Lepromatous leprosy with an uncommon presentation: a case report.

28 yr old male presented with asymptomatic nodules and few well to ill defined papules on ears, asymmetrical nerve enlargement and evanescent tender nodules on the extremities without any infiltration of the skin and madarosis. Slit skin smear done from normal skin was BI 6+. Skin biopsy showed features of lepromatous leprosy.

[Reliability and agreement of two smear reading scales for classification and monitoring of multidrug therapy in leprosy patients]. / Confiabilidad y concordancia de dos escalas de lectura de baciloscopias para clasificación y seguimiento del tratamiento con múltiples medicamentos de los pacientes con lepra.

INTRODUCTION: After the clinical diagnosis of leprosy, classification methods are necessary to define a treatment and prognosis of patients consistent with bacterial load. Bacteria are detected in skin smear, and bacterial load typically is established by the internationally used Ridley's logarithmic scale, However, in Colombia an alternative semiquantitative scale is used. OBJECTIVE: The interobserver reproducibility was established for the Ridley and Colombia scales, and the level of correlation-matching was identified between the bacillary indices obtained in order to assess the degree of interchangeability. MATERIALS AND METHODS: Standardization was attained by a reading of the smears by 2 readers with subsequent, blinded evaluation of inter-observer agreement. Each reader quantified the bacterial load of for each sample (n=325) using the Colombian and the Ridley scales. The degree of interobserver agreement was assessed with weighted kappa coefficient. The level of correlation and agreement between the measurements of the bacillary index was established with coefficient of Lin. RESULTS: The interobserver weighted kappa coefficient was 0.83 for the Colombia scale and 0.85 for the Ridley scale. The Lin coefficient was 0.96 for the correlation-matching of bacillary indexes. CONCLUSIONS: Interobserver agreement obtained for both scales was excellent as the correlation-matching bacillary indices determined with both methods. With the cut-off points yielded a good level of agreement, ensuring interchangeability between the scales defining the high or low bacterial load.

Possible mode of emergence for drug-resistant leprosy is revealed by an analysis of samples from Mexico.

Mexico is a country with sporadic leprosy cases, and the reemergence of drug resistance is a concern. In this study, molecular analysis of Mycobacterium leprae was employed to clarify the spread of drug-resistant leprosy. Thus, drug resistance-determining regions in the folP1, rpoB, and gyrA genes, which are associated with resistance to dapsone, rifampicin, and ofloxacin, respectively, were analyzed by direct sequencing of the PCR product. No mutations in the folP1 gene were observed in any of the 72 slit skin samples obtained from 38 patients, although two samples carrying a mutation at codon 425 in the rpoB gene, which confers resistance to rifampicin, a key component of multidrug therapy, were identified. In addition, a mutation at codon 91 in the gyrA gene, which correlates with ofloxacin resistance, was found in one sample. These results demonstrate the existence of rifampicin- and ofloxacin-resistant leprosy. Interestingly, wild-type and mutant sequences in the gyrA gene were found to coexist in one clinical sample. In addition, all three drug resistance-related mutations were found in only one of the two earlobes of the patients concerned, suggesting a possible pathway for the spread of drug-resistant M. leprae.

Canadian case report of erythema nodosum leprosum successfully treated with prednisone and thalidomide.

BACKGROUND: Erythema nodosum leprosum (ENL) is a disease rarely encountered in Canada. It is characterized by multiple remissions and recurrences, often requires long-term treatment, and can result in debilitating sequelae. OBJECTIVE: To promote rapid recognition and adequate therapy for ENL. METHODS: Case report of a 39-year-old man diagnosed with an ENL. The clinical and histopathologic features, treatment provided, and response to treatment are detailed in this article. RESULTS: ENL presented itself as painful cutaneous lesions on the face and limbs, bilateral paresthesia of the fourth and fifth fingers, and systemic symptoms. Prednisone 40 mg daily for a week and then 60 mg daily for another week reduced the lesions by 80% and the pain by 50%. Although prednisone 60 mg daily was continued for one more week and then stopped, thalidomide was started at a dose of 300 mg daily for 4 weeks and then reduced gradually, which led to complete resolution. CONCLUSION: At the 7(1/2)-month follow-up, the patient remained completely asymptomatic.

Skin smears in leprosy: is reduction in number of sites justified?

An analysis of 377 sets of positive skin smears of leprosy patients was done to determine the minimum sites needed to detect all smear positive leprosy patients. A combination of earlobe and a selective site could pick up 95.5% of the patients. An additional smear from the forehead increased the sensitivity of 97.7%. The results suggest that the sites for skin smears may be reduced to a combination of the earlobe and one selective site smear from a skin lesion to be able to detect most smear positive leprosy patients.

Survey for leprosy in nine-banded armadillos (Dasypus novemcinctus) from the southeastern United States.

Ears from 853 nine-banded armadillos (Dasypus novemcinctus) from Alabama, Arkansas, Florida, Georgia and Mississippi were examined microscopically for evidence of leprosy. All were negative for both acid-fast bacteria (Mycobacterium leprae) and lesions compatible with leprosy.

Acid fast bacilli in lymph node aspirate and smears from ear lobules and fingers in long treated patients.

Skin slit smears from fingers and ear lobules and lymph node aspiration smears stained with Ziehl-Neelsen stain were studied in 43 patients of LL or BL disease. All the patients had taken dapsone monotherapy for 3-7 years. None of the patients had clinical evidence of dapsone resistance. Small number of bacilli were detected in 16 patients. Lymph node aspirate was positive in 5 cases, whereas ear lobule and fingers yielded bacilli in 12 and 13 cases respectively. It is recommended that in addition to the traditional ear lobe it is imperative to study other sites as well. Study from fingers is recommended for the sake of simplicity. Where facilities are available sampling of the lymph node may also be attempted to advantage.

Choice of skin slit smears for study of bacterial and morphological indices.

Skin slit smears of 46 patients of lepromatous leprosy (16 untreated, 30 long treated) were studied from ear lobules, fingers, elbows and knees. In untreated patients ear lobules gave highest BI, as compared to other sites. MI from ear lobules was higher than elbows and knees but slightly lower than that from fingers. In treated patients sites other than ear lobules yielded solid staining bacilli more frequently. Multiple sites and especially peripheral sites are recommended for study of skin slit smears to discover persistent bacilli.