Leprosy Research Articles

An In Silico Approach for Function Prediction of Hypothetical Proteins of Mycobacterium laprae TN

Mycobacterium leprae, also well-known as Hansen’s coccus spirally, generally found in lukewarm tropical countries, is a bacterium that causes leprosy (Hansen's disease). M. leprae was revealed in 1873 by the Norwegian physician Gerhard Armauer Hansen. Leprosy is principally a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions are the primary external sign. Leprosy can occur at all ages from infancy to the elderly, but through treatment, it can be forfended. A total of 1605 proteins is available in Mycobacterium leprae TN, out of which 595 proteins were hypothetical (37.07%). Ten diverse tools were applied to interpret hypothetical proteins of M. leprae TN like BLASTP, InterProScan, COGniter, protFUN, CDD, TMHMM, Phyre meta server, PFP, Protfun. To conclude 312 proteins were established having several functions, which is 52.44% of the total hypothetical proteins. Out of ten tools, the utmost numbers of hypothetical proteins (49.75%) were predicted by BLASTP. Worldwide, two to three million people are estimated to be permanently disabled of leprosy. Including, The highest number of cases in India.

HARP: a database of structural impacts of systematic missense mutations in drug targets of Mycobacterium leprae

Computational Saturation Mutagenesis is an in-silico approach that employs systematic mutagenesis of each amino acid residue in the protein to all other amino acid types, and predicts changes in thermodynamic stability and affinity to the other subunits/protein counterparts, ligands and nucleic acid molecules. The data thus generated are useful in understanding the functional consequences of mutations in antimicrobial resistance phenotypes. In this study, we applied computational saturation mutagenesis to three important drug-targets in Mycobacterium leprae (M. leprae) for the drugs dapsone, rifampin and ofloxacin namely Dihydropteroate Synthase (DHPS), RNA Polymerase (RNAP) and DNA Gyrase (GYR), respectively. M. leprae causes leprosy and is an obligate intracellular bacillus with limited protein structural information associating mutations with phenotypic resistance outcomes in leprosy. Experimentally solved structures of DHPS, RNAP and GYR of M. leprae are not available in the Protein Data Bank, therefore, we modelled the structures of these proteins using template-based comparative modelling and introduced systematic mutations in each model generating 80,902 mutations and mutant structures for all the three proteins. Impacts of mutations on stability and protein-subunit, protein-ligand and protein-nucleic acid affinities were computed using various in-house developed and other published protein stability and affinity prediction software. A consensus impact was estimated for each mutation using qualitative scoring metrics for physicochemical properties and by a categorical grouping of stability and affinity predictions. We developed a web database named HARP (a database of Hansen's Disease Antimicrobial Resistance Profiles), which is accessible at the URL - https://harp-leprosy.org and provides the details to each of these predictions.

Acrokeratoelastoidosis in hansen's disease: A new insight

Acrokeratoelastoidosis (AKE), first described by Costa in 1953, is characterized by small, firm, keratotic papules with central umbilication along the borders of the hands and feet. It is a type of palmoplantar marginal papular keratoderma and needs to be differentiated from other marginal papular keratodermas. AKE can be inherited or sporadic, with predisposing factors being excessive sun exposure, hyperhidrosis, and repetitive trauma. We here describe a case of AKE in a leprosy patient with probably secondary to repetitive chronic trauma due to loss of sensory function.

Leprosy and social deprivation: Definition of priority areas in an endemic state Northeastern Brazil.

Leprosy is a disease that reserves close relation with social and economic conditions. Brazil is the only country that has not yet reached the goal of eliminating the disease as a public health problem. This study aimed to analyze social deprivation in the municipalities of Bahia and its relation with the detection of new cases of leprosy in the population. It is an ecological study conducted in the state of Bahia, from 2001 to 2015. Variables analyzed: detection rate of new cases, social deprivation index (SDI) and Hansen's disease in children under 15 years of age. The SDI was built on four variables: socioeconomic performance index, per capita income, proportion of extremely poor, and household density. For spatial analysis, local empirical bayesian modeling and global and local Moran statistics were used. Statistical analysis used multivariate, spatial and logistic regression, odds ratio calculation and analysis of variance. Leprosy showed heterogeneous distribution in the state, with concentration in the north-west and south axis. 60.4% (n = 252) of the municipalities presented very low life conditions. An association was observed between living conditions and the detection of leprosy, with higher coefficients in the municipality group with better living conditions (p < 0.001). It was concluded that the worst conditions acted as an impediment to the diagnosis, while increasing the risk of illness. Good conditions have the opposite effect.

The study of glucose-6-phosphate dehydrogenase deficiency from persons affected by Hansen's disease in Korea

The study of glucose-6-phosphate dehydrogenase deficiency from persons affected by Hansen's disease in Korea

A Clinicohistopathological Correlation of Hansen's Disease in a Rural Tertiary Care Hospital of Central India.

Background:Leprosy is an ancient, chronic granulomatous infectious disease caused by Mycobacterium leprae, principally affecting the skin and peripheral nerves. The clinical manifestations of leprosy are variable and can mimic a variety of other skin diseases. Thus, histopathological examination plays an important role in early diagnosis and management.Aim:The aim was to study the clinicohistopathological correlation of all suspected cases of Hansen's disease.Materials and Methods:A retrospective study was conducted on 207 skin biopsies obtained from patients clinically diagnosed as new lesion of leprosy in the department of pathology from 2016 to 2019. Demographic, clinical details of the patients were retrieved from hospital information system. Hematoxylin–eosin- and Fite–Faraco-stained sections were evaluated for features confirming leprosy and further categorized as per Ridley–Jopling system. Sensitivity, specificity, and concordance rates were studied.Results:The male-to-female ratio was 1.5:1. The agreement between histopathological and clinical diagnoses was more than 90% in all the subclasses except for borderline tuberculoid leprosy (BT) and tuberculoid leprosy (TT) which showed an agreement of 86.5% and 88.4%, respectively. The sensitivity of clinical diagnosis ranged from 69.70% for indeterminate to 100% for histoid and neuritic types. The specificity ranged from 90% for BT and TT to 100% for neuritic leprosy.Conclusion:Clinical diagnosis of early leprosy lesions offers difficulties even to experienced dermatologists as a patient presents in different clinicopathological forms, depending on host immune status. Thus, the correlation between clinical, histopathological, and bacteriological features is required for diagnosis and classification of leprosy. Nerve damage is irreversible; therefore, early detection and treatment is important to prevent Grade 2 disabilities.

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.

Hansen's Disease: A Neglected Tropical Infectious Condition

This case of Hansen's disease reminds clinicians of all ages and era that leprosy is not a disease of the past as such a systematized multidisplinary approach and timely referral to specialists should be followed when evaluating any patient with chronic dermatoses of unknown cause.Early diagnosis of leprosy coupled with prompt treatment with Multi Drug Therapy (MDT) are the most important steps in preventing permanent debilitating deformity and disability.

Resurgence of yaws in Benin: Four confirmed cases in the district of Z, Southern Benin

Yaws is an infectious neglected tropical disease (NTD) caused by the Treponema pallidum pertenue which is highly contagious and transmitted through direct contact with an infected person. It mainly affects skin, bone and cartilage and predominantly in children under 15 years of age. The last cases in Benin were documented in 1982 in the districts of Adjohoun, Bonou and Dangbo in Southern Benin. In line with the global strategy of yaws eradication, yaws surveillance had been reactivated in Benin in 2012 through the National Control Programme of Leprosy and Buruli Ulcer (PNLLUB). Following two yaws prevalence surveys among schoolchildren in 2012 and 2013 in Southern Benin, that failed to detect yaws case, the PNLLUB adopted in 2016 field mass medical consultation campaign as an integrated screen and case management strategy for skin NTDs. During the field mass medical consultation organized in five districts in Southern Benin within October – December 2018, four yaws cases had been confirmed in two villages in the district of Ze. These are the first yaws cases confirmed in Benin since 1982 and thus confirm the re-emergence of yaws in Benin. Key words: Yaws, reemerging infectious diseases, Benin.

Strategies to combat on the resurgence of leprosy: Points to be emphasized

COMMENT TO A WORLD REPORT PUBLISHED

Borderline tuberculoid hansens with type 1 reaction in a HIV patient: an IRIS phenomenon over an unusual site

&lt;p class="abstract"&gt;Immune reconstitution inflammatory syndrome (IRIS) is an acute symptomatic expression of a latent infection during the recovery of the immune system and it occurs as a response to antiretroviral therapy. Opportunistic infections can act as a trigger for IRIS. Hansens disease is an infection caused by &lt;em&gt;Mycobacterium leprae&lt;/em&gt;. There are very few case reports reporting the development of borderline tuberculoid hansens with type 1 reaction as IRIS. We here report a unique case of IRIS in a HIV patient who presented with borderline tuberculoid leprosy with type 1 lepra reaction presenting over unusual site following highly active antiretroviral therapy administration.&lt;/p&gt;

Case Series: Management of Foot Drop

Aim: To highlight the functional outcome of surgical management of foot drop in patients with Hansen disease.&#x0D; Case Presentation: We present three cases of foot drop following Hansen’s disease that were managed surgically by Tibialis posterior transfer. The patients had preoperative physiotherapy for ten days and postoperative physiotherapy for four weeks. Their post-operative periods were uneventful and the corrections were satisfactory.&#x0D; Discussion: Involvement of common peroneal nerve in Hansen’s disease usually results in paralysis of the anterior tibial and/or peroneal muscles. Hansen’s disease patients with foot-drop walk with a ‘high-stepping gait’, lifting the leg high as if climbing steps even while walking on level ground. When the paralysis has been present for more than six months to one year without recovery, the best option of treatment at this stage is corrective surgery and the main aim of the corrective surgery is to restore active dorsiflexion of the foot so that the gait becomes normal. This is achieved by re-routing the tendon of Tibialis posterior muscle, brings that tendon to lie in front of the ankle and is anchored distally. If the tendo-achillis tendon is found to be tight, it should be lengthened as the first step of the Tibialis posterior transfer operation.&#x0D; Conclusion: Surgical correction of foot drop usually leads to restoration of active dorsiflexion of the foot thereby preventing development of secondary deformities and ulceration. Our patients were able to dorsiflex their feet after the surgical correction.

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.&#x0D; Objectives: To categorize and correlate types of leprosy clinically and histomorphologically in Kumaon region.&#x0D; Methods: The present cross-sectional study of 62 cases was conducted in the Department of Pathology &amp; 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.&#x0D; 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.

Hansen's Disease and Dermatology

Hansen's Disease and Dermatology

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

Clinico-etiological analysis of annular skin eruptions: a cross-sectional study from Western Maharashtra

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Annular skin eruptions commonly present in dermatology outpatient department. The most common cause of annular lesions encountered among the adult population in developing nations is dermatophytosis. The aim of the study was to identify risk factors and determine etiology of annular skin lesions after correlation of clinical, pathological, serological and mycological features and to analyze the clinical and laboratory features.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study was conducted on 103 patients presenting with annular skin eruptions to the Dermatology outpatient/inpatient department of BJ Government Medical College and Sassoon Hospital, Pune during a two year period (2015 to 2017).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; During a two year period from 2015 to 2017, 103 patients with annular skin eruptions were enrolled. Of these, 67% (65.05%) had superficial dermatophytosis while 16 (15.5%) had Hansens disease. Other groups of sporadic cases found were chronic plaque psoriasis (54.85%), pityriasis rosea (43.9%), pityriasis versicolor (21.9%), secondary syphilis (21.9%), granuloma annulare (21.9%), annular elastolytic giant cell granuloma (11%), Bowens disease (11%), erythema multiforme (11%), porokeratosis (11%) and sarcoidosis (11%). Statistically significant association was found between number, color, site and symptoms in superficial dermatophytosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This was a novel study that attempted a comprehensive clinico-etiological compilation of annular skin eruptions analyzing a large number of clinical variables and risk factors. Based on the observations, an algorithmic clinical approach has been suggested to facilitate early diagnosis and treatment initiation.&lt;/p&gt;

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.

AS HISTÓRIAS DE VIDA DOS FILHOS SEPARADOS PELA “LEPRA” NO ESPÍRITO SANTO

O presente estudo aborda a temática dos filhos indenes dos “leprosos” que foram internados compulsoriamente no Educandário Alzira Bley em Cariacica-ES, no período entre 1937-1979, devido a legislação vigente para o período. O método utilizado para explicitar as condições de vida dentro da instituição e as marcas deixadas na memória dos egressos foi a história de vida.

Escritas de si e de uma doença: um estudo sobre produções de caráter biográfico e autobiográfico de ex-portadores do mal de Hansen

This article investigates some elements of representation in literary work based on memoirs of people with Hansen's disease (formerly known as leprosy) who lived the confinement forced upon people with this disease in Brazil until the mid-1980s. In addition to the stigma associated with leprosy, this policy traumatized patients, who faced social exclusion and loss of relationships; these experiences yielded autobiographies, biographies, and even romances inspired by their memories of life in isolation. Our objective is to understand, through the study of some of these records, how these people saw themselves and how they viewed the disease and their places of confinement.

O “direito à memória”: Escola Eunice Weaver, memória individual e a constituição de um arquivo histórico em Goiás

This article describes the construction of a documentary archive for the Eunice Weaver School, part of the Educandário/Preventório Afrânio de Azevedo Training Complex (inaugurated in Goiânia in 1943). We stress the importance of creating similar archives to provide access to the memories of those subjected to policies related to preventing Hansen's disease (leprosy). The documentation covers the period 1945-1990, depicting the everyday lives of blameless children who were institutionalized as part of state policies to prevent this disease. The material is regionally focused, expanding the number of known sources for the history of institutions and this disease in the state of Goiás, and served as a potential resource for patients attempting to gain release.