Treatment Of Leprosy Research Articles

Prevalence of Mental Morbidities in a Tertiary Care Leprosarium in North India: A Cross-Sectional Study

Background: Leprosy is a chronic infectious disease causing substantial physical and mental morbidity. Every year around 200,000 new cases are reported globally. (WHO) Despite continuous efforts to eradicate leprosy, prevalence of the disease is still a concern especially in India. The treatment of leprosy has always focused on elimination of bacteria, correction of physical deformities and preventive aspects with little emphasis on its psychiatric implications. Therefore, it is imperative to understand the link between the disease and mental health of the patient. This study aims to estimate the prevalence of psychiatric morbidities among leprosy patients admitted in a tertiary care center in north India. Methods: Data was collected from patients admitted in a tertiary care leprosy center in North Delhi by using a well-structured questionnaire DASS-21 which included total of 21 questions, 7 questions each pertaining to depression, anxiety and stress. Findings were analyzed using SPSS version 20.0. Frequencies and percentages were used and the association between the variables was tested using the chi-square test. Results: Findings suggested that there is causal relationship between leprosy disease and mental health. Prevalence of depression, anxiety and stress was 28%, 56% and 44% respectively which significant. Of note, the prevalence was higher in adults aged between 25-35 years as compared to adults aged 35-45 years. Patients with physical deformities were found to higher prevalence of mental health issues such as depression (18%), anxiety (28%), Stress (24%). Conclusion: This study found that there was a significantly high prevalence of depression, anxiety, and stress among individuals affected by leprosy especially among those with physical deformities. Hence, appropriate psychological counselling must be considered as an essential part of therapeutic intervention for leprosy patients.

PERFIL EPIDEMIOLÓGICO DA HANSENÍASE NO BRASIL NO CONTEXTO DA PANDEMIA DO COVID-19: UMA REVISÃO BIBLIOGRÁFICA INTEGRATIVA

Objective: to analyze the epidemiological profile of leprosy during the pandemic, as well as to identify the challenges faced in the diagnosis and treatment of this chronic disease. Methodology: this study explored the impact of the COVID-19 pandemic on leprosy in Brazil through an integrative literature review. The review was conducted through a well-defined process, following a guiding question. Searches were conducted in several databases, including MEDLINE, LILACS, Scielo, using descriptors related to leprosy and COVID-19. Results: the COVID-19 pandemic significantly affected leprosy in Brazil. A reduction in case counts was observed, in addition to the suspension of health services and barriers in access to treatments. Conclusion: this research provided a more detailed view of how COVID-19 affected leprosy in Brazil and highlighted important aspects that require attention. However, the implications of this work for the field of health and nursing are evident, offering a basis for improving the treatment of leprosy and other public health issues during periods of emergency.

Alice Ball and leprosy

In this month's article, George Winter discusses the forgotten story of Alice Ball, the chemist who pioneered a treatment for leprosy

NURSING CARE FOR PATIENTS WITH LEPROSY TREATED BY PRIMARY CARE: INTEGRATIVE REVIEW

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Its predilection for the skin and peripheral nerves gives this disease particular characteristics, making its diagnosis simple. Brazil continues to be the second country in the world in terms of the number of cases, after India. Approximately 94% of known cases in the Americas and 94% of newly diagnosed cases are reported in Brazil. The disease manifests itself in two stable and opposing poles (virchowian and tuberculoid) and two unstable groups (indeterminate and dimorphic). In another classification, the disease is divided into tuberculoid, borderline or dimorphic forms, which are divided into dimorphic-tuberculoid, dimorphic-dimorphic and dimorphic-lepromatous and lepromatous forms. Microscopic examination of smears is the most useful complementary test for diagnosis. Treatment of leprosy includes: specific chemotherapy, suppression of reactive eruptions, prevention of physical disability, physical and psychosocial rehabilitation. Polychemotherapy based on rifampicin, dapsone and clofazimine has proven to be very effective and the prospects for controlling the disease in Brazil are real in the short term.

Exploring the dynamics of leprosy transmission with treatment through a fractal–fractional differential model

Leprosy continues to be a significant public health challenge in many parts of the world, necessitating novel approaches to understanding and controlling its transmission. The dynamics of leprosy are examined in this study by means of a caputo fabrizio fractal–fractional differential system model. Leprosy transmission and treatment are complex and non-linear processes that can be captured by fractal–fractional derivatives. The temporal progression of the disease is the primary focus of our mathematical analysis, which evaluates a variety of parameter values, including initial population densities and compartmental transitions. Through simulations, we examine the impact of critical parameters on the severity and spread of diseases, as well as the rates of recovery and treatment. Numerical results of the model offer valuable insights into the impact of these parameters on leprosy dynamics, which is beneficial for public health interventions. The stability analysis of the model identifies supplementary conditions that are necessary for the success of disease control. By incorporating these novel mathematical techniques, we hope to improve our understanding of leprosy transmission and ultimately contribute to more effective control strategies. Based on our findings, additional studies investigating the relation between population density, treatment accessibility, and recovery rates are warranted. We hope that by graphically representing the relationships between these factors, we can draw attention to the possibility of targeted interventions that can reduce the transmission of leprosy. This study provides a strong basis for future studies on infectious disease modeling and aids leprosy-affected communities in developing strategies to mitigate the disease’s impact.

Exploring the Utility of High-Resolution Ultrasonography and Color Doppler of Peripheral Nerves in Monitoring Response to Treatment in Leprosy Patients: A Prospective, Observational Study.

Diagnosis and monitoring of nerve function impairment (NFI) presents an ongoing challenge in global leprosy control. This was a prospective, observational study in leprosy patients receiving treatment with cutaneous and neurological examinations done every 3 months for 1 year. High-resolution ultrasonography and color Doppler (HRUS-CD) was performed in all patients at baseline, completion of treatment, and anytime during the study period if a patient had deterioration of nerve function noted clinically. All peripheral nerves were assessed, and parameters studied were cross-sectional area (CSA), length of thickening, endoneural flow signals (ENFS), and distortion in fascicular symmetry. Of 54 treatment-naive leprosy patients, loss of sensation was noted in 37 (68.5%), paresthesia in 20 (37.0%), and neuropathic pain in 7 (12.9%) at baseline presentation. At end of treatment of leprosy, maximum improvement in NFI across all clinical criteria was seen in ulnar and radial nerves (P <0.05). The number of impairments on HRUS-CD decreased consistently, significantly for ulnar (P = 0.009 right ulnar, P = 0.012 left ulnar) and right radial (P = 0.025) nerves, and significant improvements in CSA and ENFS were seen across multiple nerves, which correlated with improvement in NFI as well. Abnormal HRUS-CD findings in the target nerves were significantly associated with multibacillary cases (odds ratio [OR]: 4.33; 95% CI: 0.62-30.31), those in reaction (OR: 9.42; 95% CI: 1.51-58.66), and those older than 40 years (OR: 3.14; 95% CI: 0.49-19.93). This study provides objective evidence of improvement in NFI with anti-leprosy treatment, supporting integration of HRUS-CD imaging in monitoring nerve involvement in leprosy.

Curcuma caesia Roxb. - Update of phytochemicals and pharmacological properties

Curcuma caesia Roxb. commonly known as ‘black turmeric’ is an erect rhizomatous herb characterized by bluish‑black rhizomes and leaves with a deep red-violet midrib. It is a native of northeast and central India and also found in Java and Myanmar. The plant is used in traditional medicine for the treatment of several metabolic disorders, leukoderma, leprosy, rheumatic complaints, bronchial disorders, menstrual disorders, gastrointestinal problems, neurological disorders, cancer and diabetes. The rhizomes contain 1.3-7.14% anthocyanins which determine its bluish black hue. 1,8-cineole, camphor, ar-turmerone, linalool, ocimene, ar-curcumene, zingiberol, curzerenone and tropolone were reported as the major components of rhizome oil from different geographical locations. The leaf oil is dominated by 1,8-cineole, camphor and borneol. Furanodienone and curzerenone were identified as the marker compounds for determining the quality of rhizomes. The present review is an update of its phytochemical constituents and pharmacological properties.

ERYTHEMA NODOSUM LEPROSUM: CONDITION DEVELOPED BY NON-ADHERENCE

Erythema Nodosum Leprosum (ENL) is a rare immune-mediated complication of leprosy, characterized by painful nodules and fever, and can lead to anemia and leucocytosis. A 19 y old male with a history of non-adherence to 12 adult multi-bacillary multi-drug therapy packs for leprosy presented with a 15 d complaint of fever and aggravated painful, raised, red skin lesions over two y. Laboratory findings showed neutrophilia, thrombocytosis, microcytic anemia, and traces of blood and ketones in the urine. Acid-fast bacilli with a grade of 1+ were observed in Ziel-Neelson-stained smears, confirming the diagnosis. The patient received systemic Dexamethasone, the standard treatment for Erythema Nodosum Leprosum, and resumed leprosy treatment. Symptomatic care was given, and the patient was discharged. This case highlights the importance of early detection, efficient monitoring, and adherence to therapy to reduce ENL-related morbidity and mortality. The study emphasizes that a regular watch should be kept on leprosy patients to ensure early intervention and prevention of complications.

Leprosy as a cause of nasolacrimal duct obstruction.

Leprosy, also known as Hansen disease, is an airborne spread disease caused by Mycobacterium leprae (M. leprae) which commonly presents with skin lesions, peripheral neuropathy, and ocular involvement. This report describes a patient who presented with epiphora secondary to chronic nasolacrimal duct obstruction four years after completing antimicrobial treatment for tuberculoid leprosy. At the time of endoscopic dacryocystorhinostomy (DCR), the lacrimal sac demonstrated chronic dacryocystitis with granulomatous inflammation and a Fite positive staining bacterial rod-like structure. Pathological examination of the surgical specimen demonstrated numerous non-necrotizing granulomas in a perivascular and neural distribution, compatible with sequelae of previously treated M. leprae infection. The patient has remained symptom free six months after surgery.

Atypical dermatofibroma simulating hansenoma

Introduction: dermatofibroma is a benign mesenchymal lesion of uncertain etiology, centered in the dermis, with fibroblastic and histiocytic differentiation. The atypical variant can mimic superficial sarcoma histologically. Objective: to describe the clinical and histopathological findings of atypical dermatofibroma in a patient undergoing treatment for leprosy with multiple therapeutic failures. Case Description: the report concerns a 39-year-old woman with multiple therapeutic failures for Virchowian leprosy, who developed an atypical dermatofibroma on the upper limb, which clinically resembled a leproma. Discussion: molecular analyses suggest dermatofibroma may be associated with a neoplastic process. However, several studies correlate it to trauma, insect bites, folliculitis, immunological changes, and treated or reactive leprosy. The association of dermatofibroma and leprosy, especially in the Virchowian pole, is documented in the literature. However, there are no reports of atypical dermatofibroma associated with leprosy. Final Considerations: this case adds to other studies regarding a possible association between the pathogenesis of dermatofibroma and the immunological aspects present in leprosy.

An update of the diagnosis, treatment, and prevention of leprosy: A narrative review.

Leprosy is an infectious disease that remains a public health concern. It is caused by acid-fast Bacillus leprae, which primarily affects the skin and peripheral nerves, potentially leading to long-term disability and stigma. However, current and previous efforts have focused on developing better diagnostic and therapeutic interventions for leprosy, and its prevention needs to be addressed. In this review, we organize the currently published papers and provide updates on the global epidemiology, diagnosis, treatment, and prevention of leprosy. Several online databases, including MEDLINE (National Library of Medicine, Bethesda, MD), PubMed, EMBASE, Web of Science, and Google Scholar, were searched to collect relevant published papers. As a public health issue, the World Health Organization set the goal of leprosy elimination with a prevalence of <1 case per 10,000 people, which was achieved in 2000 and in most countries by 2010, mainly owing to the treatment of leprosy using drugs starting in 1980 and no-cost access for patients since 1995. Although diagnostic and therapeutic techniques have improved, the new occurrence of leprosy remains a critical global disease burden. With continuous technological improvements in diagnosing and treating leprosy, obtaining more relevant healthcare knowledge and preventing leprosy disability are crucial.

Dr. Nitya Anand: The Visionary Behind Saheli and the Advances in Medicinal Chemistry.

Dr. Nitya Anandwas a leading figure in Indian pharmaceutical research. His career spanned several decades, during which he significantly contributed to advancement in drug development and public health. His innovation of Centchroman (Saheli), the world's first non-steroidal oral contraceptive pill, changes the course of contraception use in India. He had done groundbreaking work in leprosy treatment, synthetic peptides, and antibiotics. With over 400 publications and 130 patents, he supervised over 100 PhD students. His work has been recognized with many prestigious awards, including the Padma Shri and the National Nehru Science Award, which have left a long-lasting impact on medicinal chemistry and public health.

Feasibility and accuracy of mobile QT interval monitoring strategies in bedaquiline-enhanced prophylactic leprosy treatment.

Some anti-mycobacterial drugs are known to cause QT interval prolongation, potentially leading to life-threatening ventricular arrhythmia. However, the highest leprosy and tuberculosis burden occurs in settings where electrocardiographic monitoring is challenging. The feasibility and accuracy of alternative strategies, such as the use of automated measurements or a mobile electrocardiogram (mECG) device, have not been evaluated in this context. As part of the phase II randomized controlled BE-PEOPLE trial evaluating the safety of bedaquiline-enhanced post-exposure prophylaxis (bedaquiline and rifampicin, BE-PEP, versus rifampicin, SDR-PEP) for leprosy, all participants had corrected QT intervals (QTc) measured at baseline and on the day after receiving post-exposure prophylaxis. The accuracy of mECG measurements as well as automated 12L-ECG measurements was evaluated. In total, 635 mECGs from 323 participants were recorded, of which 616 (97%) were of sufficient quality for QTc measurement. Mean manually read QTc on 12L-ECG and mECG were 394 ± 19 and 385 ± 18 ms, respectively (p < 0.001), with a strong correlation (r = 0.793). The mean absolute QTc difference between both modalities was 11 ± 10 ms. Mean manual and automated 12L-ECG QTc were 394 ± 19 and 409 ± 19 ms, respectively (n = 636; p < 0.001), corresponding to moderate agreement (r = 0.655). The use of a mECG device for QT interval monitoring was feasible and yielded a median absolute QTc error of 8 ms. Automated QTc measurements were less accurate, yielding longer QTc intervals.

Leprosy knowledge among primary care physicians in Southern Brazil: are we underdiagnosing?

Leprosy is a chronic infection with high morbidity in Brazil. Primary care physicians' lack of knowledge about the disease may play a significant role in underdiagnosis. This study aimed to assess primary care physicians' ability to identify typical leprosy skin lesions and their knowledge of the subject. This cross-sectional study relied on a questionnaire in which participating doctors chose one main diagnostic hypothesis and two differential diagnoses for each skin lesion presented. Five leprosy lesions were included. Questions regarding management, follow-up, and diagnostic workup for the disease were also included. The questionnaire was sentto primary care physicians working in Curitiba, in the Southern Brazilian state of Paraná, and dermatologists, who constituted the control group. Thirty-two primary care physicians and 26 dermatologists agreed to participate in the study. Primary care physicians accurately identified a mean of 1.8 ± 1.2 of the five leprosy skin lesions, while dermatologists accurately identified 2.5 ± 0.9 (P = 0.009). The main misdiagnosed leprosy forms were the lepromatous and histoid variants. Among primary care physicians, 56.2% claimed to have little knowledge of the subject and a large share of participants was unaware of recent updates in treating paucibacillary forms, even within the dermatologist subgroup. Primary care physicians in Curitiba have little information regarding the diagnosis, treatment, and follow-up of leprosy. Even dermatologists had difficulties with treatment and patient management, emphasizing the constant need for education on this subject.

A case report and literature review: Mycobacterium leprae infection diagnosed by metagenomic next-generation sequencing of cerebrospinal fluid

BackgroundLeprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) that is responsible for deformities and irreversible peripheral nerve damage and has a broad spectrum of clinical and serological manifestations. Leprosy primarily affects the peripheral nerves and rarely presents with central nervous system involvement. Diagnosing leprosy can still be difficult in some cases, especially when the infection involves uncommon clinical manifestations and extracutaneous sites. Delayed diagnosis and treatment of leprosy may lead to irreversible damage and death.Case PresentationWe report a case of a 30-year-old female presenting with “repeated high fever with symptoms of headache for 14 days”. On the day of admission, physical signs of lost eyebrows and scattered red induration patches all over her body were observed. The patient’s diagnosis was based on the clinical characteristics using a combination of metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and slit-skin smear. After confirming Listeria meningitis and multibacillary leprosy with erythema nodosum leprosum (ENL), a type 2 reaction, she was treated with ampicillin sodium, dapsone, rifampicin, clofazimine, methylprednisolone, and thalidomide. At the 1-year follow-up, the frequency and severity of headaches have significantly decreased and a good clinical response with improved skin lesions was found.ConclusionThis case highlights the importance of considering leprosy, which is a rare and underrecognized disease, in the differential diagnosis of skin rashes with rheumatic manifestations, even in areas where the disease is not endemic, and physicians should be alerted about the possibility of central nervous system infections. In addition, mNGS can be used as a complementary diagnostic tool to traditional diagnostic methods to enhance the diagnostic accuracy of leprosy.

As vulnerabilidades das mulheres na hanseníase: uma revisão integrativa de literatura

Objective: To understand the vulnerabilities to which women with leprosy are exposed and the implications for both their health and their social, religious, political, and family life. Methodology: This is an integrative literature review. Data collection was conducted in April 2024 in the Scientific Electronic Library Online (SciELO) database. The descriptor used was women and leprosy. Results: In total, nineteen articles were selected. Based on the analysis conducted, it was decided to produce three thematic categories (vulnerability, body, and stigma) to classify the crucial point of the chosen articles. Conclusion: There is a need for research that can increasingly elucidate the needs of women diagnosed with or undergoing treatment for leprosy, and to consider public policies, management, and administration of the disease from primary care. Submission: 05/20/24| Review: 05/27/24| Approval: 05/28/24

Molecular Identification of Mycobacterium leprae in the Leprosy Patients.

Several discoveries about leprosy indicate that Mycobacterium leprae transmission mainly occurs by inhalation, and the nose is a major port of entry and exit. Molecular probes have shown certain potential for the detection and identification of M. leprae in patients. The aim of this study was to identify M. leprae in nasal swab specimens using polymerase chain reaction (PCR)-based assays followed by gene sequencing methods. This observational study examines 64 anterior nasal swab samples taken from pretreatment leprosy patients, on-treatment and completed leprosy treatment in Bulukumba, South Sulawesi, Indonesia. samples were analyzed by molecular detection methods according to the standard methods at the Clinical Microbiology Laboratory of Hasanuddin University. Descriptive statistics were utilized to summarize patient demographics and outcomes. This study uses PCR to detect the M. leprae deoxyribonucleic acid (DNA) from nasal swab specimens. Data were collected from 64 patients with a percentage of male patients 51.54%. Based on the age category, the group 45-46 years was the most frequent (39.05%). PCR detection proline-rich antigen gene of a 531 bp DNA fragment from M. leprae, was positive in eight patients, and they were multibacillary. Furthermore, PCR was positive in 5 (31.25%) of 16 new leprosy patients, 2 (8.69%) of 23 on-treatment patients, and 1 (4%) of 25 treatment completed patients. Based on the results of the phylogenetic tree and analysis of 8 positive results detected by M. leprae from leprosy patients, almost all samples have a level of similarity, except for sample Ua7. M. leprae cannot grow in vitro, so molecular diagnostic tools were used to confirm the disease. This study predominantly of males with the age above 45 years of age being the most common. Eight M. leprae were positive from nasal swab leprosy patients. The sequencing findings provide insight into the genetic diversity of the genus M. leprae, so it is necessary to consider the detection of whole-genome sequence.

Immunomodulators in leprosy: A narrative review

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Current therapeutic regimen, like the multidrug therapy (MDT), are effective in treating most cases, but new cases continue to emerge in Indonesia every year. While multidrug therapy alone is adequate for treating leprosy, there is a need for adjuvant treatment options to boost the host’s immune system to prevent the worsening of leprosy and reduce the activation of M. leprae, such as immunomodulators. Discussion: Immunomodulators are drugs that can stimulate the body’s natural and adaptive defense mechanisms, acting as either immunosuppressants or immunostimulants. To understand how immunomodulatory drugs (IMiDs) work, it is important to understand the role of immunity. This article reviews the role of immunity in leprosy and discusses various immunomodulators that have been developed or investigated to enhance the host’s immune system. Substances like levamisole, thalidomide, zinc, selenium, as well as vitamins A, D, E, and C have been clinically tried in various combinations and durations, showing promise as immunomodulating agents. Conclusion: Studies have suggested that immunomodulating agents may be considered as adjuncts to MDT to enhance the elimination and clearance of bacteria, making them potential recommendations for leprosy treatment.

Employing advanced computational drug discovery techniques to identify novel inhibitors against ML2640c protein: a potential therapeutic approach for combatting leprosy.

Leprosy, caused by Mycobacterium leprae, remains a significant global health challenge, necessitating innovative approaches to therapeutic intervention. This study employs advanced computational drug discovery techniques to identify potential inhibitors against the ML2640c protein, a key factor in the bacterium's ability to infect and persist within host cells. Utilizing a comprehensive methodology, including virtual screening, re-docking, molecular dynamics simulations, and free energy calculations, we screened a library of compounds for their interaction with ML2640c. Four compounds (24349836, 26616083, 26648979, and 26651264) demonstrated promising inhibitory potential, each exhibiting unique binding energies and interaction patterns that suggest a strong likelihood of disrupting the protein function. The study highlights the efficacy of computational methods in identifying potential therapeutic candidates, presenting compound 26616083 as a notably potent inhibitor due to its excellent binding affinity and stability. Our findings offer a foundation for future experimental validation and optimization, marking a significant step forward in the development of new treatments for leprosy. This research not only advances the fight against leprosy but also showcases the broader applicability of computational drug discovery in tackling infectious diseases.

IgG seroprevalence of Toxoplasma gondii and Leishmania infantum in leprosy patients: Implications for screening and management of co-infections

Parasitic co-infections are common in developing countries and can interfere with leprosy treatment, leading to an increased risk of inflammatory leprosy reactions. This study assessed serum immunoglobulin G (IgG) levels against Toxoplasma gondii and Visceral Leishmaniasis (VL) antigens in 270 leprosy patients from Brazilian states. Regarding the respective cut-offs, the prevalence of IgG seropositivity for T. gondii and VL were 21.05 % and 47.36 % in the leprosy-negative group, and 77.7 % and 52.6 % in the leprosy-positive group. Of the 270 leprosy patients, 158 (58.5 %) presented with inflammatory leprosy reactions. Of those, 72 (59.5 %) had neuritis, 35 (48.6 %) had reverse reactions, and 28 (38.9 %) had ENL in both Brazilian states. Leprosy patients with anti-Leishmania IgG seropositivity were 3.25 times more likely to develop neuritis (95 % C.I.: 1.187 - 9.154; p = 0.019). These findings are particularly relevant for clinical settings where both leprosy and parasitic diseases are prevalent and could provide essential guidance for detecting and addressing complications arising from parasitic co-infections in leprosy patients, thereby improving clinical management strategies.