Leprosy Research Articles

Assessing Nerve Conduction Velocity as a Diagnostic and Prognostic Indicator in Leprosy Patients: A Cross-Sectional Study.

Introduction Hansen's disease is a condition in which patients develop peripheral neuropathy. In 1873, G. H. A. Hansen discovered Mycobacterium leprae, the causative agent of leprosy, a chronic infectious disease. These bacteria influence the peripheral nerves, which is likely to cause neuropathy. Sensory nerve conduction studies were performedin leprosy patients on the upper limb nerves of 30 patients in the rural area of the Wardha district in the Indian population. Methods In this study, we recruited 30 leprosy patients fromthe Department of Dermatology and A.V.B.R. Hospital, Sawangi Wardha. The patient's nerve conduction velocity (NCV) tests were carried out in the Department of Physiology at J. N. Medical College, Wardha. NCVs were obtained during these three years, beginning in 2009, while performing sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV). The latency, amplitude, and NCV parameters were recorded, and the data collection period ended in 2011. In this study, we measured both MNCVand SNCV. Results In our study, impairment of conductional velocity was observed. In leprosy patients, the MNCV values of latency, amplitude, and conductional velocity were 6.61, 3.89, and 46.92 m/s, respectively, whereas the SNCV values were 3.005, 25.17, and 38 m/s, respectively. Based on the results, it appears that the maximal sensory nerve involvement was recorded at 38 m/s conductional velocity.In NCVs, increased latency and decreased conductional velocity were found across the study. Conclusion It was concluded that nerve conduction studies are one of the non-invasive techniques for early diagnosis and management of leprosy. This study should be repeated with a larger sample size and should be multicentric.

Hansen's Disease: A Practical Update on a Neglected Globally Significant Infection.

Leprosy is a great mimicker. It is caused by Mycobacterium leprae and Mycobacterium lepromatosis, together termed the M. leprae complex. Leprosy can result in systemic manifestations; however, the neurocutaneous syndrome is the most classic. There is a gap in recognizing the condition leading to misdiagnosis and delays in treatment. Leprosy remains an important cause of aesthetic and functional impairment. In this paper, we provide a practical review of leprosy touching on pathophysiology, clinical manifestation, classification, diagnostic approach and management of the condition in a way that can translate into clinical practice and help physicians better identify and manage potential cases of leprosy.

Correction to the Article "Hansen's Disease: An Unusual Manifestation of an Ancient Disease", Published on Acta Med Port 2024 Mar;37(3):215-219

On page 215, list of authors, where it reads (in red): Mário FERREIRA1, Carlos GRIJÓ2, Joana PAULO1, Marta FONSECA1, Zélia NEVES1 It should read (in bold): Mário FERREIRA1, Carlos GRIJÓ2, Joana PAULO1, Marta FONSECA1, Zélia NEVES1, Rita BOUCEIRO MENDES3, Pedro VASCONCELOS3 On the same page 215, footer (authors affiliation), where it reads (in red): 1. Medicina III. Hospital Fernando Fonseca. Amadora. Portugal. 2. Serviço de Medicina Interna. Centro Hospitalar Universitário de São João. Porto. Portugal. It should read (in bold): 1. Medicina III. Hospital Fernando Fonseca. Amadora. Portugal. 2. Serviço de Medicina Interna. Centro Hospitalar Universitário de São João. Porto. Portugal. 3. Serviço de Dermatologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal. Article published with errors: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/20599.

Experiences of social stigma of people living with Hansen's disease in Brazil: silencing, secrets and exclusion.

Hansen's disease is a chronic, infectious and transmissible disease that is considered a public health problem in Brazil. Hansen's disease is marked by stigma and prejudice, because it carries with it a strong negative social image, reinforced by policies of social isolation in the community. A qualitative study was conducted in Ribeirão Preto, an inland city of the state of São Paulo, Brazil. Eleven patients under treatment for the disease were interviewed. The interviews were audio recorded and transcribed in full, then were analyzed through the stages of transcription, transposition and reconstitution, as informed by concepts proposed by Goffman. The results showed that the marks of stigma are still present in the twenty-first century and were presented in two axes: 'Stigma and work for the person affected by Hansen's disease' and 'The experience of stigma in the family'. The participants refer to fears of losing their jobs and of being ridiculed, which stops them talking about the disease. Regarding their families, the participants reported episodes of discrimination, the creation of family secrets and fear of relatives' reactions. All these aspects interfere in the follow-up and treatment of patients and need to be considered and welcomed by health professionals. It is recommended that these aspects are addressed in the initial training and continuing education of health professionals. La maladie de Hansen est une maladie chronique, infectieuse et transmissible, considérée comme un problème de santé publique au Brésil. La maladie de Hansen est marquée par la stigmatisation et les préjugés, car elle véhicule une image sociale fortement négative, renforcée par des politiques d'isolement social au sein de la communauté. Étude qualitative menée à Ribeirão Preto, une ville intérieure de l'État de São Paulo, au Brésil. Onze patients traités pour la maladie ont été interrogés. Les entretiens ont été enregistrés et transcrits intégralement, et ont été analysés en suivant les étapes de transcription, de transposition et de reconstitution, selon les concepts proposés par Goffman. Les résultats montrent que les marques de la stigmatisation sont toujours présentes au 21ème siècle et ont été présentées selon deux axes : 'La stigmatisation et le travail pour la personne affectée par la maladie de Hansen' et 'L'expérience de la stigmatisation dans la famille'. Les participants évoquent la peur de perdre leur emploi, la peur d'être ridiculisés, ce qui les pousse à ne pas parler de la maladie. En ce qui concerne les familles, les participants ont rapporté des épisodes de discrimination, la création de secrets de famille et la peur des réactions des proches. Tous ces aspects interfèrent dans le suivi et le traitement des patients et doivent être pris en compte et accueillis par les professionnels de la santé. Il est recommandé que ces aspects soient abordés dans la formation initiale et la formation continue des professionnels de la santé. La enfermedad de Hansen es una enfermedad crónica, infecciosa y transmisible, considerada un problema de salud pública en Brasil. La enfermedad de Hansen está marcada por el estigma y el prejuicio, ya que conlleva una fuerte imagen social negativa, reforzada por políticas de aislamiento social en la comunidad. Estudio cualitativo realizado en Ribeirão Preto, una ciudad del interior del estado de São Paulo, Brasil. Se entrevistaron a once pacientes en tratamiento para la enfermedad. Las entrevistas fueron grabadas en audio, transcritas en su totalidad y analizadas a través de etapas de transcripción, transposición y reconstitución, según los conceptos propuestos por Goffman. Los resultados muestran que las marcas del estigma siguen presentes en el siglo XXI y se presentaron en dos ejes: 'Estigma y trabajo para la persona afectada por la enfermedad de Hansen' y 'La experiencia del estigma en la familia'. Los participantes mencionan el miedo a perder sus trabajos, el temor a ser ridiculizados, lo que les impide comentar sobre la enfermedad. En cuanto a las familias, los participantes reportaron episodios de discriminación, la creación de secretos familiares y el miedo a las reacciones de los familiares. Todos estos aspectos interfieren en el seguimiento y tratamiento de los pacientes y deben ser considerados y acogidos por los profesionales sanitarios. Se recomienda abordar estos aspectos en la formación inicial y la educación continua de los profesionales sanitarios.

Erythema nodosum leprosum (Type 2 Reaction) in a Patient with Hansen's Disease from a Tertiary care hospital in Jharkhand: A case report

Lepra Reactions (LR) are inflammatory conditions with immune mediators that are highly morbid. Patients with the lepromatous end of the leprosy spectrum (BL-LL) are the only ones that develop type-2 LR. 90% of the time, it happens during or right after treatment, usually within two years. Here, we present a type-2 LR case. The sixty-year-old woman who was diagnosed with lepromatous leprosy (LL) after developing a hypopigmented skin lesion six months prior. She was treated twice at our hospital over the course of the previous six months after developing type-2 LR, which manifested as recurrent fever episodes, polyarthritis, erythema nodosum, and mononeuritis multiplex.

Complex Obstetric Case Report: Multigravida at 36 Weeks with Imminent Premature Delivery, Hansen's disease, and Prior Cesarean Section

Hansen’s disease, or leprosy, is a chronic granulomatous infection caused by the obligate intracellular bacterium Mycobacterium leprae. Pregnancy triggers leprosy in 10–25% of women because of immune disturbances, which affect the disease’s course. This study reports the case of a 26-year-old pregnant woman who presented with the chief complaint of abdominal cramps with a contraction every 10 min. The patient admitted to experience vaginal discharge since the onset of pregnancy, without itching or odor. She also revealed a history of leprosy since 2020, which manifested as lumps around the ears, face, and legs, along with numbness at the extremities. She started treatment in 2021 with multi-drug therapy (MDT) but self-discontinued at 14 weeks of pregnancy because of nausea and weakness. The management plan includes dexamethasone ( 12 mg ) intramuscularly to enhance fetal lung maturity, nifedipine ( 10 mg ) every 6 h to suppress preterm contractions, and dermatovenereological assessment to address the patient’s history of Hansen’s disease. A joint conference is planned to discuss and coordinate the management approach. This study underscores the importance of proper management with WHO-recommended multidrug therapy (MDT) comprising rifampicin, dapsone, and clofazimine. Overall, effective management strategies are crucial to prevent permanent nerve, skin, limb, and eye damage in mothers and infants affected by leprosy.Laporan Kasus: Multigravida Hamil 36 Minggu dengan Partus Prematurus Imminens, Morbus Hansen, dan Bekas Sectio CessariaAbstrakPenyakit Hansen, atau lepra, adalah infeksi granulomatosis kronis yang disebabkan oleh bakteri intraselular obligat Mycobacterium leprae. Kehamilan memicu kusta pada 10–25% wanita karena adanya gangguan imunitas yang memengaruhi perkembangan penyakit. Studi ini melaporkan kasus seorang wanita hamil berusia 26 tahun yang datang dengan keluhan utama nyeri perut dengan kontraksi setiap 10 menit. Pasien mengakui mengalami keluarnya cairan vagina yang tidak bau maupun disertai gatal sejak awal kehamilan. Pasien memilliki riwayat penyakit Hansen sejak 2020, yang ditandai dengan benjolan di sekitar telinga, wajah, dan kaki, bersama dengan mati rasa di ujung anggota tubuh. Pasien memulai pengobatan pada 2021 dengan multidrug therapy (MDT) tetapi menghentikannya sendiri pada usia kehamilan 14 minggu karena mual dan rasa lemah yang dirasakan. Rencana tatalaksana mencakup pemberian Deksametason 12 mg intramuskular untuk meningkatkan kematangan paru-paru janin, Nifedipin 10 mg setiap 6 jam untuk menekan kontraksi prematur, dan evaluasi dermatovenereologi untuk mengatasi riwayat penyakit Hansen pada pasien. Konferensi bersama direncanakan untuk membahas dan mengkoordinasikan pendekatan pengelolaan. Studi ini menekankan pentingnya pengelolaan yang tepat, dengan MDT yang direkomendasikan oleh WHO yang terdiri dari rifampisin, dapsone, dan clofazimin. Secara keseluruhan, strategi pengelolaan yang efektif sangat penting untuk mencegah kerusakan saraf, kulit, mata, dan anggota tubuh permanen baik pada ibu maupun bayi yang terkena penyakit ini.Kata kunci: Penyakit Hansen, persalinan prematur, diagnosis.

A clinicoepidemiological study of leprosy among children and adolescents in a tertiary care centre in the post elimination era

Leprosy amongst younger age indicates active foci of transmission in the community. Our aim is to analyse the epidemiological profile, clinical spectrum, reactions and deformities of leprosy among children and adolescents. This is a prospective observational study conducted on all newly diagnosed leprosy patients under the age of 19 years for one year. Of 113 newly diagnosed leprosy cases, 38 patients were under 19 years of age. Male-female ratio was 5.3:1. Mean age was 16.6 years. Borderline tuberculoid (BT) was the most common type followed by borderline lepromatous (BL) and Indeterminate (I) leprosy most common manifestation was hypopigmented anaesthetic skin lesion over exposed parts. 79% had multiple nerve trunk involvement of which ulnar nerve was the most common. Reaction and deformity were found to be in 21% and 18.3%. Both were seen only in multibacillary cases and predominantly in 15-19years of age. Risk factors for reactions were male sex, increasing age, labourers, borderline spectrum, skin lesion involving the nerve trunk, multiple nerve involvement and smear positivity. Risk factors for deformities were migrants in lower socio-economic status, increased duration of active disease and delayed diagnosis. Leprosy, a disease of long incubation period, among adolescents may indicate missed cases of childhood leprosy. Training through integrated service in early diagnosis and its complication, introduction of an exclusive type of treatment (MB MDT) for all categories for a shortened duration and newer drugs for reactions, sustained commitment to follow-up care and health education among community is a need at this post elimination era.

Navigating diagnostic and therapeutic challenges in ocular manifestations of Hansen's disease and trachoma: A narrative review.

Neglected tropical diseases (NTDs) encompass a group of approximately 20 diseases prevalent in tropical and subtropical regions, closely associated with poverty, affecting over a billion people in low-income countries. This manuscript aims to explore the ocular manifestations and burden of two significant NTDs, namely Hansen's disease and trachoma while addressing gaps in understanding and management. Hansen's disease, caused by Mycobacterium leprae , has a long history and presents with diverse neurological and ocular manifestations. Despite the availability of treatment, ocular complications persist, leading to significant visual impairment in some cases. The manuscript emphasizes the importance of early diagnosis, regular ophthalmic examinations, and follow-ups to prevent and control ocular complications, reducing the burden of visual impairment and blindness. Trachoma, caused by Chlamydia trachomatis , remains the leading infectious cause of blindness in underdeveloped and remote areas. The manuscript highlights the clinical diagnosis and implementation of the World Health Organization's (WHO's) SAFE (surgery, antibiotics, facial hygiene, and environmental sanitation) strategy to prevent transmission and associated blindness. However, challenges in health surveillance tools and underreporting of trachoma cases are addressed, emphasizing the need for improved strategies to combat the disease effectively. Through a comprehensive review of the ocular manifestations and management of Hansen's disease and trachoma, this manuscript contributes to the existing knowledge base and enhances a deeper understanding of these NTDs. Addressing gaps in understanding and management emphasizes the importance of implementing WHO's strategies and collaborative efforts to achieve the global goal of reducing the burden of NTDs and improving community health and well-being. The manuscript underscores the significance of early intervention, preventive measures, and technological advancements, providing valuable insights for policymakers, healthcare professionals, and researchers working in the field of NTDs.

The potential role of artificial intelligence in the clinical management of Hansen's disease (leprosy).

Missed and delayed diagnoses of Hansen's disease (HD) are making the battle against it even more complex, increasing its transmission and significantly impacting those affected and their families. This strains public health systems and raises the risk of lifelong impairments and disabilities. Worryingly, the three countries most affected by HD witnessed a growth in new cases in 2022, jeopardizing the World Health Organization's targets to interrupt transmission. Artificial intelligence (AI) can help address these challenges by offering the potential for rapid case detection, customized treatment, and solutions for accessibility challenges-especially in regions with a shortage of trained healthcare professionals. This perspective article explores how AI can significantly impact the clinical management of HD, focusing on therapeutic strategies. AI can help classify cases, ensure multidrug therapy compliance, monitor geographical treatment coverage, and detect adverse drug reactions and antimicrobial resistance. In addition, AI can assist in the early detection of nerve damage, which aids in disability prevention and planning rehabilitation. Incorporating AI into mental health counseling is also a promising contribution to combating the stigma associated with HD. By revolutionizing therapeutic approaches, AI offers a holistic solution to reduce the burden of HD and improve patient outcomes.

Extrusão de disco intervertebral em Buldogue Francês

Também conhecida como hérnia de disco ou discopatia canina, a extrusão de disco intervertebral em cães é uma doença degenerativa crônica ou aguda, muito comumente encontrada em clínica médica de pequenos animais, em que ocorre o “extravasamento” do disco intervertebral. Essa discopatia está dividida em três tipos, conhecidas como doença de Hansen tipo I, II e III. Este trabalho tem como objetivo descrever um relato de caso de extrusão de disco intervertebral ocorrido em Bulldog Francês desde a sua chegada na clínica até a recuperação do paciente e suas características como sintomatologia, diagnóstico e tratamento. O caso foi acompanhado durante o estágio curricular obrigatório em Medicina Veterinária na clínica Focinhos e Patinhas, em Curitiba no estado do Paraná.

Retinal Vasculitis in a Patient with Hansen's Disease.

Hansen's disease is endemic in over 140 countries worldwide and a potentially blinding condition. We describe a case of retinal vasculitis in a patient with Hansen's disease with concomitant positive antiphospholipid antibody serology, a potentially under-reported complication in this setting. A 37-year-old Brazilian man systemically stable on triple therapy (clofazimine, rifampin, dapsone) for Hansen's disease presented for a comprehensive ophthalmic evaluation. Dilated exam revealed diffuse peripheral intraretinal hemorrhages in his right eye. Fluorescein angiography showed peripheral non-perfusion, abnormal shunt vessels and leakage from the retinal veins in the right eye and peripheral non-perfusion and vascular leakage in the fellow eye, consistent with vasculitis. Laboratory workup was notable for positive antiphospholipid antibodies (lupus anticoagulant, anticardiolipin IgM, anti-beta-2 glycoprotein 1 IgM) and normocytic anemia. As antiphospholipid antibodies are present in a large proportion of patients with Hansen's disease, it is possible that retinal vasculitis may be more common than previously thought. The extent to which retinal vasculitis occurs in Hansen's disease remains uncertain and possibly underestimated due to the frequency of anterior segment scarring, which impedes retinal evaluation. Heightened surveillance for potential retinal vascular complications is warranted.

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.

Efficacy of 3D Printed Finger Prosthesis for patients affected with Hansen’s Disease to Restore Hand Function

Introduction The greek word LEPROSY was renamed by the term Hansen’s disease by Norwegian physician Gerhard Armauer Hansen. In 2009, WHO Goodwill Ambassador Yohei Sasakawa called for an end to usage of the word leprosy, since he described it as ‘an extremely damaging term’ that contributes to stigma and impacts human rights. Since 2010, leprosy mission gives assurance that the word is not condoned by media channels or used by public figures. HD ranges from mild to severe (based on one or more skin areas affected and damage caused to organs).There were 5.2 million people affected by leprosy globally, in 1980 but by 2020 this decreased to fewer than 2,00,000. Leprosy can affect people in many ways. The Cochrane database of systemic reviews , 2019 lists that 30% of people affected with leprosy experience nerve damage. People with untreated leprosy become visibly disfigured often have psychologic and social problems. Mosby’s Medical Dictionary 2009 defines trophic ulcers as “a pressure ulcer caused by external trauma to a part of body or by vascular insufficiency leading to loss of afferent nerve fibres. The most severe complications result from infection of the peripheral nerves, which causes deterioration of sense of touch and inability to feel pain and temperature. The nerve damage is reversible when treated early, but becomes permanent when appropriate treatment is not available for sufferer. Damage to nerves may cause loss of muscle function, leading to paralysis. It may also lead to sensation abnormalities or numbness, which may lead to additional infections, ulcerations, and joint deformities. Also, damage to peripheral nerves may cause muscle weakness that can result in deformities. M. leprae attacks nerve endings and destroys the body's ability to feel pain and injury. Without feeling pain, people with leprosy have an increased risk of injuring themselves. In some cases, autoamputation has been reported to affect the tip of fingers. People with peripheral nerve damage may unknowingly burn, cut, or otherwise harm themselves. Infected nerves may enlarge also & this can be palpated. The fingers may be weakened, causing them to curve inward (claw hand). When therapeutic amputation is decided for a patient affected with HD, occupational therapist can suggest preserving as much of hand as possible, to prepare wearing 3D printed prosthesis. 3-D printing is a new rising technology, Objects made in 3D printing range from plastic figurines and mould patterns to steel machine parts and titanium surgical implants. Related to Hansen Disease, It facilitates manufacturing hand parts with irregular and uncommon geometric shapes. Freedom offered by 3D printing techniques has paved the way for the application of new design for best appearances. The advantages of 3D printing could be used to fabricate prosthetic hands based on the biological design principles. The purpose of this study is to assess efficacy of 3-D printed finger prosthesis to manipulate objects & to restore hand function in HD clients.

Type II Reaction Erythema Nodosum Leprosum: A Case Report

Leprosy, or Hansen's disease, is a chronic granulomatous infectious disease caused by Mycobacterium leprae. This is a case of a 25-year-old male from Micronesia who presented to a hospital in the Midwest with a two-week history of a widespread, nodular, erythematous, painful rash most severe on his lower extremities and sparing only his hands and feet. In addition to the cutaneous manifestations, the patient met the criteria for Systemic Inflammatory Response Syndrome (SIRS) due to his presentation of tachycardia, tachypnea, leukocytosis, and elevated inflammatory markers. A short course of antibiotics, including Piperacillin-Tazobactam and Vancomycin, and IV steroids were started on admission. A skin biopsy taken from the center and edge of a lesion on the patient’s right arm demonstrated acute and chronic granulomatous superficial and deep inflammation with abundant acid-fast bacilli consistent with lepromatous leprosy from a Mycobacterium leprae infection. Once the National Hansen's Disease Center was contacted previous therapies were stopped and a multidrug therapy, consisting of Rifampin, Moxifloxacin, Minocycline, Methotrexate, and Prednisone was started. The multidrug therapy promptly resulting in substantial clinical improvement over the subsequent months. This case emphasizes the significance of early recognition, accurate diagnosis, and timely initiation of appropriate treatment in leprosy management, even in unlikely regions such as the Midwestern United States.

Overview of Leprosy Reactions at Universitas Sumatera Utara Medical Faculty Hospitals between 2017 and 2021

BACKGROUND: Leprosy, or Morbus Hansen, is a chronic granulomatous disease caused by Mycobacterium leprae that involves the skin and peripheral nerves, with or without motor disorders. Leprosy reactions are immune-mediated acute or subacute inflammatory episodes that interfere with chronic disease and are classified into three types: type 1 (RR), type 2 (ENL), and the Lucio phenomenon. AIM: The purpose of the study is to describe the epidemiology of leprosy reactions at Universitas Sumatera Utara (USU) teaching hospitals and provide a description of factors associated with the reactions that might provide valuable information for future studies. METHODS: This is a cross-sectional analytic study with total sampling on medical records of patients in the Dermatology and Venereology Polyclinic at H. Adam Malik Hospital Medan and USU Education Hospital in 2017–2021. RESULTS: The incidence of leprosy reactions at the USU Medical Faculty Education Hospital in 2017–2021 was 41 cases. The majority of reaction types were type 2 reactions (68.3%). Risk factors for type 1 reactions were a history of reactions, being elderly, multiple lesions or nerve involvement, and co-infections, whereas the risk factors for type 2 reactions were LL, younger age, bacterial index >4+, stress, and co-infections. The highest age group proportion was 18–59 years (95.1%) and was more common in men (70.7%), which mostly appeared before treatment (39.1%). The incidence of leprosy reactions was 26 new cases per 100 patients. CONCLUSION: The highest proportion of leprosy reactions was type 2, within the adult age group (18–59 years), males, and before treatment.

Habitual Abortion in Hansen’s Morbus

Based on WHO data, Indonesia is one of the countries contributing around 10,000 cases of Hansen’s morbus 2019. Hansen's morbus, or leprosy, is a chronic bacterial infection (Mycobacterium leprae) that attacks skin tissue, peripheral nerves, and the respiratory tract. Hansen's disease can occur during pregnancy and worsen during pregnancy. Pregnancy causes a relative decrease in cellular immunity. This can be explained because immunosuppression occurs during pregnancy. Pregnancy is dangerous for women with Hansen’s morbus . This case study describes a case of habitual abortion with Hansen’s morbus . The patient had a history of Hansen's morbus and had discontinued the medication. During pregnancy, the patient never underwent examination and treatment for Hansen's morbus. So, the patient experiences the habit of abortion. For this reason, it is necessary to carry out good treatment for pregnant women with Hansen's disease so that the mother and fetus receive appropriate treatment.

High-Resolution Ultrasound in Evaluation of Peripheral Neuropathy in Patients of Hansen's Disease.

Hansen's disease (HD) is a major public health problem in developing countries. It causes peripheral neuropathy, and if left untreated, it leads to deformities. It is important to diagnose such cases early, and prompt treatment should be given to patients to preserve nerve function. A total of 40 patients with HD who were already on multi-drug therapy (MDT) or treatment-naive were included in this study. These were clinically diagnosed cases of HD as per the Ridley-Jopling classification, and these patients were subjected to high-resolution ultrasonography (HRUS). A total of 19 controls were also included. The patients were clinically evaluated, and HRUS of bilateral ulnar nerves (UNs) was performed in all cases and controls. The other peripheral nerves, if clinically thickened, were evaluated using HRUS. The cross-sectional area (CSA) of the UN in cases was significantly thickened as compared to controls. There was no difference in the CSA of patients on MDT as compared to treatment naïve patients. In two patients with pure neuritic HD, the clinical examination missed the bilateral nerve enlargement, and only unilateral nerve thickening was clinically appreciated. However, bilateral thickening was detected on HRUS. HRUS is a non-invasive and sensitive diagnostic tool that gives significant information on nerve structure and morphology. HRUS adds a new dimension to diagnosing HD, particularly the pure neuritic type, with the assessment of early nerve damage, which can prevent disabilities. HRUS is an objective diagnostic tool that can complement the clinical examination.

Telltale signs of hansen's disease: discolored, hypoesthetic patch and deformities of the hand

Telltale signs of hansen's disease: discolored, hypoesthetic patch and deformities of the hand

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.

Ulnar nerve mononeuropathy in a patient with Hansen's disease: Clinical and radiological features.

Leprosy is a chronic infection caused by bacteria called Mycobacterium leprae. This is a prevalent disease in low-income countries, and it has not been completely eradicated. We present the case of a 29-year-old man with a previous diagnosis of Hansen's disease, who consulted for pain in the left elbow and wrist, associated with fever with preserved mobility and pain on palpation. Diagnosis of mononeuropathy of the ulnar nerve was made by MRI of the elbow and forearm. This entity corresponds to an infrequent complication of this infection with few cases reported in the literature. Our added value with this case is to show and explain the clinical imaging correlation, which is vital to understand the presentation of symptoms and to carry out a comprehensive and rapid approach to establish adequate and timely treatment.