Nueva forma de presentación de la lepra lepromatosa en forma de patrón Prurigoide: descripción de un caso / No disponible

La lepra puede presentar diversas y complejas manifestaciones clínicas. Las lesiones cutáneas más frecuentemente encontradas son: máculas, pápulas, placas, nódulos y tubérculos. El propósito de esta comunicación es resaltar una forma de presentación atópica de lepra lepromatosa, en un adulto joven de sexo masculino, cuya lesiones iniciales eran pápulas excoriadas en superficie simulando una urticaria papular/prurigo simple. En este caso en particular, la anatomía patológica fue determinante para el diagnóstico correcto. Hacemos hincapié en que la lepra lepromatosa es una «gran simuladora» y los clínicos deberían estar alertas ante estas formas de manifestación rara, que ocurren en ciertas regiones endémicas

Leprosy may have diverse and complex clinical manifestations. Skin lesions most commonly found are: macules, papules, plaques, nodules and tubers. The purpose of this communication is to highlight a form of atypical presentation of lepromatous leprosy, in a young adult male, whose initial lesions were excoriated papules on surface simulating a prurigo/papular urticaria. In this particular case, the pathology was decisive for correct diagnosis. We emphasize that lepromatous leprosy is a great imitator and clinicians should be aware of these rare forms of manifestation, occurring in certain endemic areas

Borderline tuberculoid leprosy in a woman from the state of Georgia with armadillo exposure.

In the southern and southeastern United States, the 9-banded armadillo is an important reservoir for Mycobacterium leprae, the causative agent of leprosy (Hansen's disease). Here, we describe a woman living in Georgia with borderline tuberculoid leprosy who worked for many years in a garden where armadillos burrowed or were buried. There was no history of foreign travel or known exposure to a person with leprosy. Treatment with 6 once-monthly combined doses of rifampin, ofloxacin, and minocycline was successful.

Reactional tattoo inoculation borderline tuberculoid leprosy with oedematous tattoos.

Tattoo inoculation borderline tuberculoid (BT) leprosy in upgrading reaction with prominent tattoo oedema developing after starting paucibacillary multidrug therapy (PB MDT) is reported. The diagnosis was confirmed by histopathology. An excellent response to oral steroids and PB MDT was seen. There is only one similar report in the literature.

Estimating the relative recurrence risk ratio using a global cross-ratio model

The relative recurrence risk ratio lambdaR (and particularly the sibling recurrence risk ratio, lambdaS) is often of interest to those wanting to quantify the genetic contribution towards risk of disease or to discriminate between different genetic models. However, estimating lambdaR for complex diseases for which genetic and environmental risk factors are both involved is not straightforward. Ignoring environmental factors may lead to inflated estimates of lambdaR. We present a marginal model which uses a copula function to model the association in cumulative incidence rates between pairs of relatives. This model is applicable to present-state data and allows estimation of risk of disease in a pair of relatives (and hence lambdaR), given measured environmental covariates. We apply the model to leprosy among sibling pairs from the Karonga district, Malawi. If risk factors are ignored, the apparent lambdaS in this population is over 3. Accounting for known nongenetic risk factors reduces it to just under 2.

Disertaciones sobre la lepra en la Sevilla de finales del Siglo de las Luces / Dissertations about leprosy in the Seville of final of the century of the lights

Introducción. La lepra es una enfermedad conocida desde la más remota antigüedad histórica. La sociedad reaccionó de manera violenta contra ella debido al miedo al contagio y al hecho de que mutila a sus víctimas de forma espantosa. Desarrollo. Producida por el Mycobacterium leprae, esta enfermedad afecta únicamente al sistema nervioso del ser humano. Las pautas y reconocimientos practicados durante años a los sospechosos de estar afectados de lepra se basaban casi siempre en una serie de requisitos que conformaban, en caso de verificarse, la denominada ‘declaración de leproso’. Los médicos dieciochocescos, conscientes de las consecuencias que suponía establecer un diagnóstico de lepra, en parte por las limitaciones de la Medicina de la época y en parte por el riesgo innato en el reconocimiento de la semiología de la enfermedad en las primeras fases y sus cambiantes síntomas, adoptaban posturas cautas y en ocasiones demasiado prudentes. Estos problemas quedan planteados en distintas disertaciones presentadas en la Regia Sociedad de Medicina y otras Ciencias de Sevilla, durante el último tercio del siglo XVIII. Se analizan un total de ocho disertaciones relativas a la enfermedad, de entre las cuales destacan por su contenido y calidad las dos presentadas por el médico Bonifacio Ximénez de Lorite en 1765 y 1788 (AU)

Introduction. Leprosy is a well-known disease from ancient history. Society reacts violently due to the fear of infection, and the fact that it causes appalling physical mutilation. It is produced by Mycobacterium leprae, which only affects the nervous system of human beings. Development. The norms and examinations that for many years were practiced upon those suspected of being infected by the leprosy organism are based almost always in a series of requirements that were in keeping with cases of verification, thus named the ‘declaration of leprosy’. Doctors in the 18th Century, conscious of the consequences of the disease, established a diagnostic procedure for leprosy. But as a result of the medical limitations of the time, and the innate risk of examination of the sufferer in the early phases and their changing symptoms, they adopted a cautious stance and on occasion were overly prudent. These problems remained established in different dissertations presented in the Royal Society of Medicine and other Sciences of Seville during the last third of the 18th Century. A total of eight dissertations related to this disease are analyzed. Two presented by Doctor Bonifacio Ximénez de Lorite in 1765 and 1788 are noteworthy due to the contents and quality (AU)

[A rare cause of carpal tunnel syndrome: leprosy. Latency period of decades is possible]. / Seltene Ursache eines Karpaltunnelsyndroms: Lepra. Jahrzehntelange Latenzzeit möglich.

In a 63-year-old German woman with no apparent exposure to leprosy, clinical and histological evidence of tuberculoid leprosy was found. A noteworthy feature of this case is either the very long incubation time of 45 years, or the mode of infection involving an only short encounter in an endemic region. In the event of unclear lesions--on white skin not, typically, hypopigmented, but reddish--accompanied by disordered sensation, we in Europe must also give consideration to the possibility of a sporadic case of leprosy. A particular characteristic of this case was leprous neuritis involving the median nerve which was diagnosed clinically as carpal tunnel syndrome, and scheduled for surgical treatment. Under treatment with dapsone and rifampicin, however, the condition cleared up completely.

An historical and clinical review of the interaction of leprosy and pregnancy: a cycle to be broken.

Since earliest history the person with leprosy has been shut out from society. Laws have prohibited marriage and allowed divorce of those with leprosy. Segregation of the sufferer from the rest of society has been followed by separation of the sexes, and of leprous parents from their children. With the advent of antileprotic drugs, first dapsone then multidrug therapy (MDT), infection can be treated, individuals made non-infectious, and the pool of infection in the community reduced. The clinical signs of leprosy are due not to the degree of infection but to the immunological status of the host. Hormonal changes at puberty and in pregnancy can cause variation of the host's immune status. Pregnancy in women with leprosy is a hazardous undertaking. First appearance of leprosy, reactivation of the disease and relapse in 'cured' patients is likely to occur particularly in the third trimester of pregnancy. Leprosy reactions caused by variation in cell mediated and humoral immunity are triggered off by pregnancy: type 1 reaction (reversal reaction, RR) occurs post partum, while type 2 reaction (erythema nodosum leprosum, ENL) peaks in late pregnancy. Both types of reaction continue long into lactation. Neuritis with loss of both sensory and motor function is associated with relapse and reaction. Relapse, reaction and nerve damage, especially 'silent neuritis', with subsequent deformity and disability, occur not only in women on apparently effective treatment but also in those who have received MDT and have been released from treatment (RFT). To prevent disability, research is urgently needed into the mechanisms of early and late reaction and neuritis. Pregnancy is not only a trigger factor for reaction but an ideal in vivo model for research. Up to 20% of children born to mothers with leprosy may develop leprosy by puberty. While early leprosy in young children is self-healing, when marriage and childbearing take place at an early age the daughters of mothers with leprosy are likely to run the risk of experiencing the adverse effects of pregnancy on leprosy. Increased awareness and health education, as well as long term surveillance of 'cured' leprosy patients, are essential to break a potentially vicious cycle of leprosy and pregnancy. Women with cured leprosy could play an important role in screening for and detection of both early leprosy in children and late, post-MDT RFT, nerve damage in their mothers.

The dot-ELISA test for the detection of anti-PGL-1 IgM in leprosy patients and their contacts

Since dot-ELISA has recently been reported to be a sensitive, simple and method, we have compared it with the conventional microplate ELISA method. Sera of 124 leprosy patients, 136 household and professional contacts, and 92 controls were tested for a antibodies against a Mycobacterium leprae antigen using dot-ELISA on nitrocellulose membrane filters and microplate ELISA. The sensitive of the techniques was similar for multibacillary patients, but dot-ELISA was less sensitive for paucibacillary patients although it was more specific (100%) than ELISA (93,4%). Of 21 household contacts that gave a response by ELISA, 3 were also positive by dot-ELISA; one of these 3 developed indeterminate leprosy 12 months later and the other was diagnosed as borderline lepromatous after 28 months. These data indicate that dot-ELISA has a high spedificity and can be a useful tool in field evaluation

Prospective immunological follow-up in household contacts of Mexican leprosy patients.

A 6-year prospective study of 79 household contacts of leprosy cases was made in order to correlate the development of the disease with their specific T-cell immunity, measured by the Mitsuda test, and levels of anti-Mycobacterium leprae antibodies determined in three consecutive observations with the FLA-ABS test. Overall in the contacts, 71.7% were Mitsuda positive and 93.6% showed seropositivity, without regard to their age, sex, or leprosy type of their index case. Households were divided into lower-risk and higher-risk groups according to either the paucibacillary or multibacillary character of their index case. The lower-risk group consisted of 19 contacts of 2 tuberculoid (TT) and 5 indeterminate cases. The higher-risk group was made up of 60 household contacts of 18 active lepromatous (LL) cases. All but two contacts in the former group had a positive Mitsuda reaction; the most common antibody titer was 1:160, with a tendency to stabilize or decrease over time. In the two Mitsuda-negative contacts, increased antibody levels were observed. In the higher-risk group, 61.6% were Mitsuda positive and showed a humoral profile similar to those Mitsuda positive in the lower-risk group. In most of the Mitsuda-negative LL contacts, the antibody levels remained constant or progressively increased, suggesting a high probability of active subclinical infection. This assumption was partially supported by the finding of a new borderline lepromatous (BL) leprosy case in the Mitsuda-negative LL contact group. Nevertheless, the contribution of the close and extensive contact with a multibacilliferous case as a risk factor was difficult to evaluate because of the small size of the sample studied.

T-cell response to my mycobacterial antigens in lepromatous and tuberculoid leprosy

We showed that a large fraction of lepromatous patients do harbor helper-type circulating T-cells that can be activated in vitro by Mycobacterium leprae. M. leprae and PPD triggered T-cell lines could be then obtained from both tuberculoid and lepromatous patients. The proliferative response of these helper T-cells is predominantly directed against epitopes shared by several species of mycobacteria, in lepromatous patients as well as in tuberculoid patients, but species specific T-cells are also present. When presented in the context of M. leprae, these cross reactive epitopes usually fail to stimulate the T-cell lines of lepromatous patients, because of the contamination of the lines by supressor T-cells actavable by M. leprae. In one lepromatous patient, PPD and M. leprae reactive T-cell lines and clones (of the CD4 phenotype), exhibited a strong cytotoxic activity to autologous target cells coated with antigen: the relevance of this phenomenon to the pathophysiology of lepromatous leprosy remains however unknown.

Lepra tuberculóide en Mexico

La lepra tuberculoide es del tipo benigno de la enfermedad, no infectante, regresivo y de curación espontánea, las manifestaciones clínicas son en piel y nervios periféricos. Fué descrita por primera vez por Jadassohn en 1898. Se le forma crónica mas estable, que cursa habitualmente con leprominorreación positiva y baciloscopia negativa, la segunda es de aparición aguda, nemos estable, en la qual encontrar al principio la baciloscopía positiva y leprominorreación negativa es casi la regla. En los niños la lepra tuberculoide adquiere caracteres especiales, distinguiéndose en éstos 3 tipos de lesiones: nodulares, liquenoides y sarcoides. Para conecer los aspectos clínicos y epidemiológicos de la lepra tuberculoide en México, se hizo una revisión de los archivos del Centro Dermatológico Pascua, de 1955 a 1964, hallándose un total de 1046 expedientes de lepra, de loscuales 190 correspondieron al tipo tuberculoide, encontrádose que es más frequente en el sexo feminino en el adulto de 21 a 50 anos de edad, más frecuentemente diseminada, predominante la variedad fija y la lesion eritematoescamosa

Epidemiologia: Parte 1. contagio familiar y extrafamiliar en lepra / Parte 2. Estudio de los convivientes que se encontraron enfermos de lepra en el periodo que va de 1946 a agosto de 1950 / Epidemiology: Part 1, I infect relative and extrarelative in leprosy.Part 2. Study of the convivientes that were patients of leprosy in the period that goes of 1946 to August of 1950

El estudio hecho en 272 enfermos del Sanatorio de Las Mercedes, muestra que en 178 casos(65,5%) el contagio fue familiar y que en 94 (34,5%) casos el contagio se produjo fuera de la familia. El hecho de que entre los miembros de la familia de un enfermo aparezca mayor numero de enfermos y que entre ellos se encuentran formas mas graves de lepra que entre los enfermos que adquirieron la lepra fuera de su familia, hace pensar que el contagio de la lepra necesita un contacto prolongado con el enfermo contagioso y de una predisposicion familiar hereditaria que favorezca el contagio. La incidencia de la lepra (en Costa Rica) entre los parientes del enfermo es del 6%. Este porcentaje puede aumentar con los futuros examenes de control. Se encontró positivos son responsables del contagio. El contagio entre parientes se realizo en el 70% cuando vivian en la misma casa y en el 30% cuando habitaban casas distintas.