Profile of Rheumatological Manifestations in Leprosy in a Tertiary Care Hospital from Himachal Pradesh.

The rheumatological manifestations of leprosy occur singly or in varying combinations, particularly during lepra reactions. Despite being third most common, these remain under diagnosed and under reported. This study has been carried out to study the spectrum of rheumatological manifestations in leprosy patients. One hundred consecutive patients of leprosy presenting during January to December 2013 were studied for rheumatological manifestations. Complete hemogram, serum biochemistry, urinalysis, rheumatoid factor, ASO titer, C-reactive protein, ANA, and x-rays for hands, feet, chest and involved joints were performed. These 100 (M:F 66:34) patients aged between 16-80 years had indeterminate (2 patients), TT (4 patients), BT (26 patients), BB (2 patients), and LL leprosy (32 patients). 27 patients had rheumatological manifestations; arthritis involving large or small joints in 23 patients being the commonest. 7 of 24 patients in type-1 lepra reaction had enthesitis in 3 patients and oligoarthritis in 4 patients. Rheumatoid arthritis-like polyarthritis was noted in 19 patients with type-2 reaction. Tenosynovitis, dactylitis, bony changes were also noted. Except for one case, these features were present in patients having lepra reactions. Rheumatoid factor in 14, ANA in 15, C-reactive protein in 45 cases was positive. ASO was positive 34 cases. Symmetrical polyarthritis involving small joints of hands and feet, oligoarthritis, enthesitis and dactylitis are common in leprosy particularly with borderline leprosy, type-2 lepra reaction especially in the presence of positive RAfactor.

Clinico-epidemiological trends of leprosy in Himachal Pradesh: a five year study.

This retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. In this study, we included patients registered from January 2004 to December 2008 with the urban leprosy clinic of our tertiary care centre. Data regarding demographic details, clinical features, treatment and complications was extracted from the records of the leprosy clinic. 163 patients attended the clinic during this period with male to female ratio of 3:1. Majority of patients (47.8%) were in the middle age group (20-40 years) and 13.49% patients were < 20 years of age. In the clinical disease spectrum, 53.98% patients were in the borderline spectrum followed by lepromatous leprosy (33.12%) and polar tuberculoid leprosy (5.52%). Pure neuritic and indeterminate leprosy accounted for 3.06% each. Histoid lesions were present in 7.4% of lepromatous leprosy patients. 9.2% patients had definite history of contact in the family or neighborhood. 28.22% patients were immigrants either from Nepal or adjoining states of Himachal Pradesh. Epidemiological studies and contact tracing can decrease the disease burden and morbidity associated with the disease. Multidrug therapy (MDT) helps preventing and reducing the disease progression, severity and disabilities.

The role of acute decompression and restoration of spinal alignment in the prevention of post-traumatic syringomyelia: case report and review of recent literature.

STUDY DESIGN: Case report. INTRODUCTION: Acute post-traumatic syringomyelia formation after spinal cord injury has been considered a rare complication. At this writing, most recent reports have surfaced in neurosurgical journals. As an entity, post-traumatic syringomyelia has not been widely appreciated. It has been confused with conditions such as Hansen's disease or ulnar nerve compression at the cubital tunnel. One study also demonstrated that the occurrence of syrinx is significantly correlated with spinal stenosis after treatment, and that an inadequate reduction of the spine may lead to the formation of syrinx. This reported case describes a patient in whom post-traumatic syringomyelia began to develop 3 weeks after injury, which improved neurologically after adequate decompression. SUMMARY OF BACKGROUND DATA: A 30-year-old man sustained a 20-foot fall at work. He presented with a complete spinal cord injury below T4 secondary to a T4 fracture dislocation. The patient underwent open reduction and internal fixation of T1-T8. After 3 weeks, the patient was noted to have ascending weakness in his bilateral upper extremities and some clawing of both hands. METHODS: A computed tomography myelogram demonstrated inability of contrast to pass through the T4-T5 region from a lumbar puncture. An incomplete reduction was noted. The canal showed significant stenosis. A magnetic resonance image of the patient's C-spine showed increased signal in the substance of the cord extending into the C1-C2 area. The patient returned to the operating room for T3-T5 decompressive laminectomy and posterolateral decompression including the pedicles, disc, and posterior aspect of the body. Intraoperative ultrasound monitoring showed a good flow of cerebrospinal fluid past the injured segment. RESULTS: On postoperative day 1, the clawing posture of the patient's hands was significantly diminished, and the patient noted an immediate improvement in his hand and arm strength. Over the next few days, the patient's strength in the bilateral upper extremities increased to motor Grade 4/5 on manual testing. A magnetic resonance image 4 weeks after decompression showed significant improvement in the cord diameter and signal. CONCLUSIONS: Post-traumatic syringomyelia has not been reported at so early a stage after injury. This disorder is an important clinical entity that must be recognized to prevent potentially fatal or devastating complications. As evidenced by the reported patient and the literature, if this disorder is discovered and treated early, permanent deficit can be avoided. The prevention of post-traumatic syringomyelia requires anatomic realignment and stabilization of the spine without stenosis, even in the case of complete injuries, to maintain the proper dynamics of cerebrospinal fluid flow.

Actinomycotic mycetoma.

A case of actinomycotic mycetoma presenting as multiple nodules with sinuses and swelling of left foot of six years duration is being reported. The diagnosis was confirmed histologically.

Rowell's Syndrome.

A 65-year old woman presented with long standing history of lupus erythematosus with episodic eruption of erythema mutiforme - like lesions. Immunological investigations revealed positive rheumatoid factor, ANF and histology was consistent with the clinical findings.

Sexually transmitted diseases in leprosy patients in north and northeastern India. A futile search for human immunodeficiency virus antibody.

Three-hundred-eighty-four leprosy patients were clinically examined for sexually transmitted diseases (STD) in north and northeastern India, revealing a high incidence (5.2%) of STD among them. Eighteen males, one female, and one eunuch were found to have chancroid ulcer, gonococcal urethritis, lymphogranuloma inguinale, and primary chancre. Of these patients, only 100, selected randomly, could be screened serologically for STD due to Treponema pallidum, herpes simplex (type 1 and 2), Entamoeba histolytica, hepatitis-associated virus, cytomegalovirus, Chlamydia trachomatis and human immunodeficiency virus (HIV); 100 control sera were included for comparison. In addition, sera from another 133 normal subjects and another 176 lepromatous patients were also screened for HIV antibody. Thus, a total of 233 normal sera and 276 leprosy sera were tested for HIV antibody. Although our leprosy patients have shown significantly high incidences of clinical STD and also high seropositivity against T. pallidum, herpes-simplex viruses types 1 and 2, hepatitis-associated virus, and cytomegalovirus, the search for antibody against HIV was negative. Our clinical and serological data suggest promiscuity in our patient population. The absence of HIV antibody in this high-risk population, however, seems to be an enigma.

Cutaneous Chromomycosis with Pulmonary Geotrichosis.

An 80 year old farmer had cutaneous chromomycosis on the lateral aspect of right foot. He had associated pulmonary pathology caused by another fungus Geotrichum candidum simulating miliary tuberculosis. Complete regression of the pulmonary lesions and partial regression of the cutaneous lesions was observed with iodide therapy.

Superficial Mycoses in Simla.

A clinico-mycological study of 114 cases of dermatophytosis is presented.Tinea pedis 38.6%) is the commonest clinical type found in this region. A relatively high prevalence of tinea unguium (23.7%) was', observed. T rubrum was the commonest isolate (46.2%). An unusual finding was the isolation of T.Schoenleni in four cases of tinea pedis. The factors responsiblefor high prevalence of tinea pedis and tinea unguium are discussed.

Localised Cutaneous Sporotrichosis of Face - a Case Report From India.

A case of localized cutaneous sporottichosis of face has been reported. This is the first case of this type from India and the first of sporotrichosis reported from Himachal Pradesh.North India.

Diabetic status in leprosy.

The diabetic status of the local Jhansi patients (120 cases) was established before and after antileprosy treatment. Control studies were performed in normal healthy subjects (50 persons) without family history of diabetes mellitus. Random normals showed an incidence of diabetes only 2%, while leprosy patients (94 males and 26 females) had incidence of diabetic status of 14.2%. The highest incidence (19.3%) of diabetes was in lepromatous leprosy and lowest incidence (6.4%) in tuberculoid leprosy patients. Repeated studies in leprosy after treatment showed not only clinical improvement for leprosy but also disappearance of the chemical and latent diabetes mellitus and lowering of blood sugar levels in manifest diabetes mellitus. Incidentally it was noted that 'diabetic status' was worse among males (82.3%) and with advancing age. Association and improvement of diabetic status with specific treatment would tentatively suggest that Mycobacterium leprae lesions are not confined to skin alone but somehow also related to carbohydrate metabolism. A careful management of the chemical and latent diabetes may help in clinical management of leprosy too.

Diabetic status in leprosy

The diabetic status of the local jhansi patients (120 cases) was established before and after antileprosy treatment control studies were performed in normal healthy subjects (50 person) without family history of diabetes mellitus. Random normals showed an incidence of diabetes only 2% while leprosy patients (94 males and 26 females) had incidence of diabetic status of 14.2%. The highest incidence (19.3%) of diabetes was in lepromatous leprosy and lowest incidence (6,4%) in tuberculoid leprosy patients. Repeated studies in leprosy after treatment showed not only clinical improvement for leprosy but also disappearance of the chemical and latent diabetes mellitus and lowering of blood sugar levels in manifest diabetes mellitus

Skin Lesions (non Neoplastic and Non Hansen Disease) in Jabalpur Area.

The paper deals with 588 cases of skin diseases studied histopathologically between 1968 and 1974. Neoplastic and Hansens's diseases have not been included in this study. The diseases have been studied with emphasis on their incidence, types and clinicopathological features. Psoriasis, lichen planus, vitiligo, chronic dermatitis, eczema, lupus vulgaris, mofluscum contagiosum etc. are reported in this paper. The results are presented and discussed.

Platelet function in leprosy.

In a group of 50 leprosy patients, platelet function tests were found to be abnormal in 44. More than half the patients showed significant impairment in platelet adhesiveness and aggregation to collagen which correlated best with increase in serum IgM levels. ADP-induced aggregation of platelets was not a major defect and Pf-3 availability was reduced only in a fourth of the patients. In vitro incubation of collagen with plasma from leprosy patients significantly reduced its ability to clump normal platelets. This appears to be the first report of defective platelet function in leprosy, and it is thought that such changes may in part be due to increased IgM globulins in the blood and/or to alterations in the collagen brought about thereby.