Pathogenesis, Clinical Considerations, and Treatments: A Narrative Review on Leprosy.

Hansen disease, known as Leprosy, is an infectious disease caused by Mycobacterium leprae. The disease was once thought to be highly contiguous, and patients with leprosy were treated poorly and had to face discrimination due to the gruesome disease's complications. Mycobacterium leprae, the bacterium causative of leprosy, can generally be found in the nine-banded armadillo. The bacterium is transmitted via aerosol droplets and broken skin-to-skin contact. Once M. leprae enters the body, it will target peripheral nerves and the lining mucosa of the skin and eyes, thus causing inflammation and tenderness of the affected area. Over time, this will lead to peripheral neuropathy and weakness of the affected body parts. Treatment of leprosy involves multi-drug combinations such as dapsone, rifampin, and clofazimine. Even though leprosy is curable, early detection and treatment are crucial to preventing irreversible damage and disabilities. Prevention measures include early detection, treatment regimen adherence, close contact prophylaxis, contact tracing, and community awareness. This review aims to provide the latest diagnostic and therapeutic recommendations for leprosy. It outlines the epidemiology, microbiology, clinical treatment, and immunological methods used to detect leprosy.

Lagoftalmo na hanseníase: experiência clínica em centro de referência amazonense / Lagophthalmos in leprosy: clinical experience in an Amazon reference center

RESUMO Objetivo: O presente trabalho teve por objetivo caracterizar o perfil epidemiológico e clínico de pacientes com lagoftalmo associado à hanseníase, atendidos no ambulatório de oftalmologia da Fundação Alfredo da Matta, Manaus, Amazonas. Métodos: Trata-se de estudo retrospectivo realizado por meio da análise dos prontuários clínicos dos pacientes incluídos no estudo. Sexo, idade, forma clínica, grau de incapacidade no diagnóstico e desfecho foram obtidos dos prontuários. Início, tipo de comprometimento (unilateral ou bilateral), grau de intensidade do lagoftalmo e alterações oculares associadas também foram compilados. Resultados: Foram incluídos 65 pacientes; 66,1% eram do sexo masculino e 53,8% tinham idade superior a 60 anos. Em relação à classificação operacional da hanseníase, a maioria dos pacientes (81,5%) era multibacilar: 33,8% na forma de hanseníase borderline e 47% virchowiana. 36,9% casos apresentavam sequelas oculares associadas ao lagoftalmo: opacidade corneana, epífora, ceratopatia em faixa, e neovascularização corneana.41,6% evoluíram para a cegueira. O lagoftalmo foi conduzido de forma clínica em 23 pacientes e a abordagem cirúrgica foi indicada em 42. Em relação ao tratamento cirúrgico consistiu principalmente no implante de peso de ouro e na cantoplastia de Tessier. Discussão: O lagoftalmo nessa casuística acometeu mais homens idosos, esteve relacionado à forma multibacilar, com hanseníase do tipo virchowiano como relatado na literatura. O diagnóstico de lagoftalmo foi tardio na maioria dos casos, explicando o grande número de sequelas incluindo a cegueira. Conclusão: O presente estudo reforça a necessidade de acompanhamento oftalmológico precoce para que as potenciais e graves sequelas associadas a essa condição sejam evitadas.

ABSTRACT Objective: The present study aimed to characterize the epidemiological and clinical profile of patients with lagophthalmos associated with leprosy, seen at the ophthalmology outpatient clinic of Fundação Alfredo da Matta, Manaus, Amazonas. Methods: This is a retrospective study carried out by analyzing the medical records of the patients included in the study. Sex, age, clinical form, degree of disability in diagnosis and outcome were obtained from medical records. Onset, type of impairment (unilateral or bilateral), degree of intensity of lagophthalmos and associated eye changes were also compiled. Results: 65 patients were included; 66.1% were male and 53.8% were older than 60 years. Regarding the operational classification of leprosy, most patients (81.5%) were multibacillary: 33.8% in the form of borderline leprosy and 47% virchowian. 36.9% of cases had ocular sequelae associated with lagophthalmos: corneal opacity, epiphora, band keratopathy, and corneal neovascularization.41.6% progressed to blindness. Lagophthalmos was performed clinically in 23 patients and the surgical approach was indicated in 42. Regarding surgical treatment, it consisted mainly of gold weight implantation and Tessier's canthoplasty. Discussion: Lagophthalmos in this sample affected more elderly men, was related to the multibacillary form, with leprosy-like leprosy as reported in the literature. The diagnosis of lagophthalmos was delayed in most cases, explaining the large number of sequelae including blindness. Conclusion: The present study reinforces the need for early eye care so that the potential and serious sequelae associated with this condition are avoided.

Corneal blindness in Platos cave: the acting forces to prevent and revert corneal opacity. Part I: epidemiology and new physiopathological concepts / A cegueira corneal na caverna de Platão: as forças para prevenir e reverter a opacidade da córnea. Parte I: epidemiologia e novos conceitos na fisiopatologia

ABSTRACT The burden of corneal blindness and visual deficiency can be felt worldwide. Its association with several endemic diseases such as childhood blindness, trauma, infectious keratitis (including variants caused by herpes, hanseniasis, and fungi), vitamin A deficiency, diabetes mellitus, and other dry eye syndromes reflects its poorly understood underlying mechanisms and suggests that the actual frequency of the disease is underestimated. The low effectiveness of preventive and therapeutic strategies against corneal scarring or deformity predicts a high frequency of patients with corneal blindness in the future. Corneal blindness is associated with environmental factors and socioeconomic limitations that restrain health assistance and maintain a modest efficiency of the current therapeutic strategies for resolving corneal diseases in large-scale programs. We present here a critical review of the concepts associated with corneal blindness that need to be considered when planning strategies to prevent and treat corneal blindness worldwide (to be able to leave Plato's cave, where corneal blindness is encaged.

RESUMO O problema da deficiência visual e da cegueira corneal abrange o mundo todo e corresponde à quarta causa de cegueira e deficiência visual, com acometimento estimado de mais de 16 milhões de pessoas. A associação com várias doenças endêmicas, como cegueira infantil, trauma, ceratites infecciosas (incluindo herpes, hanseníase e fungos), hipovitaminose A, diabetes mellitus e outras causas de síndromes de olho seco, indicam que a verdadeira frequência é subestimada e que os diferentes mecanismos são pouco conhecidos. A baixa eficácia na prevenção e tratamento da cicatriz e deformidade da córnea permite antecipar que a prevalência da cegueira corneal irá crescer no futuro. As razões para o aumento da cegueira corneal envolvem fatores ambientais, limitações socioeconômicas para ampliar a assistência à saúde e a modesta eficiência das estratégias terapêuticas para resolver o problema em grande escala. O presente trabalho traz uma revisão crítica dos conceitos associados à cegueira corneal. Essa análise é uma etapa necessária para preparar o caminho com o objetivo de deixar a caverna que encarcera a cegueira corneal, em analogia ao mito de Platão, e melhorar as estratégias para prevenir e tratar a cegueira corneal em escala mundial.

Ocular complications of leprosy in yemen.

OBJECTIVES: This study was conducted to identify the main ocular- and vision-threatening complications of leprosy in Yemen. METHODS: This is a cross-sectional observational study which took place from February to July 2010. Leprosy patients attending the Skin and Venereal Diseases Hospital in the City of Light in Taiz, Yemen, who consented to participate in the study, were enrolled. Detailed demographic and medical histories were taken and clinical examination findings were recorded. A detailed eye examination, including visual acuity (VA), slit-lamp, and fundus examinations, was conducted on each patient by a qualified ophthalmologist. RESULTS: A total of 192 patients (180 male, 12 female, with a male to female ratio of 15:1) were included in the study. The majority of the patients (157; 81.8%) were over 40 years. Over two-thirds of the patients (129; 67.2%) had had leprosy for more than 20 years. Ocular complications were found in 97% of cases; 150 (39.1%) of the patients' eyes had at least one pathology. Eyelid involvement was the most common problem observed in 102 (26.5%) patients. Half of the eyes (192; 50%) had a VA of <6/60. The main cause of blindness among these patients was corneal opacity detected in 69 out of 192 patients (35.9%). CONCLUSION: Ocular complications are frequent among leprosy patients in Yemen. They are true vision-threatening lesions. It is important to prevent these lesions through early diagnosis and adequate treatment.

Ocular leprosy in institutionalized Nigerian patients.

OBJECTIVE: This study was aimed at presenting the profile of ocular lesions observed in the in-mates on multidrug treatment, of a leprosy rehabilitation centre in Nigeria. DESIGN: Cross-sectional. METHOD: One hundred patients were selected by systematic random sampling. Sixty-nine had ocular involvement and were the subjects of this study. The age range was 15 to 80 years with a mean age of 51 years. There were 57 males (82.6%) and 12 females (17.4%). The range of duration of treatment was two months to 30 years, with a mean of 15 years. Examination of the anterior and posterior segments of the globe and its adnexa was carried out using Penlight, magnifying loupe and direct ophthalmoscope. Visual acuity was recorded using the Snellen charts. RESULTS: Lepromatous leprosy patients had the greatest incidence of ocular lesions. Ocular lesions were more in patients who have had leprosy for ≥ 15 years. Madarosis (72.5%) and lagophthalmos (29.0%) were the commonest lesions. Corneal involvement was seen in 36.2%. Conjunctivitis in 14.5% . Trichiasis in 10.1% and ectropion in 8.7% . 17.4% were legally blind (VA≤3/60) in the better eye, and 17.4% had cataract in at least one eye. There was no statistically significant difference in the incidence of ocular lesions among males and females, and between patients with Lepromatous and Tuberculoid leprosy. CONCLUSION: Ocular complications are common and sight threatening in leprosy patients. Regular screening and outreach by eye care providers should be incorporated into leprosy care programmes.

Hanseníase ocular: uma abordagem histórica / Ocular leprosy: a historical approach

Houve uma acentuada queda na prevalência da hanseníase nas últimas três décadas. Contudo, a incidência não diminuiu na mesma proporção. Hoje, três anos após a última data estipulada pela Organização Mundial da Saúde para o controle da hanseníase, pacientes considerados curados ainda necessitam de cuidados especiais por causa de suas incapacidades e reações imunológicas. A literatura médica refere cegueira em 4 por cento a 11 por cento dos pacientes estudados e, mais de 20 por cento com graves problemas visuais devido a exposição da córnea, invasão bacilar e hipersensibilidade; estes mecanismos resultam em uma população de aproximadamente 1 milhão de pacientes cegos, embora a prevalência oficial não passe de 250.000 pacientes em todo o mundo. O autor destaca a necessidade de melhor tratamento e acompanhamento dos pacientes e, conclama os oftalmologistas a tornarem-se mais perceptivos e se interessarem mais pelo tratamento das complicações oculares da hanseníase.

A sharp drop in the prevalence of leprosy occurred in the last three decades. However, the incidence has not decreased at the same rate. Three years after the World Health Organization last deadline for leprosy control, patients considered healed still need special care for their incapacities and immunopathological reactions. Medical literature reffers blindness in 4 percent to 11 percent of studied patients and more than 20 percent with severe visual problems due to corneal exposure, bacillary invasion and hipersensibility. These mechanisms result in a population of nearly one million blind leprosy patients even though official prevalence accounts no more than 250,000 patients worldwide. The author calls for better patients management and follow-up and urges ophthalmologists to become more aware and interested in the treatment of the ocular complications of leprosy.

Prevalence and etiologies of visual handicaps in leprosy patients in the south of Cameroon.

UNLABELLED: We report on a prospective study undertaken in April 2008, in 11 leper villages of the Southern Cameroon. Our aim was to determine the prevalence and the causes of bilateral blindness, low vision and unilateral blindness in the population of leprosy patients, irrespective of the clinical aspects of the illness. RESULTS: Two hundred thirty-five known and newly diagnosed leprosy patients were examined. These patients included 149 cases (63.4%) of multibacillary leprosy and 86 cases (36.6%) of paucibacillary leprosy. There were 111 case of visual handicap, representing 47.2% of the population. These visual handicap cases were subdivided into 45 cases (19%) of bilateral blindness, 35 cases (15%) of unilateral blindness and 31 cases (13.2%) of low vision. DISCUSSION: The prevalence of visual handicap among leprosy patients in Cameroon is too high. Causes in the majority of cases are age-related degenerative pathologies, and one third of cases are linked to the leprosy mycobacterium. CONCLUSION: Discovering a cure for ophthalmic pathologies is important in order to provide a better quality of life for this particular population.

Análise das principais manifestações oculares de pacientes hansenianos nas regiões Norte e Sudeste do Brasil / Analysis of the main ocular presentations in leprosy patients in Northern and Southeastern Brazil

OBJETIVO: Analisar as principais manifestações oculares encontradas em pacientes diagnosticados com Hanseníase nas regiões Norte e Sudeste do Brasil. MÉTODOS: Foram examinados 28 pacientes com diagnóstico de hanseníase, sendo 12 pacientes - Grupo I, da região Sudeste (ABC) e 16 pacientes - Grupo II, da região Norte (Amazônica) do país. O Grupo I foi observado no período de agosto de 2003 a junho de 2004 no Ambulatório de Oftalmologia da FMABC-SP e o segundo grupo na 10ª missão do Projeto Amazônia Visão 2000 realizada no mês de julho de 2004. Todos os 28 pacientes foram submetidos a exame oftalmológico completo. RESULTADOS: Em relação ao sexo notou-se em ambos os grupos predomínio do sexo masculino. Observou-se um predomínio de indivíduos de 50 a 60 anos na região amazônica e de 40 a 50 anos na região do ABC. Quanto à forma clínica da doença observaram-se na região amazônica 13 casos (81%) de hanseníase virchowiana (MHV) e 3 casos (19%) de hanseníase tuberculóide (MHT). Na região do ABC 6 pacientes (50%) foram diagnosticados com hanseníase dimorfa (MHD), 5 (41%) hanseníase virchowiana e apenas 1 (9%) hanseníase tuberculóide. Não foram encontradas formas de hanseníase indeterminada (MHI) nas 2 regiões investigadas, sugerindo que em ambas, o diagnóstico foi tardio. CONCLUSÕES: Neste estudo verificou-se um predomínio das alterações oculares com maior gravidade nos pacientes examinados na região amazônica. Encontraram-se alterações oculares principalmente nas formas clínicas mais graves da doença.

OBJECTIVE: To analyse the main ocular presentations observed in leprosy diagnosed patients in Northern and Southeastern in Brasil regions. METHODS: Twenty-eight diagnosed leprosy patients were examined divided in two groups. Group I, compound by 12 patients at southeastern (ABC) and group II, compound by 16 patients at northern region (Amazon). Group I was examined from August 2003 to June 2004 at SP, in FMABC ophthalmology outpatient service and the second group was examined during the10th Mission of 2000 Vision Amazon Project that was carried out on July 2004. The twenty-eight patients were submitted to complete ophthalmological trial. RESULTS: It was noted predominance of male in both groups. It was noted the predominance of 50 to 60 years old individuals in Amazonian region and individuals aged 40 to 50 years old in ABC region. Concerning the clinical form of the disease, it was noted that, in Amazon region, there were 13 cases (81%) of Lepromatous leprosy and 3 cases (19%) of Tuberculoid leprosy. At ABC region there were 6 patients (50%) diagnosed with borderline leprosy, 5 (41%) lepromatous leprosy and only one (9%) with tuberculoid leprosy. There weren't forms of indeterminated leprosy in both investigated regions, what suggests a late diagnosis. CONCLUSION: It was verified a predominance of the most severe ocular changings among the examined patients at Amazonian region. It was observed ocular changings, mainly in most severe clinical forms of the disease.