Unusually high incidence of multifocal epithelial hyperplasia in children of the Nahuatl population of Mexico.

BACKGROUND: Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. AIM: To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. METHODS: A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. RESULTS: Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. LIMITATIONS: Human papillomavirus typing was not done owing to a lack of facilities. CONCLUSIONS: There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.

Leprosy and stigma in the context of international migration.

If it can be argued that no single attribute or condition (leprosy included) is inherently or universally considered to be 'deeply discrediting,' to quote Goffman, then we must consider how external factors shape stigma associated with that condition in different cultural and socioeconomic contexts. Often, an analysis of what is perceived to be stigma towards people affected by leprosy uncovers other prejudices or stigmatising attitudes associated with class, gender, and/or ethnic inequalities in that society. The movement of people across international borders adds new dimensions to the experience of leprosy, as affected individuals confront different sets of understandings of the disease among healthcare professionals, friends, family, and employers in host and sending countries. Preconceptions of the immigrant 'other' in host countries may be bound up with notions of disease and danger, further complicating the experience of leprosy treatment for immigrants. Drawing on the work of others and on early stage qualitative research on leprosy among Brazilian immigrants to the United States, this paper will consider the ways in which immigration and transnational processes could affect the experience of stigma among immigrants affected by leprosy.

Elevated platelet counts and thrombocytosis in erythema nodosum leprosum.

Changes in peripheral blood platelet counts associated with the onset of symptomatic erythema nodosum leprosum (ENL) were studied by comparing, in each patient, the value obtained on the day thalidomide therapy commenced with the average of the three preceding values. In the 11 patients studied, the mean platelet count rose from 235 to 322 x 10(3)/mm3, p < 0.001. In 3, the platelet count was above the normal limit, qualifying as thrombocytosis, in 7 the rise was appreciable, and in 2 it was negligible. In the 3 patients studied 1-2 weeks after beginning thalidomide, the mean count was 414 x 10(3)/mm3. Counts obtained after 3 or more weeks of thalidomide therapy were within normal limits. This study provided no direct evidence as to the mechanism responsible for the elevated platelet count, but mediation by interleukin-6 (IL-6) was concluded to be an attractive hypothesis, consistent with prior studies of IL-6 in reactive thrombocytosis and of IL-6 in ENL.

Hansen's disease--an enigma.

Hansen's disease is an ancient condition that continues to remain endemic in several countries and also in parts of the United States. It has a varied clinical presentation that requires a high index of suspicion for diagnosis. The immune response of the patient is closely related to the presentation of the disease and is being used for immunotherapy and the development of a vaccine. The therapy regimen usually used is as recommended by the World Health Organization but several different regimens are undergoing trials to aid in decreasing the duration of therapy.

An unusual case of Hansen's disease (lepromatous leprosy) with circulating anticoagulant and macroglobulinemia.

A 42-year-old Mexican migrant laborer with a previous history of neurofibromatosis presented with a stuffy nose and chronic ulceration of his soft palate. Multiple subcutaneous nodules were found on his skin, and laboratory investigation revealed an elevated activated partial thromboplastin time (APTT). Further laboratory evaluation showed a lupus-like circulating anticoagulant deemed IgM by quantitative immunoglobulin studies. Although coagulation defects in lepromatous leprosy are rare, the preoperative preparation of a patient with leprosy may require a screening prothrombin time (PT), APTT and platelet count. Abnormalities in these values may indicate the need for specific factor assays and a search for circulating anticoagulant.

Leprosy in the United States, 1971-1981.

In the period 1971-1981, 1,835 cases of leprosy were reported in the United States; only 10% of these cases were indigenous. Since 1977, the number of new cases reported each year has risen because of an increase in imported cases of disease, a situation reflecting the increased number of refugees and immigrants who have entered the United States from areas endemic for leprosy. Forty-five of the 50 states reported cases. In only 25% of the imported cases were the patients known to have had leprosy at the time of immigration; the remaining 75% were diagnosed in this country. The highest rate of disease onset for this latter group occurred within 12 months after entry into the United States, but cases continued to be reported 10 years after entry. Active refugee resettlement programs have widely distributed persons with leprosy, contacts of diseased persons, and persons from endemic areas throughout the 50 states, a situation necessitating the development of expertise by medical professionals and public health officials in the diagnosis, treatment, and long-term follow-up of patients with leprosy.

Otolaryngologic manifestations of Hansens disease

A Mexican migrant farm worker whose condition was previously undiagnosed was examined at the University of Utah Medical Center. He had an unusual peripheral neuropathy, ulcerative and nodular skin lesions, and multiple head and neck complaints. Results of the history, physical examination, and multiple biopsies led to the diagnosis of lepromatous leprosy. Although an uncommon disease in the United States, leprosy remains a common cause of head and neck pathologic conditions in many parts of the world and must be considered in the appropriate clinical setting.

Otolaryngologic manifestations of Hansen's disease.

A Mexican migrant farm worker whose condition was previously undiagnosed was examined at the University of Utah Medical Center. He had an unusual peripheral neuropathy, ulcerative and nodular skin lesions, and multiple head and neck complaints. Results of the history, physical examination, and multiple biopsies led to the diagnosis of lepromatous leprosy. Although an uncommon disease in the United States, leprosy remains a common cause of head and neck pathologic conditions in many parts of the world and must be considered in the appropriate clinical setting.

Serum pseudocholinesterase variants in Mexican-born patients with lepromatous leprosy.

No difference in the distribution of serum pseudocholinesterase variants could be found in lepromatous leprosy patients as compared with controls. The variety of reported relationships of pseudocholinesterase variants in leprosy suggests that only in some populations is a locus regulating pseudocholinesterase genetically linked to a hypothetical locus regulating susceptibility to leprosy.