Diagnóstico tardío de lepra dimorfa. Presentación de un caso / No disponible

La lepra se considera una enfermedad granulomatosa, de evolución crónica, infecciosa, poco contagiosa, que afecta fundamentalmente piel y nervios periféricos, aunque puede afectar otras estructuras. La población masculina se ve afectada en mayor proporción que la población femenina a pesar de que la misma no distingue su aparición por sexo. Es una enfermedad que presenta manifestaciones clínicas muy variadas y que dependen de las respuestas inmunológicas del huésped y de su base genética. El diagnóstico temprano, realizado en el primer año de la aparición de los síntomas de la enfermedad, reviste la mayor importancia para el control de la misma. El presente artículo describe un caso de lepra dimorfa en un paciente de 38 años de edad, profesor de una escuela primaria rural con lesiones en cara y abdomen de más de dos años de evolución, constituyendo un diagnostico tardío de la enfermedad

Leprosy is considered a granulomatous disease, chronic, infectious, little contagious, affecting mainly skin and peripheral nerves, although it can affect other structures. The male population is affected in greater quantity than the female population. The disease presents varied clinical manifestations that depend on the immunological responses of the host and its genetic base. The early diagnosis, made in the first year of the appearance of the symptoms of the disease, is of great importance for its control. This article describes a case of dimorphic leprosy in a patient of 38 years of age, a teacher of a rural primary school with lesions on the face and abdomen of more than two years of evolution, constituting a late diagnosis of the disease

Casos inusuales de lepra en la provincial de Camagüey, Cuba, 2015 / No disponible

La lepra es una enfermedad común y aunque ya no constituye un problema de salud en el país ni en la provincia, sí se notifican casos todos los años. Este año notificamos casos con características clínicas inusuales, pues la lepra de Lucio es una forma de lepra lepromatosa que se observa fundamentalmente en México, siendo excepcional su presentación en nuestro medio. Es la denominada lepra difusa o moteada, no tiene nódulos sino que se caracteriza por presentar zonas de vasculitis múltiples en la que se produce necrosis dermoepidérmica y la aparición de úlceras planas que se unen entre sí y curan dejando cicatriz. Se caracteriza por presentar una infiltración difusa generalizada de la piel. Además, se presentó un segundo caso con lepra tuberculoide de lesión única, con engrosamiento de nervios cubitales de 10 años de evolución, sin tratamiento y sin ningún tipo de discapacidad. El tercer caso se presentó con manifestaciones clínicas muy floridas de una lepra dimorfa sin anestesia táctil, térmica ni dolorosa con un año de evolución sin tratamiento

Leprosy is a common illness in our area and although it no longer represents a public health problem in the state or at country level new cases are notified every year. This year we have diagnosed cases with unusual clinical characteristics, one with Lucio’s Leprosy is a form of lepromatous leprosy that is observed fundamentally in Mexico and unusual in our area. It is also defined as diffuse or spotted leprosy and the patient doesn’t have nodules but presents areas of multiple vasculitis in which dermoepidermal necrosis together with the appearance of plane ulcers that unite takes place and it cures leaving a scar. This type of leprosy is mainly characterized by a disseminated diffuse infiltration of the skin. We also had a second case with single lesion tuberculoid leprosy, presenting affectation of the ulnar nerve, without treatment, no visible deformities and diagnosed 10 years ago of the disease. And a third case with very florid clinical manifestations of dimorphous leprosy without tactile, thermal nor pain anesthesia with a year of evolution and without treatment is also presented

Clinical and histopathological evaluation of the effect of addition of immunotherapy with Mw vaccine to standard chemotherapy in borderline leprosy.

This study reports detailed analysis of clinical parameters and clearance of granuloma in borderline leprosy patients treated with immunotherapy and chemotherapy. It aims to assess the additive effect of immunotherapy (Mwvaccine) with standard MDT on clinical status of untreated borderline leprosy cases and on granuloma fraction of untreated borderline leprosy cases. Patients attending the OPD were serially recruited in two groups. A total of 150 cases in one treatment (trial) group (Mw vaccine plus MDT) and 120 cases in another treatment (control) group (MDT only) of border line leprosy have been included. After the formal written consent, detailed clinical examination, charting, smear examination of all untreated borderline patients of both groups was done, biopsies were taken from the active lesions of all patients of both groups at start of therapy and every six month thereafter till the completion of therapy. The same procedure was repeated every six months during the follow-up period. Standard MDT was given to all the patients of both groups according to type of disease. Mw vaccine 0.1 ml (0.5 x 10(9) bacilli) was injected intra-dermally at the start of therapy and every six months in addition to chemotherapy to the treatment group. The BT cases were followed up after 6 doses of MDT and 2 doses of Mw vaccine, and, the BB, BL cases were followed up after 24 doses of MDT plus 5 doses of Mw vaccine. Clinically, greater and faster improvement was observed in all the clinical parameters, faster attainment of smear negativity and two episodes of lepra reaction occurred in cases treated with combined chemotherapy and immunotherapy, as compared to controls (chemotherapy alone) wherein clinical improvement was slower in all parameters, slower attainment of smear negativity in bacillary index and seven showed the occurrence of reactions, histipathologically in addition to more rapid clearance of granuloma in immunotherapy treated group, a significant finding was an increase in the epithelioid cells population in this group. This suggests a possible immunoactivation of the macrophages especially in BB/BL immunotherapy group. Overall comparison of regression induced by chemotherapy alone with that induced by combined chemotherapy and immunotherapy shows a greater reduction in clinical parameters as well as granuloma fraction in BT cases as well as in BB/BL cases. This trial shows the potential usefulness of this approach of addition of immunotherapy to standard chemotherapy in borderline leprosy cases which leads to in faster recovery from disease reduced chances of reactions and faster granuloma clearance. Such information is expected to be useful in improving the immunotherapeutic approaches for treatinggranulomatous conditions in general and in leprosy in particular.

Lepra dimorfa en estado reaccional tipo 1 y 2 / Multibacillary borderline leprosy with leprosy reaction type 1 and 2

El enfoque de los pacientes con lepra se ha modificado de forma positiva en los últimos años; sin embargo, las reacciones lepróticas siguen siendo un problema clínico importante. Se reporta el caso de un paciente con lepra dimorfa multibacilar que presentó reacción leprótica tipo 1 y 2. Se discute la dificultad de su manejo.

Leprosy in type I reaction and diabetes mellitus in a patient with HIV infection

A 24-year-old man was referred to our department with history of a pale red raised lesion over the right side of the face with impaired sensation of 3 months' duration. He also had generalized weakness and increased thirst for the past 1 month. He had been treated with multidrug therapy for leprosy for 3 months and oral prednisolone for 1 month by his general practitioner. He also presented with a history of multiple sexual exposures with commercial sex workers and an ulcer ovver the penis 2 years ago, which healed spontaneously.

[Leprosy simulating other diseases]. / Lepra simulando otras enfermedades.

The low current prevalence of leprosy in Spain together with the diversity of its clinical expression make the detection of this disease difficult. Three native and three imported cases are here reported. Different specialists mistook this disease for other entities: familial polyneuropathy, autoimmune disease, tuberculosis, cutaneous mycosis, and cutaneous sarcoidosis. Lepra is a very polymorphic disease and its diagnosis is based on finding cutaneous hypoesthesic lesions, neural thickening and presence of acid-fast bacilli (in cutaneous specimens or nasal exudates).

Reatividade da lesäo cutânea de hanseníase a imunógenos epicutâneo e intradérmico / Rectivity of the leprous cutaneous by intradermic and epicutaneous immunogens

FUNDAMENTOS - Foram observados dois pacientes de doenças imunes da pele, cuja extensäo foi delimitada pela lesäo cutânea de hanseníase, sugerindo comportamentos imunológicos diferentes entre área afetada e a pele sadia do mesmo paciente. OBJETIVOS - Verificar experimentalmente, pelo teste epicutâneo com DNCB e intradêrmico com candidina, se na lesäo cutânea da hanseníase TT e BT existem modificaçöes da imunidade celular em relaçäo à pele aparentemente normal do mesmo paciente. MÉTODOS - Foram selecionados 39 voluntários portadores de hanseníase TT e BT. Em 26, foi aplicado DNCB epicutâneo e, em 13, candidina intradérmica. Os resultados desses testes foram avaliados por: resposta clínica, estudo histopatológico e exame imuno-histoquímico dos componentes celulares das reaçöes. RESULTADOS - A resposta clínica à aplicaçäo epicutânea de DNCB na lesäo de hanseníase TT e BT foi maior do que na pele sadia do mesmo paciente. Näo houve diferença com a aplicaçäo intradérmica de candidina nesses locais. As CL apresentaram diminuiçäo de número nos locais de aplicaçäo de DNCB, permanecendo esse número inalterado nos locais testados com candidina. CONCLUSOES - A lesäo cutânea de hanseníase (TT e BT) responde de modo mais intenso ao imunógeno aplicado por via epicutânea do que a pele sadia do mesmo paciente. Sugere-se que a hanseníase (TT e BT) interfira na reatividade da pele ao nível da lesäo cutânea e que as células de Langerhans näo participem dessa reatividade

Immunotherapy of lepromin-negative borderline leprosy patients with low-dose Convit vaccine as an adjunct to multidrug therapy; a six-year follow-up study in Calcutta.

The present report, which describes management of lepromin-negative borderline leprosy patients with low-dose Convit vaccine, is an extension of our earlier study on the treatment of lepromatous leprosy patients with low-dose Convit vaccine as an adjunct to multidrug therapy (MDT). The test Group I, consisting of 50 lepromin-negative, borderline leprosy patients, were given low-dose Convit vaccine plus MDT. The control group II consisted of 25 lepromin-negative, borderline leprosy patients given BCG vaccination plus MDT and 25 lepromin-negative, borderline leprosy patients given killed Mycobacterium leprae (human) vaccine plus MDT. The control group III consisted of 50 lepromin-positive, borderline leprosy patients not given any immunostimulation but given only MDT. Depending upon the lepromin unresponsiveness, the patients were given one to four inoculations of the various antileprosy vaccines and were followed up every 3 months for 2 years for clinical, bacteriological and immunological outcome. All patients belonging to the test and control groups showed clinical cure and bacteriological negativity within 2 years. However, immunologic potentiation, assessed by lepromin testing and the leukocyte migration inhibition test (LMIT), was better in the test patients receiving low-dose Convit vaccine plus MDT than in the control patients receiving BCG vaccine plus MDT or killed M. leprae vaccine plus MDT or MDT alone. But the capacity of clearance bacteria (CCB) test from the lepromin granuloma showed poor bacterial clearance in the test patients. However, there was no relapse during 6 years of follow up. Two mid-borderline (BB) patients had severe reversal reactions with lagophthalmos and wrist drop during immunotherapy despite being given low-dose Convit vaccine.

Immunotherapy of lepromin-negative borderline leprosy patients with low-dose convit vaccine as an adjunct to multidrug therapy; a six-year follow-up study in Calcutta

The present report, which describes management of lepromin-negative borderline leprosy patients with low-dose Convit vaccine, is an extension of our earlier study on the treatment of lepromatous leprosy patients with low-dose Convit vaccine as an adjunct to multidrug therapy (MDT). The test Group I, consisting of 50 lepromin-negative, borderline leprosy patients, were given low-dose Convit vaccine plus MDT. The control group II consisted of 25 lepromin-negative, borderline leprosy patients given BCG vaccination plus MDT and 25 lepromin-negative, borderline leprosy patients given killed Mycobacterium leprae (human) vaccine plus MDT. The control group III consisted of 50 lepromin-positive, borderline leprosy patients not given any immunostimulation but given only MDT. Depending upon the lepromin unresponsiveness, the patients were given one to four inoculations of the various antileprosy vaccines and were followed up every 3 months for 2 years for clinical, bacteriological and immunological outcome. All patients belonging to the test and control groups showed clinical cure and bacteriological negativity within 2 years. However, immunologic potentiation, assessed by lepromin testing and the leukocyte migration inhibition test (LMIT), was better in the test patients receiving low-dose Convit vaccine plus MDT than in the control patients receiving BCG vaccine plus MDT or killed M. leprae vaccine plus MDT or MDT alone. But the capacity of clearance bacteria (CCB) test from the lepromin granuloma showed poor bacterial clearance in the test patients. However, there was no relapse during 6 years of follow up. Two mid-borderline (BB) patients had severe reversal reactions with lagophthalmos and wrist drop during immunotherapy despite being given low-dose Convit vaccine.