Prevalence of plantar ulcer and its risk factors in leprosy: a systematic review and meta-analysis.

BACKGROUND: Plantar ulcers are a leading complication of leprosy that requires frequent visits to hospital and is associated with stigma. The extent of burden of ulcers in leprosy and its risk factors are scant impeding the development of targeted interventions to prevent and promote healing of ulcers. The aim of this review is to generate evidence on the prevalence of plantar ulcer and its risk factors in leprosy. METHODS: Databases (Medline, Embase, Web of Science, CINAHL, BVS), conference abstracts and reference lists were searched for eligible studies. Studies were included that reported a point prevalence of plantar ulcer and/or its "risk factors" associated with development of ulcers (either causatively or predictively), including individual level, disease related and bio-mechanical factors. We followed PRISMA guidelines for this review. Random-effects meta-analysis was undertaken to estimate the pooled point prevalence of ulcers. Reported risk factors in included studies were narratively synthesised. This review is registered in PROSPERO: CRD42022316726. RESULTS: Overall, 15 studies (8 for prevalence of ulcer and 7 for risk factors) met the inclusion criteria. The pooled point prevalence of ulcer was 34% (95% CIs: 21%, 46%) and 7% (95% CIs: 4%, 11%) among those with foot anaesthesia and among all people affected by leprosy, respectively. Risk factors for developing ulcers included: unable to feel 10 g of monofilament on sensory testing, pronated/hyper-pronated foot, foot with peak plantar pressure, foot with severe deformities, and those with lower education and the unemployed. CONCLUSIONS: The prevalence of plantar ulceration in leprosy is as high as 34% among those with loss of sensation in the feet. However, the incidence and recurrence rates of ulceration are least reported. The inability to feel 10 g of monofilament appears to be a strong predictor of those at risk of developing ulcers. However, there is a paucity of evidence on identifying those at risk of developing plantar ulcers in leprosy. Prospective studies are needed to estimate the incidence of ulcers. Identifying individuals at risk of ulcers will help design targeted interventions to minimize risk factors, prevent ulcers and promote ulcer healing.

The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial.

Background Wound healing shows a unique interaction of several cells, growth factors and cytokines. The healing of chronic plantar ulcer of leprosy is influenced by various factors, one of which is the concentration of growth factors and cytokines related to the pathogenesis of impaired wound healing. Growth factors and cytokines can be found in the secretome of adipose mesenchymal stem cells. Aim To compare the effectiveness of topical adipose mesenchymal stem cell-conditioned medium and framycetin gauze dressing only on the healing of chronic plantar ulcer of leprosy. Methods In this randomised controlled trial, 32 patients with chronic plantar ulcer of leprosy were recruited. After detailed clinical and initial debridement, patients were randomised to two groups to receive either topical adipose mesenchymal stem cell-conditioned medium (n = 16) or framycetin gauze dressing only (n = 16) applied every three days for up to eight weeks, following which the ulcer size, adverse reactions and complications if any were monitored weekly. Results Healing percentage increased each week in all groups. Statistical differences between groups (P < 0.05) were observed from week 2 onwards for ulcer mean size reduction and from week 3 onwards for ulcer mean depth reduction. There were no adverse reactions or complications. Limitations Off-loading on subjects were not performed. Conclusion Adipose mesenchymal stem cell-conditioned medium is a potential therapeutic agent in the management of chronic plantar ulcer of leprosy.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis.

Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

The pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy in ALERT, Kuyera and Gambo hospitals, Ethiopia.

INTRODUCTION: Leprosy remains a public health problem, mainly in Africa, Asia and Latin America. Leprosy has many complications that include leprosy reactions, development of plantar and hand ulcerations, lagophthalomus and corneal anesthesia. OBJECTIVES: In Ethiopia there is scarce information on the pattern of bacterial isolates and drug sensitivities of infected ulcers in patients with leprosy. This study was undertaken to identify the bacteriology of infected ulcers and to determine their antimicrobial susceptibility pattern. STUDY DESIGN: A descriptive cross-sectional study was conducted in 245 informed and consented leprosy patients with infected ulcers visiting ALERT, Kuyera and Gambo hospitals during the period August 2006 to May 2007. MATERIAL AND METHODS: Wound aspirate specimens were collected from ulcers of each patient aseptically and inoculated into standard bacteriological media. Antimicrobial susceptibility testing was performed for all isolates according to the criteria of the National Committee for Clinical Laboratory Standards (NCCLS) by disk diffusion method. RESULTS: Of the 245 patients investigated, 64.1% were males and 35.9% females (P < 0.05). The average age of the patients was 50 years (age range 13 to 92 years). According to Ridley-Jopling classifications, patients presented with TT (3.7%), BT, (31.4%), BL (44.5%) and LL (15.9%) types of leprosy. Plantar and hand ulcers were observed in 92.2% and 7.8% of patients, respectively. According the patients, the commonest cause of their ulcers was 'spontaneous' (56.7%). There were 44% Gram-positive and 56% Gram negative bacteria (P > 0.05). Proteus spp. accounted for 29.5% of the total isolates followed by Staphylococcus spp. (28.8%), beta-hemolytic streptococci (15.1%) and different types of Gram-negative bacteria (26.2%). Multiple organisms (two or three) were isolated from 19.6% patients. Of the 212 wound samples cultured anaerobically, 5.2% were positive for anaerobic culture. In this study both Gram-positive and Gram negative bacteria showed decreased sensitivity to most antimicrobial agents tested. CONCLUSION: Proteus spp. was the most common isolate from infected ulcers. Ciprofloxacin, norfloxacin and gentamicin were the most effective drugs against the tested bacteria mainly for Gram-negative bacteria. This refers to the in vitro-sensitivity during the study period. The results of this study may help inform clinicians about the selection of an antibiotic in situations where use of an antibiotic may be indicated.

Promovendo a cicatrizaçäo de úlceras hansênicas e näo hansênicas com laserterapia: ensaio clínico em unidades ambulatoriais do Sistema Único de Saúde / Laser therapy applied to leprous and non-leprous ulcers healing: a clinical trial in out-patient units of Public Health Service

A hanseníase apresenta, como incapacidade decorrente muito comum, a ulceraçäo plantar. Tendo em vista a necessidade de implantaçäo de programas de açäo de controle da doença e melhora da qualidade de vida dos portadores desta nos serviços básicos de saúde, este projeto viabilizou, comparativamente a afetados pela mesma lesäo, porém de outras etiologias, a utilizaçäo da laserterapia de baixa intensidade para cicatrizaçäo das úlceras hansênicas de membros inferiores. Na sua adoçäo, uma vez claramente definidos populaçäo de referência, bem como respectivos critérios de inclusäo e exclusäo, a normalizaçäo ética vigente no país prevista foi rigorosamente cumprida. Promoveram-se procedimentos adequados para padronizaçäo de condutas de mensuraçäo, avaliaçäo, aplicaçäo e acompanhamento da evoluçäo clínica e documental. Operou-se conjunto de indicadores em escalas de variáveis quantitativas e qualitativas. No primeiro caso, lidou-se com propriedades dimensionais de profundidade, comprimento, largura e volume, monitoradas pelo tempo; investigaram-se e notificaram-se padröes de secreçäo e demais sinais semiológicos pertinentes. Inferências paramédicas foram analisadas aos níveis correntes de significância, após aplicaçäo das provas de Goodman para variaçöes intra e inter populaçöes multinomiais, Anova e Wilcoxon. Desaparecimento lesional predominou estatisticamente sobre reduçäo e piora entre hansenianos 66,7(por cento); 16,7(por cento) e 16,7(por cento respectivamente) e näo hansenianos 55,3(por cento); 20,0(por cento) e 26,7(por cento) apontando näo só para aumento de repertório terapêutico, para a condiçäo estudada em unidades ambulatoriais do Sistem Único de Saúde, mas também para o sucesso de seu emprego em tais situaçöes

Degeneración maligna de úlceras en lepra

Se diagnosticaron por examen histopatológico seis carcinoma de células escamosas de diversos grados, desarrollados en úlceras crónicas o MPP en pesquizaje practicado a 234 pacientes de lepra ingresados en el hospital Antileproso de Ricón. Se realiza revisión bibliográfica al respecto

Malignant degeneration in chronic ulceration of the leg and foot in leprosy patients; two case reports

The development of squamous cell carcinoma in long-established ulcers is described in two patients with leprosy, one on the lower leg in a patient with borderline-tuberculoid (BT) leprosy and the other on the sole of the foot in a patient with lepromatous (LL) leprosy. Although sometimes stated by clinicians to be rare, and infrequently reported in the literature, it is suggested that malignant change in chronic ulcers in leprosy may be found more often if patients are examined with care and the possibility kept in mind.

Squamous-cell carcinoma arising in a leprous neurotrophic ulcer: report of a case.

Exophytic neoplasms arise rarely in neurotrophic ulcers of leprosy. When such a lesion does develop, it has clinical resemblance to an indolent and locally invasive epithelioma cuniculatum, may invade deeply, and may metastasize. The case described showed deep invasion and extensive involvement of bone. Exophytic neoplasms in neurotrophic ulcers of leprosy should be considered to be squamous-cell carcinomas, not epitheliomata cuniculata, because of their potential for rapid, deep invasion and metastases.

Squamous-cell carcinoma arising in a leprous neurotrophic ulcer: report of a case

Exophytic neoplasms arise rarely in neurotrophic ulcers of leprosy. When such a lesion does develop, it has clinical resemblance to an indolent and locally invasive epithelioma cuniculatum, may invade deeply, and may metastasize. The case described showed deep invasion and extensive involvement of bone. Exophytic neoplasms in neurotrophic ulcers of leprosy should be considered to be squamous-cell carcinomas, not epitheliomata cuniculata, because of their potential for rapid, deep invasion and metastases.

Surgical decompression of posterior tibial neurovascular complex in treatment of certain chronic plantar ulcers and posterior tibial neuritis in leprosy.

Seventy-one cases of posterior tibial neurovascular surgical decompression in leprosy are analyzed and reviewed. Thirteen had chronic refractory posterior tibial neuritis while 58 had chronic nonhealing plantar ulcers. The plantar ulcers were associated with posterior tibial neuritis and/or vascular insufficiency. The clinical and operative findings together with the results are presented and the physiopathology of neurovascular compression is discussed. The operative procedure is described. The presence of pale granulation tissue in a nonhealing ulcer seems to be a characteristic finding in these cases. Neurovascular compression in the tunnel, behind and also below the malleolus, was present in all. In operative procedures, the importance of incising the inferior calcaneal bands is stressed. The results show that the neuritis was cured in all cases, while in 53 of 58 cases the plantar ulcers healed in a short period after the decompression. This stresses the value of this procedure. The prophylactic potential of this procedure needs to be evaluated.