Disfiguring facial lesions and loss of sensation.

Hansen disease (leprosy) continues to be prevalent in some regions of Africa, Asia, and South America, and each year 100 to 300 cases are reported in the United States, especially in immigrants and patients exposed to armadillos. Treatment depends on patient presentation. Hansen disease remains highly stigmatized, though it is now clear that it is not readily transmitted through casual physical contact.

Histoid leprosy: a retrospective clinicopathological study from central Nepal.

BACKGROUND: Histoid leprosy is a rare variant of lepromatous leprosy characterized by varied morphological and histopathological appearance while having a high bacillary load. These factors contribute to an ominous threat to the elimination status of leprosy, whereby these patients may act as a reservoir of infection. OBJECTIVE: To identify the clinicopathological characteristics of histoid leprosy in Chitwan, Nepal. METHODS: A retrospective hospital-based study spanning a period of 6 years was carried out at our department. All cases clinically and histopathologically suggestive of histoid leprosy were included in our study, and all relevant data were recorded and analyzed as per standard protocol. RESULTS: Histoid leprosy comprised 2.9% of all leprosy cases. Mean age of 39.45 years and male:female ratio of 1.75:1 were seen. Previous history of leprosy was obtained in 72.7%, and de novo development of histoid leprosy took place in 27.3%. Papules were the most common lesion seen, and upper limbs were the most frequent site of involvement, and the ulnar nerve was enlarged in most cases. Mean bacillary index was 5.39. Histopathology showed epidermal atrophy, positive Fite-Faraco stain for lepra bacilli, spindle-shaped histiocytes arranged in various patterns, and a well-circumscribed area of cells in the dermis in all cases. Grenz zone and pseudocapsule were seen in the majority of patients. All cases responded well to multibacillary multidrug therapy (MB-MDT) of 2 years. CONCLUSION: A high index of suspicion is essential for diagnosing histoid leprosy, both clinically and histopathologically.

The oral cavity in leprosy: what clinicians need to know.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a bacillus that has a tropism for skin and peripheral nerves. Leprosy treatment is based on a multidrug therapy established by the World Health Organization in 1982 and, despite its widespread use, Brazil ranks second worldwide in numbers of cases. Oral involvement in leprosy has been poorly described in the literature, and few studies have shown that although the bacillus is found in mucosa, specific leprosy lesions are rare and affect patients with advanced stages of the disease. This review aimed to assess the literature on oral manifestations in leprosy and the aspects involving oral cavity in leprosy pathogenesis.

Facial tuberculoid leprosy: case report.

Leprosy is a chronic, infectious, systemic disease caused by Mycobacterium leprae and is classified as paucibacillary and multibacillary types. It is contagious and has an insidious onset. Clinical presentation is characterised by hypopigmented skin lesions with reduced sensation. Presence of acid-fast bacilli in tissue specimens is regarded as a gold standard for diagnosis. Treatment is based on multi-drug regimens. We report a case of borderline tuberculoid leprosy in a 31-year-old woman.

[Facial localizations of Buruli ulcers: two cases]. / Les localisations faciales de l'ulcère de Buruli: à propos de deux cas.

We report the first two published cases of a facial localization of Mycobacterium ulcerans ulcer (Buruli ulcer). M. ulcerans is the third most common mycobacteriosis, after leprosy and tuberculosis. Clinical manifestations involve large necrotic ulcerations with protruding edges, mainly localized on the limbs. Both of our patients, 9 and 45-year-old females, resided in endemic areas of Buruli ulcer in the Ivory Coast. The ulcers were located on the left zygomatic malar region in one patient and the submental region in the other. Treatment involved resection of the ulcer followed by total skin graft. Ulcer healing was observed after two months hospitalization in one patient. The other patient died.

Risk factors for type 1 reactions in leprosy.

A cohort of new borderline leprosy patients seen over a 7-year period were examined retrospectively for risk of type 1 reactions (T1R) associated with 12 clinical and laboratory parameters. Logistic regression analysis was used to identify a strong link between facial patches and cutaneous T1R and enlarged ulnar nerves and neural T1R. Anti-phenolic glycolipid-I seropositivity, a positive bacterial index, and disease in more than two body areas were also identified as risk factors for T1R. These data indicate that there are important clinical data which can be used to predict an individual patient's risk of developing T1R.

Response of leprosy patients with single lesions to MDT.

This study reports the clinical profile and therapeutic response of seventy-two mono-lesions leprosy cases. These 72 cases were among 578 paucibacillary (PB) cases classified according to WHO (1982) and were followed-up on multidrug therapy (MDT). Of these 72 mono-lesion cases, 46 (64%) were tuberculoid (TT) cases, 24 (33%) were Indeterminate (Ind) cases and 2 (3%) were of borderline tuberculoid (BT) types. While 37.5% of these cases presented as macular patches, the remaining 62.5% had raised erythematous lesions. In majority of cases (94%), the lesions were present on the exposed parts like legs and feet, arms and hands, face, whereas only 6% presented on covered areas of trunk and buttocks. These cases were treated with dapsone 100 mg daily for 12 months and rifampicin 600 mg once a month for 6 months. After 6 months of MDT, lesions in 81% of the patients regressed clinically and by one year of therapy 96% of cases had regressed. Treatment was stopped in all cases by one year of therapy. There were no relapse or late reaction in the 5 years of post treatment follow-up. The response of mono-lesion PB cases was better than the multi-lesions PB cases at 6 months and during the post treatment follow-up period.