Presentation Of Leprosy Research Articles

A rare case presentation of pure neural leprosy

A rare case presentation of pure neural leprosy

An unusual presentation of lepromatous leprosy as verrucous growth in the oral cavity

Leprosy is a multisystem disorder with various spectrum of cutaneous findings. In the initial era of the history of leprosy, mucosal lesions were typical. Of late, mucosal findings have remarkably declined because of early treatment of leprosy. However, oral lesions have eminent epidemiological significance, given their role in disease transmission. Oral findings are more common in multi-bacillary leprosy, and patients usually present with evident skin lesions. The hard palate is the commonest site of oral involvement. Clinical lesions do not always show specific histology of leprosy. Specific histologic features are important in disease transmission as well as recurrent reactions. Here, we report a case of multi-bacillary leprosy presenting as oral verrucous lesions in the soft palate, with histologic evidence of specific changes of leprosy. In this interesting case, a few cutaneous papules were noted during physical examination of the patient. We report this case to emphasis the irrefutable socioeconomic impact of oral lesions in leprosy.

SCD163 levels as a biomarker of disease severity in leprosy and visceral leishmaniasis.

BackgroundCD163, receptor for the haptoglobin–hemoglobin complex, is expressed on monocytes/macrophages and neutrophils. A soluble form of CD163 (sCD163) has been associated with the M2 macrophage phenotype, and M2 macrophages have been shown to down-modulate inflammatory responses. In particular, previous studies have shown that M2 is closely associated with the most severe clinical presentation of leprosy (i.e. lepromatous leprosy (LL)), as well as tuberculosis. We hypothesized that sCD163 correlates with severity of diseases caused by intracellular pathogens.Methodology/Principal findingsTo assess this hypothesis, sCD163 levels were measured in the serum of leprosy and visceral leishmaniasis (VL) patients stratified by severity of the clinical presentation. sCD163 levels were significantly higher in patients with these diseases than those observed in healthy control individuals. Further analyses on infection and disease status of leprosy and VL patients revealed a clear association of sCD163 levels with clinical parameters of disease severity. In vitro culture assays revealed that Leishmania infection induced CD163 expression on the surface of both monocyte/macrophages and neutrophils, suggesting these cells as possible sources of sCD163. FACS analyses shows that the cells expressing CD163 produces both TNF-α and IL-4.Conclusions/SignificanceTaken together, our results reveal sCD163 as a potential biomarker of severity of diseases caused by intracellular pathogens M. leprae and Leishmania spp. and have a modulatory role, with a mix of an inflammatory property induced by TNF-α release, but that potentially induces an anti-inflammatory T cell response, related to IL-4 release.

Demography, clinical presentation and laboratory diagnosis of leprosy by microscopy, histopathology and PCR from Dhaka city in Bangladesh

Demography, clinical presentation and laboratory diagnosis of leprosy by microscopy, histopathology and PCR from Dhaka city in Bangladesh

Major Risk Factors for Leprosy in a Nonendemic Area of the USA

Background178 new cases of leprosy were reported in 2015 with Florida being one of six states and contributing a large number (72%) of registered cases. It was also the only state showing an increasing occurrence compared with the previous years. Studies from other southern U.S. states in armadillos and leprosy patients demonstrate infection with the same strain of Mycobacterium leprae, confirming human armadillo exposure as the main risk factor for leprosy. In contrast, cases from Florida show no clear risk factor. We present three cases of leprosy from Hillsborough county (Florida) with no previous armadillo exposure but a different risk factor in common: being foreign-born.MethodsWe report three cases of leprosy presenting in a non-endemic area of Florida during the past five years and highlight the absence of direct armadillo exposure as a risk factor for developing the disease.ResultsCase 1: A 35-year-old male from Mexico presented with multiple erythematous non-tender cutaneous lesions and numbness in both hands. He had a history of leprosy exposure from a Haitian inmate during incarceration in Florida. Biopsy confirmed borderline lepromatous leprosy.Case 2: A 67-year-old female from Cuba presented with disseminated circular ulcerative lesions and severe hypesthesia of lower extremities. She denied leprosy or armadillo exposure. Diagnosis of borderline lepromatous leprosy was made through biopsy.Case 3: A 38-year-old female from Puerto Rico presented with disseminated painless plaques, edema of the hands with numbness and paresthesias. She worked as a nurse but denied leprosy or armadillo exposure. A biopsy confirmed borderline lepromatous leprosy with erythema nodosum leprosum.ConclusionOur case series demonstrates that a history of armadillo exposure is not always present. Other risk factors need to be considered when leprosy is a possible diagnosis in a patient. Place of birth is a very important factor due to the diverse and increasing foreign-born population in the United States.Disclosures All authors: No reported disclosures.

Clinical Characteristics and Treatment of Leprosy

The purpose of this study is to provide an up-to-date review of the clinical presentation, classification system, and treatment of leprosy (also known as Hansen’s disease). Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Leprosy affects mainly the skin and peripheral nerves with serious clinical complications, including blindness and physical deformities of the hands and feet. Leprosy is a complex microbial disease with a wide spectrum of clinical presentations and severity of disease progression and outcome. Disease classification based on bacterial indicators and the Ridley-Jopling system are standard classification systems for leprosy that enable proper categorization of different types of leprosy for evaluation and treatment purposes. Early disease detection and treatment can significantly impact the prevalence and severity of leprosy. Long term follow-up as well as disability evaluation and prevention are important measures to prevent disease relapse and to achieve a good clinical outcome for patients. Early disease detection, multidrug therapy, frequent clinical follow-up, and proper management of tissue damage and physical disabilities as a result of peripheral nerve damage are key factors to ensure a good outcome for patients.

Association between STR -794 CATT5-8 and SNP -173 G/C polymorphisms in the MIF gene and Lepromatous Leprosy in Mestizo patients of western Mexico

Lepromatous Leprosy (LL) is the most common presentation of leprosy in Mexico. LL patients are unable to activate an effective inflammatory response against Mycobacterium leprae probably due to the genetics of the host. Macrophage Migration Inhibitory Factor (MIF) is important to trigger inflammation processes. Two polymorphisms have been reported for human MIF: STR -794 CATT5-8 and SNP -173 G/C. 7-8 CATT repeats at -794 and the C allele at -173 increase the expression of MIF. We aim to determine the association between the polymorphisms in MIF gene and LL. We carried a case and controls study with 100 Mexican LL patients and 100 healthy subjects (HS). PCR was used for genotyping of STR -794 CATT5-8 polymorphism and PCR-RFLP for -173 G/C. We found that LL patients possess high -794 CATT repeats (47.1%) more often than HS (32.7%). In conclusion, a MIF polymorphism is associated with susceptibility to LL in Western Mexican population.

Pseudoathetosis and ataxia – a rare presentation of multibacillary leprosy in a non-endemic area

Pseudoathetosis and ataxia – a rare presentation of multibacillary leprosy in a non-endemic area

Uncommon clinical presentations of leprosy: apropos of three cases

Leprosy has been labelled as a great imitator since times immemorial. This mainly is because of the wide range of its clinical presentations. In endemic regions it is important to entertain the possibility of leprosy even in atypical presentations so as to avoid misdiagnosis. Here we report three cases of leprosy with uncommon disease presentations. First case had presented with eczematous morphology of cutaneous lesions without sensory loss and nerve thickening. Second case had localized type-2 reaction and third case had presented initially with only rheumatologic manifestations. Histopathology is an important tool in arriving at correct diagnosis and thus should be done in all suspected cases.

Leprosy presenting as a reversal reaction requiring urgent treatment

Leprosy presenting as a reversal reaction requiring urgent treatment

The demographic and clinical characteristics of leprosy in Saudi Arabia.

Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom (65%) were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently (33%), and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum (E.N.L.) developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers.

Leprosy presenting as a non-healing ulcer and associated unusual myth

A case of a 70 year old lady with borderline tuberculoid leprosy who presented with a chronic ulcer and associated myth has been illustrated. The need for awareness programmes focusing on these types. of myths has been stressed.

Histoid leprosy: review of the literature.

Leprosy is a chronic granulomatous inflammation primarily of the peripheral nervous system, skin, and reticuloendothelial system caused by Mycobacterium leprae. It presents clinically as an erythematous or hypopigmented anesthetic patch and a thickened and/or tender cutaneous nerve trunk. Leprosy is also called Hansen disease. Leprosy is a great imitator of other skin diseases, and it can present with different morphological lesions, which is why an expert eye is needed to diagnose it. One of the important clinical presentations of leprosy is histoid leprosy, which is very difficult to diagnose due to different clinical and histopathological findings that mimic, e.g., a fibromatous disorder. Histoid leprosy is a very rare clinicopathological variant of leprosy. It is clinically characterized by skin-colored, soft, succulent nodules, and plaques on apparently normal skin and histologically by a dense bundle of histiocytes arranged in storiform. Though histoid leprosy is a very rare type of leprosy, the higher load of lepra bacilli in these cases makes it a concern as a reservoir for leprosy.

Neuropatia da Doença de Hansen: Um Diagnóstico a Considerar na Investigação da Neuropatia Periférica

Leprosy is still one of the most frequent causes of peripheral neuropathy. Although regarded as eradicated in Portugal, is still documented in neuropathological study of patients with clinical peripheral neuropathy without proper diagnosis. Review of the cases of Hansen disease neuropathy diagnosed in Neuropathology Unit of Centro Hospitalar do Porto between 1978 and 2013, atending to gender, age, clinical manifestations and neuropathological findings. Twenty one patients were identified with neuropathological diagnosis of Hansenâs disease neuropathy, predominantly male. The mean age at diagnosis was 52 years, and sensory symptoms predominate as neurological manifestation of disease. Interval between symptoms and diagnosis was 1-38 years. In most nerve samples tuberculoid type of disease was identified. Bacilli were detected in skin and nerve in 44% of cases. Mononeuritis is the most common presentation of leprosy but other clinical manifestations are possible, including skin lesions. Infection with M. leprae injures myelinated and unmyelinated fibres, with replacement of nerve tissue by collagen fibrosis. The diagnosis of leprosy is only achieved by neuropathological study of skin lesions and / or peripheral nerve, supported by the identification of the bacillus. Hansen disease remains a public health problem in tropical areas and, although rare, still described in Western countries reason why should still be considered as a diagnostic possibility in the investigation of peripheral neuropathy.

Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review

Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.

Lymph node abscess and cardiac involvement in a patient with nodular lepromatous leprosy (LL) with erythema nodosum leprosum (ENL): A rare occurrence

With the world's focus on reducing the leprosy patient load to the extent of elimination, finding and reporting the rarer presentations of leprosy becomes important for prompt treatment. Also, these untreated patients may serve as a potential source of infection in community. We report a 35-year old man diagnosed to have lepromatous leprosy and erythema nodosum leprosum with inguinal lymph node abscess and suspected cardiac involvement that proved fatal. We stress the importance of detailed workup to look for associated systemic involvement for timely intervention and favourable outcome.

Leprosy Mimicking Psoriasis.

Leprosy Mimicking Psoriasis.

Leprosy: An unusual presentation

Leprosy is a chronic infectious disease caused by Mycobacterium leprae , commonly manifesting as hypopigmented anesthetic patches with thickened nerves. Primary hyperpigmentation in leprosy is a rare manifestation. Literature search showed only few case reports of Hansen's disease with single hyperpigmented patch and involvement of relatively immune zones like palms and soles. We report a case of leprosy presenting primarily as hyperpigmented patches over the trunk and extremities with involvement of palms and soles which is a rare presentation.

Case of arthritis secondary to leprosy.

IntroductionLeprosy is a chronic granulomatous infectious disease, which is caused by Mycobacterium leprae. High numbers of people are still affected by this disease in some of the developing countries however, it is rarely seen in non-endemic regions.Cutaneous and neurological manifestations are the common and classical presentations of leprosy. Musculoskeletal involvement is the third most common manifestation but is less frequently reported.Joint involvement can present as acute symmetrical polyarthritis or chronic polyarthritis resembling rheumatoid arthritis. Leprosy can also present with tenosynovitis, either isolated or associated with arthritis.Case presentationWe report a case of 29-year-old man who developed tenosynovitis and acute symmetrical polyarthritis including small joints of hands and feet three weeks after appearance of typical cutaneous lesion of leprosy. Patient improved with steroid and anti leprosy treatment. Patient had another acute episode with symmetrical polyarthritis four months later while on treatment.Discussion and EvaluationIn the modern era, there is increase movement of population from developing countries to developed countries, it is likely that patient suffering from leprosy with arthritis may present to rheumatology clinic in those countries where leprosy is not endemic. Exact pathogenesis for musculoskeletal manifestations is still not fully known. Our patient presented with symmetrical polyarthritis, enthesitis and systemic involvement, which was secondary to lepra reaction.Having good knowledge of musculoskeletal manifestation of leprosy, will help narrow differential diagnosis and will prevent unnecessary diagnostic workup.ConclusionLeprosy can present with different rheumatologic manifestation including tenosynovitis and acute symmetrical polyarthritis. Type 2 lepra reaction (Erythema nodosum leprosum ENL) can present with systemic manifestation and can involve skin, nerves, joints, kidneys and liver.

Borderline Hansen's disease presenting as isolated macrocheilia

Abstract Although oral lesions in leprosy are common, they are mostly described in the late stages of lepromatous pole. As there are very few studies discussing the oral findings in leprosy, involvement of oral mucosa as the only manifestation of leprosy often goes misdiagnosed. Here we are reporting a case of tuberculoid leprosy presenting as chronic lip swelling.