Tuberculoid Form Research Articles

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.

Hanseníase em menores de quinze anos no município mais hiperendêmico do Brasil

ABSTRACT Objective: To describe leprosy involvement and physical disability profiles in children and adolescents under 15 years old. Methods: Ecological time series study, based on data from the Brazilian Notifiable Diseases Information System, including new cases of leprosy residing in Palmas (TO), from 2001 to 2020. Results: A total of 471 notified cases in children and adolescents under 15 years of age were evaluated, resulting in a detection coefficient of 26.5 per 100,000 inhabitants. Of these, 52% (n=243) were women, 5% (n=24) corresponded to grade two disability, and 36% (n=168) were diagnosed through spontaneous demand. The temporal trend analysis showed a 0.5% reduction in the detection coefficient. There was a significant decrease in the diagnosis of the undetermined and tuberculoid clinical forms and a significant increase in the dimorphous form. Diagnosis through contact examination increased significantly by 13.1% and that through spontaneous demand decreased by 4.9%. The detection coefficient of cases with grade two disability reduced significantly by 7.4% while those with grade one increased by 16.8%. Conclusions: Despite the downward trend in the detection coefficient in children and adolescents under 15 years of age and in cases with grade two disability, other factors indicate failure in the adequate management of leprosy in Palmas.

Oral Lesions In Leprosy – A Study of 100 Patients

Abstract: Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, respiratory system and the eyes. The clinical spectrum of leprosy ranges from the tuberculoid form (TT) to the disseminative and progressive lepromatous form (LL). Oral lesions are rare but, when present, occur in the lepromatous form. Objective: The goal of this study was to evaluate the oral lesions in leprosy patients. Materials and Methods: 100 patients diagnosed with leprosy were clinically and histopathologically examined for oral mucosal changes. Results: Of 100 patients examined, 22 showed evident oral mucosal lesions, gingivitis and periodontitis being the commonest. Conclusion: Although, a reduced number or absence of patients exhibiting oral manifestations of leprosy is attributed to the efficacy of the multidrug therapy carried out in recent times, along with the early diagnosis of the disease. Still role of dental supervision cannot be overlooked while considering rehabilitation of these patients.

The protective role of tissue-resident interleukin 17A-producing gamma delta T cells in Mycobacterium leprae infection.

Mycobacterium leprae is a kind of disease-causing bacteria and results in leprosy in human. Gamma delta (γδ) T cell is a T-cell subset that is presented in both human dermis and epidermis. These cells bridge innate and adaptive immune responses and play critical roles in regulating anti-microbial defense, wound healing, and skin inflammation. Here, we investigated skin resident γδ T cells in patients with leprosy. Our data showed that γδ T cells significantly accumulated in skin lesions of leprosy patients with tuberculoid (TT) form. IL-23 can predominantly stimulate dermal γδ T cells to produce interleukin 17 (IL-17), a cytokine which may lead to disease protection. These γδ T cells expressed a specific set of surface molecules, and majority of these cells were Vδ1+. Also, IL-23 can stimulate the expansion of dermal γδ T cells expansion. Moreover, our results revealed that the transcription factor RORγt was responsible for IL-17A expression in leprosy lesion. Therefore, these data indicated that IL-23-responsive dermal γδ T cells were the major resource of IL-17A production in the skin and could be a potential target in the treatment of leprosy.

The two extremes of Hansen's disease-Different manifestations of leprosy and their biological consequences in an Avar Age (late 7th century CE) osteoarchaeological series of the Duna-Tisza Interfluve (Kiskundorozsma-Daruhalom-dűlő II, Hungary).

To give an insight into the different manifestations of leprosy and their biological consequences in the Avar Age of the Hungarian Duna-Tisza Interfluve, two cases from the 7th-century-CE osteoarchaeological series of Kiskundorozsma-Daruhalom-dűlő II (Hungary; n = 94) were investigated. Based on the macromorphology of the bony changes indicative of Hansen's disease, KD271 (a middle-aged male) and KD520 (a middle-aged female) represent the two extremes of leprosy. KD271 appears to have an advanced-stage, long-standing near-lepromatous or lepromatous form of the disease, affecting not only the rhinomaxillary region but also both upper and lower limbs. This has led to severe deformation and disfigurement of the involved anatomical areas of the skeleton, resulting in his inability to perform the basic activities of daily living, such as eating, drinking, grasping, standing or walking. The skeleton of KD520 shows no rhinomaxillary lesions and indicates the other extreme of leprosy, a near-tuberculoid or tuberculoid form of the disease. As in KD271, Hansen's disease has resulted in disfigurement and disability of both of the lower limbs of KD520; and thus, the middle-aged female would have experienced difficulties in standing, walking, and conducting occupational physical activities. KD271 and KD520 are amongst the very few published cases with leprosy from the Avar Age of the Hungarian Duna-Tisza Interfluve, and the only examples with detailed macromorphological description and differential diagnoses of the observed leprous bony changes. The cases of these two severely disabled individuals, especially of KD271 -who would have required regular and substantial care from others to survive-imply that in the Avar Age community of Kiskundorozsma-Daruhalom-dűlő II there was a willingness to care for people in need.

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.

Peripheral nerve tumor, a differential diagnosis with primary neural leprosy


 From December 1999 to May 2015, five patients with nerve tumors were sent to Lauro de Souza Lima Institute. It was suspected that they suffered from primary neural leprosy towards the tuberculoid clinical form, a prevalence of 4.5:10000 among the new patients assessed during the study period. All of the patients had similar clinical conditions characterized by mononeuropathy with nerve tumor associated with pain, absence of skin lesions and positive Mitsuda reaction. The authors report the main clinical characteristics and complementary tests: immunologic investigation of Mitsuda’s reaction and the antigen Phenolic GlicoLipid-1 test (PGL-1), bacilloscopic index, neurophysiologic study and image procedures. All patients were submitted to tumor resection and anatomopathological study. Four out of the five patients were diagnosed with peripheral nerve tumor (one of them with malignant schwannoma, two of them with benign schwannomas and the other with neural fibrolipoma), whereas the fifth patient was diagnosed with tuberculoid leprosy

Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana.

BackgroundDisseminated histoplasmosis remains a major killer of immunocompromised patients in Latin America. Cytological and histological methods are usually present in most hospitals and may represent a precious diagnostic method. We report 15 years of experience of the department of pathology of the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana.MethodsSpecimens from live patients from January 2005 to June 2020 with the presence of H. capsulatum on cytological and/or histological analysis were analyzed. All specimens were examined by an experienced pathologist. The analysis was descriptive.ResultsTwo hundred two cytological and histological samples were diagnosed with histoplasmosis between January 2005 and June 2020. The 202 samples included 153 (75.7%) histopathological formalin-fixed and paraffin-embedded tissues (biopsy or surgical specimens) and 49 (24.3%) cytological analysis from all organs. One hundred thirty-four patients (82.7%) were HIV-positive, 15 patients (9.3%) had immunosuppressant treatment, and 13 patients (8%) were immunocompetent. Seventy-eight of 202 (38.5%) were samples from the digestive tract, mostly the colon (53/78 cases, 70%) and small intestine (14/78 cases, 18%). Microorganisms were more numerous in digestive samples (notably the colon) than in other organs. Lymphocyte and histiocyte inflammation of moderate to marked intensity were observed in all positive specimens. Tuberculoid epithelioid granuloma were present in 16/78 (20,5%) specimens including 14 colon and 2 small intestine specimens. There were 11/202 cases of liver histoplasmosis, 26/202 (12,8%) cases of pulmonary histoplasmosis. Bone marrow involvement was diagnosed in 14 (2%) specimens (8 aspiration and 6 biopsies). Lymph nodes were positive in 42 specimens (31 histology and 11 cytology). Histopathological analysis of the 31 lymph nodes showed a variable histological appearance. Tuberculoid forms were most frequent (24/31, 77,4%).ConclusionsFrom the pathologist perspective, this is the largest series to date showing that digestive involvement was the most frequent, usually with a tuberculoid form and a greater load of Histoplasma. With awareness and expertise, cytology and pathology are widely available methods that can give life-saving results in a short time to help orient clinicians facing a potentially fatal infection requiring prompt treatment.

Temporal analysis of leprosy in the metropolitan region of Aracaju, Sergipe, Brazil: 2001-2013

The study carried out a temporal analysis and description of the epidemiological profile of leprosy in the metropolitan region of Aracaju, Sergipe, Brazil, from 2001 to 2013. It was a temporal study based on secondary data from the Notifiable Diseases Information System (SINAN). In this study, the variables were analyzed: municipality of residence; number of cases diagnosed per year from 2001 to 2013; age; schooling; race / skin color; operational classification (paucibacillary or multibacillary); clinical form (indeterminate, tuberculoid, dimorphic, virchowian); and degree of disability, assessed at the time of notification and upon medical discharge: Degrees 0, I and II. The data were plotted in a spreadsheet (Microsoft Excel ©) and subsequently analyzed according to the descriptive statistical measure of association and the adhesion test was measured by the Bioestat 5.0 software. For the time trend analysis, it adopted the simple polynomial regression model, the variable time centralization to avoid autocorrelation between the terms of the equations. It was detected a total of 3,519 cases in Aracaju region. The predominant form paucibacillar. Clinical tuberculoid form of leprosy was the most frequent. The temporal analysis showed a declining trend to statistical significance (p <0.05). The multibacillary predominated in the municipalities of Barra dos Coqueiros and Our Lady of Socorro. The results showed that the population did not have access to adequate health program and the Ministry of Health's strategies did not meet the goal of WHO for the elimination of leprosy.

Epidemiological and spatial characterization of leprosy in Aracaju, Sergipe, Brazil

Leprosy is a chronic infection, being considered a serious public health problem due to its magnitude and high disabling potential. In this perspective, this study aimed to analyze the epidemiological profile of leprosy patients and spatial characteristics of the disease in Aracaju, Sergipe, Brazil. This was an ecological, descriptive and analytical study of 559 leprosy patients from Aracaju, from 2011 to 2015. All information was obtained from Information System for Notifiable Injuries, Ministry of Health of Brazil. Descriptive and analytical statistical analyzes and spatial characterization methods were used. A decreasing tendency in the detection of leprosy cases during the study period was observed, with the relative frequency going from 23% (n = 129) in 2011 to 14.5% (n = 81) in 2015. The tuberculoid form was the most common (28.2%, n = 158), followed by dimorphic (24.5%, n = 137), undetermined (21.5%, n = 120) and lepromatous (20.6%; n = 115). The multibacillary operational classification also corresponded to the majority of notifications (52.4%, n = 293), with the associated factors age ≥ 16 years (OR = 2.42, 95% CI = 1.12-5.25) and male gender (OR = 2.74, 95% CI = 1.94-3.86) (p <0.05). A high risk cluster for the illness and the higher density of the mean detection incidence by the Kernel estimate was more concentrated in the central-northern portion of Aracaju. Statistical analysis allowed a better understanding of the epidemiological profile of leprosy patients and the identification of critical areas for illness and spread of the disease.

Contexto clínico-epidemiológico dos casos de hanseníase notificados em Governador Valadares, Minas Gerais - Brasil, entre 2015 e 2019

Objetiva-se caracterizar o contexto clínico-epidemiológico dos casos de hanseníase notificados no município de Governador Valadares (GV) entre 2015 e 2019. Metodologia: Trata-se de um estudo ecológico no qual foram analisadas variáveis sociodemográficas (sexo, faixa etária e escolaridade) e variáveis clínicas (forma clínica, classificação operacional, número de lesões, presença de incapacidade e tipo de saída). Resultados: Entre os 387 casos notificados, 52,1% eram do sexo masculino, 26,6% apresentavam idade ≥65 anos e 22,9% possuíam da 1ª a 4ª série do ensino fundamental incompleta. Com relação às variáveis clínicas, 42,8% foram classificados como dimorfos e 56,3% como multibacilares. Além disso, foi possível identificar que a maior parte apresentava 5 ou mais lesões (43,4%) e grau de incapacidade zero (71,3%). Observou-se ainda correlação entre ser do sexo masculino e apresentar forma virchowiana (*p=0,0001), multibacilar (*p=0,0004), possuir 5 ou mais lesões (*p=0,0008) e desenvolver incapacidade de grau 2 (*p=0,002). Por outro lado, houve correlação entre ser do sexo feminino e forma tuberculóide (*p=0,001) e o surgimento de somente 1 lesão (*p=0,002). Torna-se importante ressaltar que os percentuais de cura permaneceram acima de 90%. Considerações finais: A hanseníase é uma doença de impacto em GV, fato que torna imprescindível o diagnóstico precoce e a prevenção por meio de medidas de educação em saúde.

190 Highly efficient, massively-parallel single-cell RNA-seq analysis of leprosy skin lesions identifies IL-1β as a key regulator of an antimicrobial gene network linked to host defense

Reversal reactions (RR) in leprosy provide an opportunity to investigate mechanisms of host defense against bacterial infections in skin, as patients upgrade from the disseminated lepromatous (L-lep) form to the self-limiting tuberculoid (T-lep) form, often associated with significant tissue injury. Here we performed single-cell RNA-seq to study gene networks associated with host defense comparing lesions from RR vs. L-lep patients (n=10). We detected 43,363 genes in 21,318 cells, with an average of 741 genes and 3,556 transcripts per cell. The 11 subclusters of T cells, myeloid cells, keratinocytes (KC), endothelial cells (EC) and fibroblasts (FB) that were enriched in RR lesions contained 567 genes that encoded programs known to be involved in antimicrobial responses. In addition, pseudotime analysis identified differentiation of macrophages (MF) and KC in the progression from L-lep to RR. We identified IL-1β as a key upstream regulator of the antimicrobial gene network as well as the differentiation programs of both MF and KC. In addition to the direct regulation of genes involved in the vitamin D antimicrobial pathway (IFNG, CD40LG, CD40, IL32, VDR), IL-1β induced the antimicrobial chemokines (CCL2, CCL4, CCL8, CCL20; CXCL1, CXCL2, CXCL3, CXCL8, CXCL11; CX3CL1) and antimicrobial proteins (GBP2; MMP9, MMP14; S100A6, S100A10) in different cell types. IL-1β regulated Th17 cell responses including the antimicrobial protein IL-26. IL-1β coordinates the antimicrobial response from diverse cell types in leprosy as well as inducing differentiation of MF, KC and T cells, such that blockade of the IL-1 receptor could provide an opportunity to mitigate concomitant tissue damage that leads to permanent nerve injury in RR patients.

Histopathological changes in leprosy and its correlation with IHC markers

Leprosy is a chronic granulomatous disease. It involves the psychological, socioeconomic dimensions of an individual. Histopathology is considered as an accurate method for diagnosing leprosy. Immunity is largely T-cell mediated, whereas deficiency of T-cells causes lepromatous leprosy. The relative proportion of T and B lymphocytes were studied using CD3 and CD20 immunohistochemistry markers (IHC). A Retrospective, prospective and observational study was carried from August 2016 to July 2019. The cases were divided based on histopathological findings. IHC markers CD3 was used to study T cell whereas CD20 was used to study B-cells. As per Ridley Jopling classification maximum cases belonged to indeterminate forms. Bacillary load of 4+ and above was seen in lepromatous leprosy. CD3 showed strong positivity in all types whereas CD20 showed more focal positive staining for lepromatous leprosy than tuberculoid and indeterminate forms.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015.

INTRODUCTION The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher’s exact, or Fisher-Freeman-Halton tests were performed.RESULTS A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015.CONCLUSIONS Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Epidemiological, temporal and spatial dynamics of leprosy in a municipality in northeastern Brazil (2008-2017): an ecological study.

INTRODUCTION: Leprosy is a chronic infectious disease caused by Mycobacterium leprae.This study aimed to analyze the epidemiological, temporal, and spatial dynamics ofleprosy in a municipality in northeastern Brazil. METHODS: This is an ecological study on new leprosy cases in the population of Arapiraca (Alagoas, Northeast Region, Brazil), from 2008 to 2017. Data extracted from a national database were analyzed forepidemiological indicators, factors associated with physical disabilities, and spatialanalysis in the neighborhoods of Arapiraca. RESULTS: A total of 292 new cases of leprosy were recorded, particularly occurring among the following groups: women, the age group of 46-59 years, brown-skinned individuals, people with less than eight years of schooling, and urban residents; the new cases were also predominantly the tuberculoid form and were of the paucibacillary classification of the disease. Almost 1/3 of the people had some degree of physical disability, which was mainly associated with the group 60 years of age and older, black ethnicity, and the multibacillary clinical form of leprosy. The joinpoint regression showed a stationary temporal behavior of indicators. There was a heterogeneous spatial distribution with active transmission areas, especially in the neighborhoods Primavera, Baixão, Ouro Preto, and downtown. CONCLUSIONS: The epidemiological indicators revealed complexity in the process of leprosy development. These spatial and temporal studies are relevant to help in the planning, monitoring, and guidance of interventions in the municipality. The spatial analysis showed heterogeneous distribution in the analyzed neighborhoods.

A case of borderline tuberculoid leprosy with atypical and complicated manifestations

This article presents a clinical case of a 52-year-old man suffering from oligobacillary border-tuberculoid leprosy in the acute phase associated with an established diagnosis of pulmonary tuberculosis and hepatitis C.Aim: to present a clinical case of leprosy with atypical and complicated manifestations.Materials and methods. A 52-year-old patient had been receiving treatment for allergic dermatitis for a long time.Results. The patient was diagnosed with: A 30.2. Borderline tuberculoid leprosy (Paucibacillary Leprosy, Borderline tuberculoid form. Acute phase). The patient demonstrated atypical complications of the leprosy process in the form of ulcerative necrotic rashes.

Endoplasmic Reticulum Stress Markers and Their Possible Implications in Leprosy's Pathogenesis.

Mycobacterium leprae causes leprosy, a dermatoneurological disease which affects the skin and peripheral nerves. One of several cellular structures affected during M. leprae infection is the endoplasmic reticulum (ER). Infection by microorganisms can result in ER stress and lead to the accumulation of unfolded or poorly folded proteins. To restore homeostasis in the cell, the cell induces a series of signaling cascades known as the unfolded protein response called UPR (unfolded protein response). The present work is aimed at investigating the in situ expression of these markers in cutaneous lesions of clinical forms of leprosy and establish possible correlation expression patterns and types of lesion. A total of 43 samples from leprosy patients were analyzed by immunohistochemistry with monoclonal antibodies against GRP78/BiP, PERK, IRE1α, and ATF6. A statistically significant difference between the indeterminate, tuberculoid, and lepromatous clinical forms was detected, with high expression of GRP78/BiP, PERK, IRE1α, and ATF6 in tuberculoid forms (TT) when compared to lepromatous leprosy (LL) and indeterminate (I) leprosy. These results represent the first evidence of ER stress in samples of skin lesions from leprosy patients. We believe that they will provide better understanding of the complex pathogenesis of the disease and facilitate further characterization of the cascade of molecular events elicited during infection.

Leprosy in individuals under the age of fifteen in priority cities, Mato Grosso, Brazil.

We aimed to compare the sociodemographic, clinical and epidemiological characteristics of individuals under the age of 15, reported to have leprosy, and who lived in priority and non-priority cities, as well as to compare the spatial distribution of these reported cases in such cities. This is a cross-sectional study of new leprosy cases in individuals under the age of 15 (n=429) registered in the Information System for Notifiable Diseases from the State of Mato Grosso, Brazil, between 2011 and 2013. The diagnosed cases were compared regarding sociodemographic, clinical and epidemiological aspects using the chi-square test at a 5% significance level. The spatial distribution was made through ArcGIS 10.2 software. Of the 141 assessed cities in the state, according to the spatial distribution, 58.1% (n=82) showed a high, very high and hyper-endemic mean incidence coefficient, and, of these, 34.1% (n=28) include the group of priority municipalities. Of the new cases included in the study, 73.9% (n=317) were reported in priority cities. We observed a difference in the proportion of cases registered among the cities, with a greater proportion in priority cities, in the age group from five to nine years old (χ²=4.09; p=0.043), in the white race (χ²=7.01; p=0.008) and in the tuberculoid clinical form (χ²=3.89; p=0.048). There was a greater proportion in non-priority cases with regard to non-urban areas (χ²=24.23; p<0.001), two to five skin lesions (χ²=5.93; p=0.014) and spontaneous demand (χ²=6.16; p=0.013). The differences highlighted regarding clinical and epidemiological characteristics between the cities demonstrate the difficulty of endemic control in both municipality groups.

Langerin (CD207)-positive cells in leprosy: Possible implications for pathogenesis of the disease with special emphasis on dermal immunoreactivity

Leprosy is a disease caused by Mycobacterium leprae, which is characterized by two distinct poles, the tuberculoid pole and the lepromatous pole, depending on the immune response to the bacillus. Langerin-positive cells are dendritic cells that appear to play an essential role in the development of the disease. These cells are specialized in the processing and presentation of antigens, exerting an important function in the activation of the immune system. To evaluate the expression of langerin-positive cells (CD207+) in skin lesion fragments of patients with a diagnosis of M. leprae infection and to associate the expression of these cells with the polar forms of the disease. Langerin-positive cells were detected in larger numbers in lesions of patients with the tuberculoid form compared to those with the lepromatous form. The presence of a larger number of these cells in patients with the tuberculoid form suggests an important participation of langerin-positive cells, capturing antigens and favoring an effective immune response to infection with M. leprae.

Histomorphometric approach to differentiate skin lesions of tuberculoid leprosy from sarcoidosis.

More than 200 000 new cases of leprosy are detected worldwide annually. Physicians commonly have difficulty in differentiating tuberculoid form of leprosy (TL) from sarcoidosis' cutaneous manifestation. Skin biopsies of 33 patients with TL and 24 with sarcoidosis were reviewed on hematoxylin and eosin- and Gomori-stained sections, in order to find reliable criteria for distinguishing one disease from another. Nine of the 24 features analyzed presented significant predictive value for diagnosis (P < .05). Predominance of tuberculoid granulomas in adnexal and neural distribution, and granulomas replacing the nerves localized within sweat gland glomeruli were predictive to TL diagnosis. For sarcoidosis, dermal fibrosis, back-to-back distribution of the granulomas, presence of atypical giant cells and plasma cells, greater number of conventional giant cells, and spared nerves beside the granuloma were predictive criteria. The median surface density of reticulin fibers was significantly higher in sarcoidosis (3.44) than in TL (2.99). Nonetheless, using logistic regression, this variable did not discriminate between the diseases (P = .096). Isolated histological features are not fully predictive to differentiate the 2 diseases. However, those with statistical value can assist this distinction in diagnostic practice. Although the results of the analysis of the reticulin fibers density did not tell apart TL from sarcoidosis, they corroborate the idea of fiber fragmentation within tuberculoid leprosy granulomas, reiterating the importance of morphometry in the histological examination.