46.6% had no formal education. Participants with multibacillary type of leprosy were 72.7% and forty three (48.9%) resided at the leprosarium Center. Ocular findings were present in 69% of study participants. Cataract was the most common (45.5%), 15.6% had lagophthalmos, 9.1% had keratitis and 9% uveitis. There were 19 (21.6%) patients who were blind with the best corrected visual acuity of less than 3/60 in the better eye. Conclusion: Patients with leprosy and ex-leprosy have significant prevalence of ocular pathologies which affects their vision. Patients with low socio-economic status and Multibacillary type of leprosy are more affected. Cataract is the most common cause of visual impairment, however other sight threatening conditions like lagophthalmos, exposure keratitis and uveitis are also common.

Effect of Curcuma longa Extract as Adjuvant Therapy on IL-6 Serum Levels in Leprosy Type 1 Reaction Patients

Type 1 leprosy reaction / Reversal reaction (RR) is an inflammatory episode in existing leprosy lesions and aggravates the pain rate. Long-term therapy with steroids causes a variety of side effects, so an adjuvant therapy alternative is needed to alleviate steroid use. Curcuma longa rhizome extract has become an anti-inflammatory therapy choice in various previous inflammatory diseases. This study aims to determine the anti-inflammatory effect of Curcuma longa rhizome extract as an adjuvant therapy for reversal reaction patients by analyzing serum levels of IL-6 as a marker of inflammation. The pre and post-test randomized single-blinded controlled trial was conducted on two groups, namely control (RR patients with steroid therapy & placebo) and treatment (steroid therapy & Curcuma longa rhizome extract 1 gram/day). IL-6 serum levels were analyzed from sampling before and after the intervention for one month. The serum levels of IL-6 post-test in the control group were significantly higher than those of the pre-test. The treatment group showed lower serum levels of IL-6 post-test compared to pre-test, although there was no significant difference. Curcuma longa rhizome extract 1 gram/day for one month as adjuvant therapy for patients with type 1 leprosy reaction did not significantly reduce serum IL-6 levels.

The role of monocyte chemoattractant protein-1 (MCP-1) as an immunological marker for patients with leprosy: a systematic literature review

Leprosy, a significant global health concern affecting primarily the peripheral nerves and integumentary system, is influenced by the host immune system’s response, affecting its pathology, disease progression, and reaction occurrence. MCP-1, integral to leprosy’s immunological processes, holds promise as a diagnostic tool and predictor of reaction occurrence. This systematic review aimed to investigate MCP-1’s involvement in leprosy. Literature search, employing specified MeSH keywords, covered databases such as PubMed, Scopus, ScienceDirect, and Wiley Online Library until September 30th, 2023, yielding seventeen relevant studies. Assessing each study’s quality with the Newcastle-Ottawa Scale (NOS) and investigating bias using the Risk of Bias Assessment tool for Non-randomized Studies (RoBANS), a narrative synthesis compiled findings. Seventeen distinct studies were included, each characterized by diverse designs, sample sizes, demographics, and outcome measures, highlighting MCP-1’s potential in diagnosing leprosy, differentiating it from control groups, and discerning leprosy types. Furthermore, MCP-1 shows promise in predicting leprosy reversal reactions. Although MCP-1 offers clinical benefits, including early diagnosis and type differentiation, further research with larger sample sizes and standardized methodologies is imperative to confirm its diagnostic utility fully.

A comparative study on the detection of Mycobacterium leprae DNA in urine samples of leprosy patients using Rlep-PCR with other conventional samples.

Mycobacterium leprae causes leprosy that is highly stigmatized and chronic infectious skin disease. Only some diagnostic tools are being used for the identification M. leprae in clinical samples, such as bacillary detection, and histopathological tests. These methods are invasive and often have low sensitivity. Currently, the PCR technique has been used as an effective tool fordetecting M. leprae DNA across different clinical samples. The current study aims to detect M. leprae DNA in urine samples of untreated and treated leprosy patients using the Rlep gene (129 bp) and compared the detection among Ridley-Jopling Classification. Clinical samples (Blood, Urine, and Slit Skin Smears (SSS)) were collected from leprosy and Non-leprosy patients. DNA extraction was performed using standard laboratory protocol and Conventional PCR was carried out for all samples using Rlep gene target and the amplicons of urine samples were sequenced by Sanger sequencing to confirm the Rlep gene target. The M. leprae DNA was successfully detected in all clinical samples across all types of leprosy among all the study groups using RLEP-PCR. Rlep gene target was able to detect the presence of M. leprae DNA in 79.17% of urine, 58.33% of blood, and 50% of SSS samples of untreated Smear-Negative leprosy patients. The statistical significant difference (p = 0.004) was observed between BI Negative (Slit Skin Smear test) and RLEP PCR positivity in urine samples of untreated leprosy group. The PCR positivity using Rlep gene target (129 bp) was highest in all clinical samples among the study groups, across all types of leprosy. Untreated tuberculoid and PNL leprosy patients showed the highest PCR positivity in urine samples, indicating its potential as a non-invasive diagnostic tool for leprosy and even for contact screening.

Factors Associated with High Prevalence of Multibacillary Leprosy in West Bengal: A Case-Control Study.

High proportion of multibacillary (MB) among newly diagnosed leprosy cases poses a public health challenge. This study aimed to find out the factors associated with the high burden of MB leprosy in West Bengal. This case-control study was conducted from August 2020 to December 2022 in three high-endemic districts (annual new case detection rate ≥10/lakh) of West Bengal. MB cases registered under the National Leprosy Eradication Programme were considered as case and paucibacillary (PB) cases were considered as control. Weighted sample sizes for cases and controls in each of the three districts were selected using simple random sampling from the list of registered leprosy patients. Requisite data were collected through structured interview with a validated questionnaire in Bengali. R, version 4.1.1 (R Foundation for Statistical Computing, 2021, Vienna, Austria) was used for data analysis. A binary logistic regression model was prepared with the type of leprosy as a dependent variable. Three hundred and ninety-eight individuals, 204 MB and 194 PB, participated in this study with 1.97% nonresponse rate. Gender, marital status, and diagnostic delay (adjusted odds ratio = 2.75 [1.66,4.65]) were associated with developing MB. Not perceiving the symptoms seriously (90, 56% [PB], 97, 51% [MB]), lack of knowledge about the disease and its complications (47, 29% [PB], 53, 28% [MB]), delayed referral by the private practitioners (11, 7% [PB], 22, 12% [MB]) were the major reasons of delay. This study identified a vulnerable group - married and migrated males. Changing from annual screening to quarterly screening along with capacity building and awareness generation of the targeted population is the need of the hour for eradicating the disease.

Dermatoscopic evaluation of leprosy: A multi-centre cross-sectional study.

Background Leprosy is known to be a great mimicker. Its dermatoscopic evaluation may be of value in establishing diagnosis. Objective To study the dermatoscopic findings encountered across the leprosy spectrum. Methods This was a multi-centre cross-sectional study of leprosy patients, where after a thorough cutaneous and neurological evaluation, representative skin lesions from the study patients were photographed in standard settings, and the most representative skin lesions were chosen for dermatoscopic evaluation. Data was entered in a structured proforma and a descriptive analysis of dermatoscopic patterns was carried out. Results A total of 53 cases of ages between 14 and 80 years, ranging from tuberculoid to the lepromatous spectrum of disease, with active skin lesions in the form of patches and plaques were included. The spectrum of leprosy as per Ridley-Jopling classification at diagnosis was indeterminate in 1 (1.9%), tuberculoid in 1 (1.9%), borderline tuberculoid in 25 (21.5%), borderline lepromatous in 9 (17%), lepromatous in 14 (26.4%) and histoid in 3 (5.7%). Dermatoscopic features included distorted pigment network in 48 (90.6%), focal white areas in 40 (75.5%), reduced eccrine and follicular openings in 43 (81.1%), widened skin lines in 28 (52.8%), circle hairs in 15 (28.3%) and white shiny streaks in 17 (32.1%). Conclusion Dermatoscopy is a practical, non-invasive device to assess skin lesions of leprosy and provide cues to its diagnosis, spectral classification and differentiating it from other granulomatous disorders. However, dermatoscopy alone cannot reliably differentiate between the various types of leprosy and future large-scale studies are required. Limitations of the study The numbers for each subtype were variable and few in some spectrum of leprosy patients. A dermatoscopic-histologic correlation was not done.

An Observational Study to Correlate the Histopathological and Dermoscopic Features in Leprosy Patients in a Tertiary Care Hospital.

Leprosy is a chronic granulomatous infection with varied clinical presentations. Dermoscopy is a noninvasive technique widely used in the diagnosis of various skin diseases. To see the correlation between the clinical and dermoscopic features with the histopathological findings in leprosy. A prospective observational study was conducted on clinically suspected leprosy patients attending the dermatology outpatient department (OPD) for 18 months. Representative lesions were observed by dermoscopy, and a biopsy was performed, followed by histopathology for final diagnosis. Patients were categorized by Ridley-Jopling classification. A total of 70 clinically suspected leprosy patients were included in the study. Amongst 70 cases, 56 cases were diagnosed as leprosy by dermoscopy, and 53 cases were confirmed as leprosy by histopathology (hematoxylin and eosin [H and E] staining and Fite-Faraco staining). The other six cases were diagnosed as other nonspecific dermatitis by histopathological findings. Eleven cases that were dermoscopically negative were also confirmed by histopathology to be truly negative. There are three inconclusive cases of dermoscopic findings, which were diagnosed as mid-borderline leprosy by histopathology. Dermoscopic and histopathological correlation was found above 87% in all types of leprosy except mid-borderline leprosy, which showed only a 25% correlation. Dermoscopy is a useful noninvasive tool to assess lesions of leprosy, requires less time for diagnosis, skin features are magnified several times and may become evident before clinical presentation. It definitely helps to reduce the number of biopsies in case of diagnosis of leprosy. However, in doubtful cases, histopathology is required for definitive diagnosis as it is the gold standard to date.

Leprosy in North India in Post-Elimination Era: A Retrospective Study

Abstract Background: India achieved elimination target for leprosy in December 2005. However, many pockets in the country continue to report significant number of cases. Aim: The aim of the study was to study the profile of leprosy cases presenting to a tertiary care hospital in North India in post-elimination era. Patients and Methods: The study was conducted at Hansen’s disease clinic. The study design was a retrospective observational study. Chart review of treatment naive leprosy patients enrolled between 1st January 2018 and 31st December 2019 was done. Data regarding demographic profile, clinical spectrum of leprosy, slit-skin smears (SSSs) and histopathological findings were analysed. Statistical Analysis: Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 23 (SPSS Inc., Chicago, IL, USA). Data were statistically described in terms of range, mean ± standard deviation, frequency (number of cases), and relative frequency (percentages). Results: Amongst a total of 115 patients, males (68%, n = 79/115) outnumbered females. Children (<15 years) constituted 0.86% cases (n = 1/115) and 26% cases (n = 30/115) were above 50 years of age. Multibacillary leprosy (73%, n = 84/115) was more common. Borderline lepromatous (41.7%, n = 48/115) was the most common clinical type of leprosy, whereas Grade 2 disability was noted amongst 0.05% (n = 6/115) patients at presentation. SSS were positive in 60% (69/115) cases. Conclusions: The present study showed a significant increase in cases in the older age group and decrease in new cases in children. Furthermore, multibacillary cases outnumbered the paucibacillary cases. Similar trends were reported to be an indicator of decreasing incidence of leprosy in countries that eliminated leprosy. We speculate that India may be entering a phase of decreased community transmission of leprosy. Further, multicentric studies across the country may throw more light.

Backward logistic regression analysis of the determinants of the hand function among patients with leprosy: A cross-sectional study.

The hands are the most common site of disability in leprosy. Hand dysfunction could result in difficulty performing activities of daily living. Therefore, hand function should be regularly assessed to ensure that any decrease in hand function could be diagnosed earlier. This study included 110 patients with leprosy from Likupang and Lembata, Indonesia. Hand function was assessed using the modified Jebsen test to measure hand function respective of the dominance. The grip and pinch strength were used as objective measures of clinical arm function. The World Health Organization (WHO) hand disability grade were used to determine the degree of impairment. Other factors such as age, sex and the type of leprosy were also considered. All factors were analysed using backward logistic regression. Among the 110 participants, a decrease in the dominant (48.2%) and non-dominant (50.9%) hand functions were found. Pinch strength (OR: 3.39; 95% CI: 1.13-10.19) and age (OR: 4.91; 95% CI: 1.72-14.03) were significantly associated with hand function irrespective of the dominance. Conversely, the WHO hand disability grade (OR: 2.97; 95% CI: 1.10-8.04) and type of leprosy (OR: 0.34; 95% CI: 0.12-0.97) were significantly associated with only function of the dominant hand. There is a significant association of age and pinch strength with hand function regardless of the hand dominance. In contrast, the WHO hand disability grade and type of leprosy are significantly associated with the function of the dominant hand only.

Radiological changes in leprosy patients with disabilities and deformities of hands and feet

Background/Aim: Leprosy (Hansen's disease) affects the skin and nerves. Hands and feet are commonly involved in all types of leprosy often leading to deformities. This study explored radiological changes in leprosy patients with hand and foot disabilities/deformities. Methods: Observational retrospective study was the chosen design. Study was conducted on 50 leprosy patients presenting at a tertiary care hospital with hand and foot disabilities during 2020-2022. Leprosy types were clinically diagnosed, confirmed by acid-fast bacilli staining. Bacteriological index (BI) and morphological index (MI) were calculated via Ridley's scale. Histopathological examination of the skin lesions was also conducted. Radiological exams, anteroposterior and lateral X-rays, identified specific/non-specific bone changes. Results: Mean age was 38.8 years, bone changes identified at 40.3 years. Radiological changes were seen in 42.0 % patients (34 % patients had non-specific and 16 % had specific changes). These changes were seen more common and earlier in females as compared to males, the difference however was not significant (p = 0.6). Mean BI (2.8) and MI (32 %) of the patients with bone changes were slightly higher than those without bone changes but the differences were not statistically significant (2.2 and 27 %) (p = 0.2). Common specific changes were periostitis and subarticular erosion while osteopenia and phalangeal resorption were the most common non-specific changes. Conclusion: Non-specific bone changes were more common than specific ones and in females as compared to males. Lepromatous leprosy (LL) was associated with maximum bone changes with varied involvement in other types of leprosy.

Self-stigma of leprosy affected persons in Jaffna District

Leprosy new case detections are stagnant over the past 20 years and continue to be stigmatized in socially marginalized groups and the urban poor are less likely to seek care. There is a big gap in studies related to leprosy stigma in Sri Lanka. This study aimed to measure the stigma among leprosy affected persons in Jaffna District.This was a cross sectional descriptive study done in dermatology clinic, teaching hospital, Jaffna using all 109 leprosy patients. The validated interviewer administered questionnaire with the tool (Internalized Scale of Mental Illness (ISMI) adapted for leprosyaffected persons) was used to measure the stigma. Average of mean scores (with SD) was calculated to demonstrate the level of stigma. The level of stigma to different domains/item responses were described by presenting compound bar diagrams/charts.Mean age of the participants was 40.3±18.6yrs. Most of the participants were males (53.2%), Sri Lankan Tamils (97.2%), Hindus (77.1%), married (65.1%), from MOH Chankanai area (50.5%) and affected by MB type of leprosy (68.8%). Only 44% completed secondary education, 36.7% had no job and 32.1% were manual workers. The mean score of (ISMI) leprosy patients was 2.43 which mean high level of stigma. The response pattern to different components of ISMI was heterogeneous.

Diagnosis and Treatment of Leprosy in Taiwan during the COVID-19 Pandemic: A Retrospective Study in a Tertiaty Center.

Currently, over 200,000 new cases of leprosy are reported annually worldwide. Although leprosy was thought to have been eradicated in Taiwan, a few new cases still occur annually. Protean clinical manifestations of leprosy and immunological reactions result in delayed diagnoses. In addition, drug-resistant leprosy is emerging and poses treatment challenges. In this retrospective study, we collected and analyzed the clinicopathological features, leprosy type, treatment response, and relapse rate of patients with leprosy in our hospital between January 2009 and November 2022. We found that 54% of patients were Indonesian, and borderline lepromatous leprosy was predominant (39%); moreover, histoid leprosy and the Lucio phenomenon were also reported. Polymerase chain reaction analysis identified four positive cases, including a dapsone-resistant (4%) case. Our findings indicated good control of leprosy and a lower rate of dapsone resistance than that reported by the World Health Organization (4% vs. 13%) from 2009 to 2015. We found that the patient profile in terms of the treatment duration, recurrence rate, systemic symptoms, and neurological symptoms did not differ between before and during the pandemic. We report the recent advances in leprosy diagnosis, drug-resistant gene mutations, post-exposure prophylaxis, vaccination, and the effect of coronavirus disease 2019 on leprosy to facilitate updated leprosy diagnosis and management.

Childhood Leprosy in Postelimination Era: A Clinico-Epidemiological Prospective Observational Study from India

Background: Although India has achieved national level elimination of leprosy in December 2005, it reports highest number of leprosy cases in the world. Incidence of leprosy amongst young children indicates active foci of transmission in the community, making it a robust epidemiological indicator to assess the progress of leprosy control programs. Aim and Objectives: To study prevalence, clinical spectrum, patterns of extracutaneous involvement, reactions, relapse, demographic profile, anthropometric characteristics of children with leprosy. Materials and Methods: A prospective observational study of children younger than 14 years old with clinical signs and symptoms of leprosy, including cases diagnosed from October 2018 through September 2020 at a tertiary hospital in Eastern India. Results: Childhood leprosy constituted of 10.4% of total new leprosy cases. Mean age observed was 11.14 ± 1.5 years. 30.4% were females and 69.6% were males. The mean average duration was 9.95 ± 12.3 months. 82.1% of children belong to below poverty line (BPL) status. 19.6% of children had malnourishment/stunting/thinness, and 55.4% had anemia. 84.1% presented with skin discoloration. The most common site affected was upper limb (57.1%). 29.2% had contact history. A single case of relapse (1.7%) was reported. Most common peripheral nerve involved was ulnar nerve (67.8%). 8.9% of children had type 1 lepra reaction, and 1.7% had type 2 lepra reaction. 73.21% presented with borderline tuberculoid clinical type of leprosy. 19.6% showed slit skin smear positivity. Conclusion: Pockets of high endemicity of childhood leprosy as detected in the current study point toward the unmet need of better healthcare facilities along with increased awareness, campaigns, and school surveys for early diagnosis and treatment for the prevention of complications and spread in community.

THE SUCCESSFUL FACTORS TREATMENT OF MB TYPE LEPROSY IN THE WORKING AREA OF JENU PUBLIC HEALTH CENTER, TUBAN REGENCY

Leprosy is a chronic infection caused by Mycobacterium leprae which if not treatedimmediately will become progressive. The government has a treatment success target of >90%,but in some areas the effort to eradicate leprosy type MB is still slow [1]. The purpose of this studywas to determine the success factors for the treatment of MB type leprosy in the working area ofthe Jenu Public Health Center, Tuban Regency.The research design used was descriptive, cross sectional time approach. The populationis all patients with leprosy who seek treatment in the working area of the Jenu Public Health Centerfor a cohort period of 76 months (January 2016-April 2022) as many as 35 people, the samplingtechnique used is total sampling. Research instruments in the form of questionnaires andobservation sheetsThe results of the study were obtained from 35 patients with MB type leprosy almostentirely (82.9%) were found without disability, all (100%) immediately received treatment, all(100%) received good family support, all (100%) the role of health workers was good.The success of treatment for leprosy type MB requires support from the family and thesurrounding community, the family is the closest person who can supervise and control thepatient's condition. Treatment of leprosy also requires the role of health workers because healthworkers can provide encouragement to patients, in addition, if the patient has not taken themedicine, the health worker will come to give the medicine. Efforts to find and treat patients withMB type leprosy are very important, for this reason, family and community support are needed sothat there is no feeling of shame and immediately comes to the nearest health servic

Morbus Hansen

Morbus Hansen (MH) which is called leprosy or leprosy is an infectious disease that causes health problems throughout the world. Leprosy is spread all over the world, especially in tropical and subtropical areas and attacks all ages with the highest frequency in the age group of 20 to 30 years. Case Presentation : Mr. AB, male, aged 33 years, came complaining of numbness and frequent tingling. Hands and feet began to swell and sore. Some toenails fall off unnoticed. Physical examination found composmentis awareness. The general status of the patient was madarosis in both eyelashes, the eyes looked anemic. Ears found infiltrates in both earlobes. Dermatological status in the facial region and superior extremities showed multiple hyperpigmented macules and patches, well defined, geographic shape, sizes vary. Bacteriological examination with Slit Skin Smear on the earlobes found 1-10 Acid-Fast Bacilli (AFB) / 100 fields of view (+1). Bacteriological Index obtained +1. Conclusion: The patient was diagnosed with MB type leprosy accompanied by Erythema Nodusum Leprosum

Cardiovascular events associated with thalidomide and prednisone in leprosy type 2 reaction

BackgroundThalidomide is the drug of choice for the treatment of type 2 leprosy reactions and is often associated with corticosteroids. The use of these drugs in multiple myeloma is associated with the risk of cardiovascular events, but there have been few studies assessing this risk in leprosy patients. ObjectiveTo evaluate the occurrence of cardiovascular events in patients with multibacillary leprosy and their correlation with the use of thalidomide and prednisone. MethodsAnalytical cross-sectional study of all patients diagnosed with multibacillary leprosy treated at the Dermatology Service between 2012 and 2022, using electronic medical records. Thromboembolic vascular events, both arterial and venous, including acute myocardial infarction, were considered. The main independent variable was the concomitant use of thalidomide and prednisone during follow-up. ResultsA total of 89 patients were included, of which 19 used thalidomide and prednisone concomitantly. There were five cardiovascular events (26.3%), three of which of deep venous thrombosis. The combined use of medications was associated with the events (PR=6.46 [3.92 to 10.65]; p<0.01). Study limitationsSmall number of events, single-center retrospective study. ConclusionThe hypothesis of an association between cardiovascular events and the concomitant use of thalidomide and prednisone is supported, but more robust prospective studies are required for a better assessment.

Borderline type leprosy with variation of clinical manifestations and histopathology: two case reports

Link of Video Abstract: https://youtu.be/HgIJyHrxoOc Background: Leprosy is a chronic disease caused by Mycobacterium leprae. This disease can be diagnosed if one of the four criteria is met. Histopathological examination can vary depending on the spectrum of the disease. The following describes two cases of borderline-type leprosy that aimed to increase understanding of the diagnosis and management of leprosy, especially the borderline type. Cases: Both cases had complaints of numb spots on the body. The first case had more lesions than the second one with borderline-borderline histopathological examination results, while the second one had borderline lepromatous histopathological examination results. Both patients received the same therapy (multidrug therapy for multibacillary leprosy). During observation, there were no drug side effects that the patient could not tolerate. The prognosis in both cases is dubia, depending on the patient's adherence to treatment. Conclusion: The diversity of clinical and histopathological features can occur, including cases of leprosy. Early diagnosis and prompt treatment should be started as possible to prevent disabilities.

The Correlation between Leprosy Types and Reactions with Disability of Leprosy Patients in Universitas Mataram Hospital

The purpose of this study is to analyze the correlation between leprosy types and reactions with the disability occurrence of leprosy patients in the outpatient clinic of Universitas Mataram (UNRAM) Hospital. This study was an analytical observational study with a retrospective approach and cross-sectional design. Medical records of leprosy patients were utilized to gather the information from January 2021-April 2023. The Fisher-exact test was used to analyze the data. There were 25 patients included in the study. There were 15 male patients (60%) while women were 10 patients (40%). In the majority, there were 12 patients (48%) around 25-45 years old. Based on occupation, fourteen patients (56%) were unemployed followed by 9 employed patients (36%). Furthermore, there were 24 patients (96%) who suffered from multibacillary leprosy. Twenty patients (80%) had type 1 reactions while the other 5 patients (20%) had type 2 reactions. Among leprosy patients, there were 17 disabled patients due to leprosy in this study. There was no association between leprosy types and disability occurrence (p-value 1.0). The correlation between leprosy reactions and disability was not significant either in UNRAM Hospital (p-value 0.28). There was no association between leprosy types and reactions to disability of leprosy patients in UNRAM Hospital.

COVID-19 vaccination and leprosy-A UK hospital-based retrospective cohort study.

Individuals with leprosy are at risk of leprosy reactions, T-cell mediated immunological complications, which lead to nerve function impairment. Leprosy reactions require systemic immunosuppression which is a risk factor for severe COVID-19. Vaccination for SARS-CoV-2 infection is recommended in the UK and became widely available in 2021 with individuals at increased risk of severe disease, including the immunosuppressed, prioritised. Vaccines for SARS-CoV-2 may provoke a T cell response. The latter poses a theoretical risk of provoking an immunological response to latent Mycobacterium leprae infection leading to clinical disease or in those with clinical disease triggering a leprosy reaction. BCG vaccination is associated with the development of leprosy in a small proportion of healthy contacts of people with leprosy within twelve weeks of administration. BCG causes a Th1 immune response. We performed a retrospective cohort study to determine the SARS-CoV-2 vaccination status of individuals diagnosed with leprosy attending the Leprosy Clinic in 2021 and whether any had developed leprosy or experienced a new leprosy reaction within twelve weeks of receiving a dose of a SARS-CoV-2 vaccine. The electronic patient records were used to retrieve data. Fifty-two individuals with leprosy attended the clinic in 2021 of which five people were newly diagnosed with leprosy. Thirty-seven (71%) were male and the median age was 48.5 years old (Range 27-85 years). Eight (15.4%) individuals were taking multi-drug therapy (MDT) and eight (15.4%) had completed MDT within three years of the study. Twenty-two (41.5%) individuals were prescribed a systemic immunosuppressant drug during 2021. Ten (18.9%) individuals have one or more risk factors for severe COVID-19. The SARS-CoV-2 vaccination status of fifty (96%) were recorded of which forty-nine were vaccinated (98%). One individual had declined vaccination. One individual was diagnosed with borderline tuberculoid (BT) leprosy having developed red skin lesions with reduced sensation (which increased in size and number) and thickened peripheral nerves one week after a second dose of BNT162b2 vaccine. Another individual who had completed MDT more than three years earlier developed red plaques and tender thickened nerves consistent with a leprosy Type 1 reaction eight weeks after a single dose of BNT162b2 vaccine (having received two doses of CoronaVac vaccine three months earlier). The development of BT leprosy and a Type 1 reaction in another individual shortly after a dose of BNT162b2 vaccine may be associated with vaccine mediated T cell responses. The benefits of vaccination to reduce the risk of severe COVID-19 outweigh these unwanted events but data from leprosy endemic countries may provide further information about potential adverse effects of augmented T cell responses in individuals with leprosy or latent M. leprae infection.