Presentation Of Leprosy Research Articles

Histopathologic Study of Hansen’s Disease

Introduction: Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae. Accurate clinical and histopathological diagnosis forms the backbone for appropriate treatment and preventing deformities and drug resistance. Several studies have been conducted on clinical presentation of leprosy however there is a paucity of leprosy related histopathological data from Nepal. Objectives: The objectives of this study were to evaluate histopathological features of leprosy in skin biopsies, categorize them into various types based on Ridley Jopling classification and to correlate with clinical presentations. Methodology: Ninety six skin biopsies histologically diagnosed cases of leprosy from 16th October 2020 to 15th April 2021 were included in the study. Ethical consent was taken from the Institutional Review Committee of KMCTH (Ref.:011020202005). Hematoxylin and Eosin stain was used to study histopathological details. Wade- Fite stain was used to evaluate Bacillary index. The lesions were classified as per the Ridley-Jopling classification. Histopathologic findings were correlated with clinical diagnosis. Results: Male to female ratio of patients was 2.4:1. Most of the cases were seen in the third decade of life (39.6%). Most of the cases presented clinically as papules, nodules and hypoaesthetic patches involving predominantly extremities of the body. Commonest histological diagnosis was Borderline Tuberculoid (BT) leprosy (31/96). All cases of Lepromatous leprosy (LL) showed Acid Fast Bacilli on Wade- Fite stain. Tuberculoid leprosy cases showed granulomas and perineural involvement. Conclusion: Histopathological examination remains the gold standard for definite diagnosis and categorization of Hansen’s disease.

A unique case of borderline lepromatous leprosy presenting with both hypopigmented and hyperpigmented macules

Primary hyperpigmentation is rare in leprosy. We report a patient with borderline lepromatous (BL) leprosy who presented with both hypopigmented and hyperpigmented macules. Histopathology with Masson Fontana staining and immunohistochemistry with HMB 45 revealed decreased melanin granules in keratinocytes of basal and superficial layers in hypopigmented macules when compared to hyperpigmented macules. It appears that hypopigmentation in leprosy lesions may be due to defective transfer of melanin into keratinocytes.

070 Bacillary Load and Reactional States in Leprosy - A Surge in Severity the COVID Era?

Leprosy is an ancient albeit neglected chronic infectious disease mainly affecting the skin and peripheral nerves, often affecting the world’s most impoverished communities. This retrospective observational study was undertaken of clinically diagnosed patients with Leprosy presenting to the outpatient clinic in two timeframes: January 2019 - December 2019 (pre COVID period in our country) and January 2020 - December 2020 (COVID period). Slit Skin Smears and bacteriological (BI)/morphological indices (MI) were calculated of these Reactional states and relapse, if present, were classified, features described, and compared. Among 32 clinically diagnosed cases of Leprosy, 17 (53%) presented in preCOVID period and 15 (46%) presented in the COVID era. Among the 17 patients of Leprosy (preCOVID), 1 most patients (70.5%) were paucibacillary. Three patients (17.6%) had Lepra reaction. The male to female ratio 1.4:1, and most patients were rom rural areas, aged between third and fourth decade. The majority of the cases (58.8%) had BI of 1+. In 11 (64.7%) cases MI was less than 25. In comparison, patients who reported following the COVID outbreak were mainly multibacillary type (66.6%). Seven patients (46.6%) had Lepra reactions. There was a slight female preponderance in the patients (Male: female = 1:1.14). They mainly (66.6%) belonged to urban areas and were aged between fourth to fifth decade. The majority of the patients had a BI 4+ (66.6%). Most patients had MI greater than 50 (80%), 3 patients had relapse (20%). The restrictions imposed by the pandemic have resulted in a delayed cccess to dermatological care, thus increasing the bacillary load and severity of Leprosy. The wide-reaching repercussions of COVID on the health care system have negatively impacted elimination efforts and increased the risk of Leprosy transmission. Large-scale studies are needed to assess the impact of COVID restrictions and ways to ensure the availability of drugs and supportive care.

Coexistence of Mycobacterium Tuberculosis and Mycobacterium Leprae in a Patient- an Alarm of Inadequate Innate Immune Response?

Mycobacterium tuberculosis (M.Tb) and Mycobacterium leprae (M.Leprae) are Gram-positive aerobic Acid-Fast Bacilli (AFB) causing chronic granulomatous infections like Tuberculosis (TB) and Leprosy respectively. They can present with varied manifestations according to the host’s immune status and response.[1] Both are prevalent in clusters in developing countries; however, the simultaneous occurrence of both infections in an individual is rare even in endemic areas (0.02 per 100,000 population).[2] Few case reports showing the coexistence of TB and leprosy, majority are TB developing following immunosuppressive treatment of leprosy reactions. Of which pure neuritic presentation of leprosy in an old treated case of Pulmonary Tuberculosis (PTB) has not been reported yet. Here we are reporting a case of PTB while on treatment developed neurological manifestations, diagnosed to be a case of poly neuritic leprosy (PNL). PNL is a rare form of leprosy, characterised by an area of sensory loss along the distribution of single/multiple thickened nerve trunks with or without motor deficit in the absence of skin lesions.
 Keywords: TB with Pure Neuritic Hansen, SNP- PPTN22, Defective Lymphocyte Transformation, SNP- Granulomatous infection

Single Plaque Lepromatous Leprosy Presenting as Granuloma Annulare

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, primarily affecting the peripheral nerves and skin. The clinical presentation of leprosy is highly variable, depending on the immune status of the individual. Based on the Ridley–Jopling classification, the clinical spectrum ranges from tuberculoid to lepromatous leprosy (LL). In all its stages, it can mimic various other conditions. Early and accurate diagnosis of leprosy is crucial because late recognition may give rise to permanent deformity resulting from the disease. Here, we report a case of LL clinically presenting as granuloma annulare in a 75-year-old man, which was diagnosed and confirmed by histopathology.

Isolated Leprosy of Bilateral Ear Lobes, A Rare Presentation of Leprosy

Hansen disease is a chronic infectious disease caused by Mycobacterium leprae. It can present with a variety of clinical manifestations depending on the immune status. Ear lobes are commonly involved in leprosy. However, isolated earlobe involvement of both ear lobes is rare. We present a case of a 25-year-old man who presented with isolated swelling of both pinna, which on slit skin smear turned to be multi-bacillary leprosy. The bilateral pinna swelling started as asymptomatic, multiple skin colored shiny papules which progressively became lobular over a period of a year. Isolated involvement of the pinna in a patient without lesions in other body parts is an unusual initial presentation of leprosy. However, leprosy should be kept as a rare differential diagnosis of isolated lesions on the ear in patients not responding to conventional treatment.

Lepromatous leprosy mimicking systemic lupus erythematosus

We describe a case of a 36-year-old woman who presented with bilateral symmetrical polyarthritis of the hands, malar rash, and discoid rash over three months. She was initially diagnosed and treated as systemic lupus erythematosus but later proven to have lepromatous leprosy. The patient showed a remarkable improvement after the administration of steroids. Due to typical features of a connectivetissue disorder, a positive serological marker, photosensitivity, typical age of onset and initial response to treatment led to the confusion and delay in diagnosis of lepromatous leprosy. Further, this case emphasizes the importance of obtaining a detailed contact history and taking a skin biopsy even in a typical connective tissue lesion. Our case illustrates an unusual presentation of lepromatous leprosy mimicking systemic lupus erythematosus.

A Case of Histoid Leprosy Presenting as Immune Reconstitution Inflammatory Syndrome (IRIS) in a Patient of Human Immunodeficiency Virus (HIV) Infection on Highly Active Retroviral Therapy (HAART).

A Case of Histoid Leprosy Presenting as Immune Reconstitution Inflammatory Syndrome (IRIS) in a Patient of Human Immunodeficiency Virus (HIV) Infection on Highly Active Retroviral Therapy (HAART).

Clinical study to relook into the case definition and treatment of leprosy

Introduction: The statistical elimination of leprosy in India is something to cheer about but the steady appearance of newer cases still haunt us. It is sad to note that countries with high prevalence of Leprosy administer once a month of rifampicin while developed nations administer daily rifampicin. Materials and Methods: We have done a retrospective analysis of all the leprosy cases seen in the department of Dermatology, Belagavi Institute of Medical Sciences, India. A total of 64 cases were analyzed using the case records and various parameters were recorded. Results: Out of 64 cases, 13 were treated as out patients and 51 were treated as in patients. The most common age group was 21-40. Males outnumbered the females. There were 62 cases of multibacillary and only 2 cases of paucibacillary. Of 64, 30 were newly detected, 19 were receiving treatment and 15 cases had completed treatment but had one or more complications. Family h/o leprosy was noted in 4.The most common presenting complaints were: Multiple painful, reddish raised skin lesions – 24; Spontaneous blisters/Ulcers on the hand/feet – 21; Hypopigmented patches – 13. As per the clinical criteria of WHO, only 37 patients had anaesthetic patches, 52 had nerve thickening and only 11 demonstrated bacilli in the slit skin smear. Discussion: A good number of patients are being seen with lepra reactions or complications. Conclusions: It is quite evident that the presentation of leprosy is changing. This is a paradigm shift in the initial presentation and needs a relook into the existing diagnostic criteria. Keywords: Leprosy, Multidrug therapy, Leprosy elimination.

An unusual ocular presentation of histoid leprosy

Leprosy is a chronic granulomatous infection caused by mycobacterium leprae, mainly affecting the skin and peripheral nerve. Histoid type of leprosy, which is considered as an extremely rare variant of lepromatous leprosy. We report a case of a 50/year old male presented to our institute with chief complain of conjunctival swelling in both eyes, encroaching over cornea and involving limbus and sclera, associated with painless blurring of vision. An incisional biopsy of the right eye was performed under local anesthesia. Histopathology of right eye biopsy revealed spindle shaped cells having bland looking nuclei and variable amount of cytoplasm which was suggestive of histoid leprosy. A dermatology consultation was sought and patient was diagnosed to have leprosy. Consequent to which he was started on MBALD (multibacillary anti leprosy drug), and showed improvement in patient`s visual acuity as well as regression of right eye swelling and disappearance of left eye swelling.

Leprosy presenting as eczema

Leprosy presenting as eczema

Leprosy presenting with papulosquamous skin lesions in a case of human immunodeficiency virus infection

Leprosy has a wide range of clinical manifestations, which sometimes imposes a clinical challenge and may lead to misdiagnosis. Interactions between leprosy and human immunodeficiency virus (HIV) have been little studied and poorly understood to date. However, coinfection still poses dilemmas in leprosy as to the occurrence of the immune reconstitution inflammatory syndrome manifesting as clinical leprosy and reversal reactions, higher chances of relapse after the successful completion of the multidrug therapy (MDT) and drug interactions between MDT and antiretroviral therapy. Furthermore, coinfection can lead to atypical clinical manifestations of leprosy. Herein, we describe a rare presentation of leprosy in a patient of HIV infection who reported with papulosquamous lesions over both upper and lower limbs histopathologically consistent with Hansen's disease.

A Case of Histoid Hansens Mimicking as Neurofibroma in Presentation in a Post Elimination Era

Histoid leprosy is an unusual leprosy variety generally following the failure of therapy. It occurs de novo from time to time with a history of insufficient or improper treatment. In this case report a case of such a presentation of histoid leprosy mimicking as neurofibroma in 25-year-old male patient of Kalaburagi region in post elimination era is presented. The frequency of leprosy of 0.6210000 had been recorded in March 2017 National Leprosy Eradication programme NELP.nbsp

Pathogenesis and Host Immune Response in Leprosy.

Leprosy is an ancient insidious disease caused by Mycobacterium leprae, where the skin and peripheral nerves undergo chronic granulomatous infections, leading to sensory and motor impairment with characteristic deformities. Susceptibility to leprosy and its disease state are determined by the manifestation of innate immune resistance mediated by cells of monocyte lineage. Due to insufficient innate resistance, granulomatous infection is established, influencing the specific cellular immunity. The clinical presentation of leprosy ranges between two stable polar forms (tuberculoid to lepromatous) and three unstable borderline forms. The tuberculoid form involves Th1 response, characterized by a well demarcated granuloma, infiltrated by CD4+ T lymphocytes, containing epitheloid and multinucleated giant cells. In the lepromatous leprosy, there is no characteristic granuloma but only unstructured accumulation of ineffective macrophages containing engulfed pathogens. Th1 response, characterised by IFN-γ and IL-2 production, activates macrophages in order to kill intracellular pathogens. Conversely, a Th2 response, characterized by the production of IL-4, IL-5 and IL-10, helps in antibody production and consequently downregulates the cell-mediated immunity induced by the Th1 response. M. lepare has a long generation time and its inability to grow in culture under laboratory conditions makes its study challenging. The nine-banded armadillo still remains the best clinical and immunological model to study host-pathogen interaction in leprosy. In this chapter, we present cellular morphology and the genomic uniqueness of M. leprae, and how the pathogen shows tropism for Schwann cells, macrophages and dendritic cells.

Looking into Array of Clinical Presentations of Patients with Leprosy and their Clinico-epidemiological Profile: A Retrospective Study

Introduction: The prevalence of leprosy in India has decreased to <1 per 10,000 population by 2016 after the introduction of Multidrug Therapy (MDT) in 1982; still wide variations in Prevalence Rates (PR) continue to exist across the states and regions in the country. Aim: To determine the current clinical profile of leprosy and study various presenting features of patients with leprosy at a tertiary care hospital in North India. Materials and Methods: A retrospective study, based on seven years data, was conducted on patients diagnosed and registered in the leprosy clinic of a tertiary care hospital in North India, from January 2013 to December 2019. Data regarding their demographic details, presenting complaints, clinical features, associated complications and treatment administered was analysed and was entered into Microsoft Excel and presented as tables. Results: A total of 181 patients of leprosy were registered over a period of seven years. There were 133 males and 48 females with M:F ratio of 2.77:1. Of the total patients registered, 3.86% were children (≤14 years) and 97.8 % patients were immigrants from the adjoining states. The most common clinical type was Multibacillary (MB) leprosy in 88.95% patients whereas most frequent morphological type was Borderline Tuberculoid (BT) leprosy (72.93%). Thirty-three (18.23%) patients presented with leprosy reaction (Type 1 reaction in 16.6% and Type 2 reaction in 1.66%). World Health Organisation (WHO) grade 2 deformities (G2D) were diagnosed in 3 (1.66%) patients, with claw hand being the most common deformity (1.10%). Anaesthetic to hypoaesthetic patches were the most common presenting feature (64.1%). Conclusion: Despite statistical elimination, MB disease and leprosy reactions are commonly seen as presenting manifestations. It highlights the need for high quality leprosy services including good referral system for an active case detection. Varied clinical presentations of leprosy should be contemplated while examining patients that can assist in an early and better case detection that will prevent delay in therapy and associated deformities and also decrease the transmission of disease in the community.

Are children safe from complications of leprosy? A study from North Kerala

Objectives:The aims of the study were (1) to document the demography and clinical profile of patients with leprosy at a tertiary referral center from 2009 to 2018. (2) To compare the disease manifestation in children aged 12 years/below and the same in patients above 12 years.Materials and Methods:Case records of all patients diagnosed to have leprosy as per the World Health Organization cardinal criteria at our tertiary referral center from 2009 to 2018 were included in this study. The findings recorded in those aged 12 years/below were compared with those above 12 years using Pearson’s Chi- square test.Results:A total of 705 patients who attended our institution during the 10 year period were diagnosed to have leprosy. Six hundred and sixty-four (94.2%) were above 12 years of age and 41 patients (5.8%) were aged 12 years or below. Lepromatous spectrum cases, pure neuritic cases, Grade 2 disability, and lepra reactions were not documented in any of the patients aged 12 years or below which were contrary to the observations in those above 12 years. The differences were found to be statistically significant.Limitations:Retrospective design and small number of childhood cases were the main limitations of the study.Conclusion:Clinical presentation of leprosy in children differs from that in adults. Detection of disease in childhood offers an opportunity to cure the disease with less risk of developing some of the important disease and therapy-related complications.

Chronic Unilateral Uveitis as a Manifestation of Leprosy: A Case Report and Literature Review

ABSTRACT Purpose: To describe a case of leprosy presenting chronic anterior uveitis associated with other systemic lesions. Methods: Case report and systematic literature review. Results: We describe the case of a 65-year-old patient presenting clinical features of chronic uveitis and poor response to topical and intravitreal steroid treatment. Upon ocular examination, diffuse iris atrophy and macular edema were observed and laboratory tests for autoimmune and infectious diseases were within normal range. Physical examination revealed the presence of skin lesions on trunk and extremities, which were biopsied and identified as positive for leprosy. Conclusion: The case reported herein presented atypical characteristics of uveitis due to the involvement of the posterior segment of the eye. Leprosy diagnosis could be a challenge, a systematic approach is mandatory to achieve adequate treatment.

An unusual presentation of De-novo Histoid leprosy clinically mimicking as neurofibromatosis

Histoid leprosy is a rare and uncommon variant of lepromatous leprosy which generally occurs following resistance to dapsone therapy or relapse after dapsonemonotherapy or multidrug therapy. Rarely, it can occur de novo without any history of treatment. We present one such rare case of histoid leprosy mimicking neurofibromatosis presented in a 43 year old male.

Study of histomorphological variants of leprosy in correlation with bacilloscopy index in tertiary care hospital

Introduction: Leprosy is an infectious and contagious chronic disease, caused by Mycobacterium leprae, an obligate intracellular bacillus, that affects mainly the skin, nerves and mucous membranes. It can also affect the eye, nose, joints, lymph nodes, internal organs and bone marrow, especially in multibacillary patients (MB). In the majority of cases, it is transmitted from person to person through contact with patients having a high bacillary index and haven't been treated. Materials and Methods: This is an observational retrospective study of 52 cases conducted in histopathology section of Pathology department, Government Medical college, Bhavnagar, Gujarat. In this study, cases were included whose biopsy samples were received in the department with clinical suspicion of leprosy. All the case diagnosed as leprosy were evaluated by Fite Faraco stain and reported for bacilloscopy index. Results: Out of 52 cases, 40 were histomorphologically confirmed as leprosy. Maximum number of cases were observed in the age group of 31 to 40 years (47.5%). Among various anatomical site for cutaneous presentation of leprosy in maximum number of cases, the lesions were observed in upper extremity (50%). Higher number of type of leprosy observed were borderline tuberculoid leprosy (35%) followed by tuberculoid leprosy (30%). It is observed, mean bacilloscopic index is higher in cases of lepromatous leprosy whereas lower in tuberculoid leprosy. Conclusion: In our study, borderline tuberculoid and tuberculoid cases were reported with higher incidence. Bacteriological examination and bacilloscopy index add onto the morphological diagnosis and help to categorise multibacillary and paucibacillary leprosy. Keywords: Leprosy, Bacilloscopy index, Fite Faraco.

Lepromatous leprosy presenting with type II reaction before and type I reaction after treatment

Lepromatous leprosy is associated with a high bacillary load and poor cellular immune response. Early dermatologic manifestations include erythematous macules, papules, nodules, and plaques with a symmetrical distribution. Leprosy also shows two major reaction states including type I (reversal reaction) and type II (vasculitis). These reactions are usually seen in some patients who are undergoing treatment. Herein, we report an interesting patient with lepromatous leprosy who presented with skin lesions of type II reaction without receiving any anti-leprosy treatment and surprisingly showed a type I reaction eight months after the beginning of the treatment.