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1.
BMC Infect Dis ; 19(1): 1013, 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31783808

RESUMEN

BACKGROUND: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. CASES PRESENTATION: We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. CONCLUSIONS: This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.


Asunto(s)
Lepra Multibacilar/diagnóstico , Úlcera Cutánea/diagnóstico , Adolescente , Adulto , Anciano , Errores Diagnósticos , Humanos , Leprostáticos , Lepra Multibacilar/complicaciones , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Piel/patología , Úlcera Cutánea/complicaciones
2.
Int J Dermatol ; 58(12): 1415-1422, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31148144

RESUMEN

BACKGROUND: Dermatological diseases have a negative impact on quality of life (QoL), affecting mental and physical health. Leprosy patients usually present with a worse QoL compared with those affected by other conditions. Reactions, neural damage, and pain are some of the consequences that contribute to the lower QoL. However, due to the wide spectrum of the disease, symptoms vary according to leprosy's subtype. This study aimed to compare the QoL between paucibacillary and multibacillary leprosy patients. Individuals were also compared considering the presence of reactions and a correlation between questionnaires was performed. METHODS: A total of 104 patients with leprosy aged 18 years old and over were selected. QoL was assessed by the Brazilian-Portuguese validated versions of the Medical Outcomes Study 36-item short-form health survey (SF-36) and the Dermatology Life Quality Life Index (DLQI). RESULTS: Multibacillary patients showed a more impaired physical function, worse bodily pain, lower score of SF-36, and higher interference of skin on the performance of daily activities when compared to the paucibacillary group. Individuals without reactions presented lower bodily pain and less effect of the skin on clothing choices compared to those with reactions. The SF-36 domains exhibited weak correlations with most DLQI questions, and the linear regression model showed that 32% of changes in QoL were related to the skin aspect. CONCLUSIONS: Multibacillary leprosy patients have a worse QoL when compared to paucibacillary patients. Reactions played a small role in the QoL of our cohort of patients.


Asunto(s)
Lepra Multibacilar/psicología , Lepra Paucibacilar/psicología , Dolor/psicología , Calidad de Vida , Adulto , Brasil , Femenino , Encuestas Epidemiológicas/estadística & datos numéricos , Humanos , Lepra Multibacilar/complicaciones , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/microbiología , Lepra Paucibacilar/complicaciones , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/microbiología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Dolor/diagnóstico , Dolor/etiología , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Piel/microbiología , Piel/patología
3.
Am J Trop Med Hyg ; 100(5): 1145-1148, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30915953

RESUMEN

Type 1 reactions, characterized by increasing lesion erythema, pain, and nerve damage, commonly complicate leprosy. Dapsone hypersensitivity syndrome (DHS) is a potentially fatal reaction occurring 6-8 weeks into dapsone therapy. We present a case of intercurrent Type 1 reaction and DHS in a multibacillary leprosy patient recently started on multidrug treatment.


Asunto(s)
Dapsona/efectos adversos , Hipersensibilidad a las Drogas/complicaciones , Leprostáticos/efectos adversos , Lepra Multibacilar/complicaciones , Lepra Multibacilar/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Humanos , Lepra Multibacilar/diagnóstico , Masculino , Persona de Mediana Edad , Mycobacterium leprae , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/microbiología , Centros de Atención Terciaria , Resultado del Tratamiento
6.
Am J Trop Med Hyg ; 98(6): 1609-1613, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29611495

RESUMEN

Neural pain is a frequent symptom in leprosy disease. There is a paucity of data regarding neural pain diagnostics resulting in common prescriptive errors when neuritis is confused with neuropathic or mixed nociceptive-neuropathic pain. The present study identified important demographic, clinical, and neurophysiological features of 42 leprosy neuropathy patients presenting neuropathic pain (NP). During routine evaluations, patients were selected asking if they had ever experienced neural pain. Data analyses of their pain characteristics, clinical examination results, and both the Douleur Neuropathique 4 Questionnaire and Hamilton Depression Scale scores were used to classify these patients. The most common word they used to describe the sensation of pain for 25 (60%) of these patients was "burning." In the early stages of the disease and before leprosy diagnosis, 19 (45%) had already complained about NP and leprosy treatment was unable to prevent its occurrence in 15 (36%). Leprosy reactions, considered NP risk factors, occurred in 32 (76%) cases. Knowledge of typical NP characteristics could be used to develop more effective therapeutic approaches for a notoriously difficult-to-treat pain condition.


Asunto(s)
Lepra/complicaciones , Neuralgia/fisiopatología , Adulto , Anciano , Femenino , Humanos , Lepra/epidemiología , Lepra/fisiopatología , Lepra Multibacilar/complicaciones , Lepra Multibacilar/epidemiología , Lepra Multibacilar/fisiopatología , Masculino , Persona de Mediana Edad , Trastornos Motores/epidemiología , Trastornos Motores/etiología , Conducción Nerviosa/fisiología , Neuralgia/epidemiología , Neuralgia/etiología , Dolor , Dimensión del Dolor , Trastornos de la Sensación/epidemiología , Trastornos de la Sensación/etiología , Adulto Joven
8.
São Paulo; s.n; 2018. 9 p. tab, graf.
No convencional en Inglés | Sec. Est. Saúde SP, HANSEN, SESSP-ILSLPROD, Sec. Est. Saúde SP, SESSP-ILSLACERVO, Sec. Est. Saúde SP | ID: biblio-1024912

RESUMEN

The inflammatory cytokines involved in the immune response to chronic periodontal disease (CPD) in the context of leprosy reactions (LR) were analyzed in 57 new cases of multibacillary leprosy (MBL). They were stratified by the presence of CPD and LR. Messenger RNA (mRNA) expression of inflammatory mediators was determined by qRT-PCR using skin biopsy and by ELISA using serum samples, maintaining 5% of significance level in ANOVA and correlation analyses. Twenty-three (40.4%) patients presented the first LR, whereas 22 (45.0%) patients presented CPD. IL-4 and IL-6 serum levels were significantly lower in patients with CPD and LR than in patients without CPD but with LR; IFN-γ serum levels were higher in patients with CPD and LR than in patients with no CPD and no LR; IL-4 serum levels were negatively correlated with TNF-α gene expression, while IL-6 serum levels were positively correlated with IFN-γ gene expression, in the skin of subjects with CPD and LR. The presence of DPC in individuals with LR immunoregulated IL-6, IFN-γ, and IL-4 concentrations. The presence of DPC decreased serum levels of IL-6 and IL-4 in reactional individuals. CPD concomitant to LR resulted in increased IFN-γ serum levels.


Asunto(s)
Enfermedades Periodontales/patología , Lepra Multibacilar/complicaciones , Citocinas , Lepra/inmunología
12.
An. bras. dermatol ; 91(5,supl.1): 69-71, Sept.-Oct. 2016. graf
Artículo en Inglés | LILACS | ID: biblio-837954

RESUMEN

Abstract Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This bacillus has a high predilection for skin and peripheral nerves. The scalp’s anatomical properties do not favor the development of such mycobacterium. We report a case of leprosy with scalp involvement, a rare occurrence in our literature.


Asunto(s)
Humanos , Masculino , Adolescente , Dermatosis del Cuero Cabelludo/microbiología , Lepra Multibacilar/patología , Cuero Cabelludo/patología , Dermatosis del Cuero Cabelludo/patología , Biopsia , Alopecia/microbiología , Alopecia/patología , Lepra Multibacilar/complicaciones
13.
An Bras Dermatol ; 91(3): 345-9, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27438203

RESUMEN

Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.


Asunto(s)
Lepra Multibacilar/diagnóstico , Síndrome de Sweet/diagnóstico , Adulto , Eritema/diagnóstico , Femenino , Histiocitos/patología , Humanos , Leprostáticos/uso terapéutico , Lepra Multibacilar/complicaciones , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Neutrófilos/patología , Prednisona/uso terapéutico , Síndrome de Sweet/tratamiento farmacológico , Síndrome de Sweet/etiología , Síndrome de Sweet/patología , Talidomida/uso terapéutico
14.
Lepr Rev ; 87(1): 78-92, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-27255061

RESUMEN

UNLABELLED: The working hypothesis is that, viable Mycobacterium leprae (M. leprae) play a crucial role in the precipitation of Type 1 reaction (T1R) in leprosy. MATERIAL AND METHODS: A total of 165 new multibacillary patients were studied. To demonstrate presence of viable M. leprae in reactional lesion (T1R+), three tests were used concurrently viz. growth in the mouse foot pad (MFP), immunohistochemical detection of M. leprae secretory protein Ag85, and 16s rRNA--using in situ RT-PCR. Mirror biopsies and non reactional lesions served as controls (T1R-). FINDINGS: A significantly higher proportion of lesion biopsy homogenates obtained at onset, from T1R(+) cases have shown unequivocal growth in MFP, proving the presence of viable bacteria, as compared to T1R(-) (P < 0.005). In contrast, few Mirror biopsies were positive in both T1R(+) and T1R(-). With respect to Ag85, while the overall positivity was higher in T1R(+) (74%), however the intensity of staining (Grade 2+) was disproportionately higher in T1R(+) BT-BB lesions 11/20 (55%). In the rebiopsies obtained during a repeat episode of T1R, Ag 85 as well as 16s rRNA, positivity (62% & 100%) was higher in T1R(+). It is inferred therefore 'viable' bacteria are an essential component in T1R and difference in the quality of bacilli, not the quantity or the ratio of dead to viable play a role in the precipitation of T1R. In conclusion, the findings show that 'metabolically active' M. leprae is a component/prerequisite and the secretory protein Ag 85, might be the trigger for precipitation of T1R.


Asunto(s)
Lepra Multibacilar/complicaciones , Lepra Multibacilar/microbiología , Mycobacterium leprae/fisiología , Adolescente , Adulto , Animales , Antígenos Bacterianos/aislamiento & purificación , Proteínas Bacterianas/aislamiento & purificación , Bioensayo , Femenino , Humanos , Lepra Multibacilar/patología , Masculino , Ratones , Persona de Mediana Edad , ARN Bacteriano/aislamiento & purificación , ARN Ribosómico 16S/genética , ARN Ribosómico 16S/aislamiento & purificación , Piel/microbiología , Piel/patología , Adulto Joven
15.
BMC Infect Dis ; 16: 258, 2016 06 08.
Artículo en Inglés | MEDLINE | ID: mdl-27278453

RESUMEN

BACKGROUND: The clinical spectrum of leprosy is dependent on the host immune response against Mycobacterium leprae or the newly discovered Mycobacterium lepromatosis antigen. Helminth infections have been shown to affect the development of several diseases through immune regulation and thus may play a role in the clinical manifestations of leprosy and leprosy reactions. The purpose of this study is to determine the proportion of helminth infections in leprosy and its association with the type of leprosy and type 2 leprosy reaction (T2R). METHODS: History or episode of T2R was obtained and direct smear, formalin-ether sedimentation technique, and Kato-Katz smear were performed on 20 paucibacillary (PB) and 61 multibacillary (MB) leprosy participants. RESULTS: There are more helminth-positive participants in MB leprosy compared to PB (11/61 versus 0/20, p = 0.034) and in T2R participants compared to non-T2R (8/31 versus 3/50, p = 0.018). CONCLUSIONS: Our results suggest that soil-transmitted helminth infections may have a role in the progression to a more severe type of leprosy, as well as the occurrence of T2R. These findings could serve as a fundamental base for clinicians to perform parasitological feces examination in patients who have MB leprosy and severe recurrent reactions to rule out the possibility of helminth infection. Further secondary confirmation of findings are needed to support these conclusions.


Asunto(s)
Helmintiasis/epidemiología , Helmintos/aislamiento & purificación , Lepra Multibacilar/epidemiología , Mycobacterium leprae/inmunología , Microbiología del Suelo , Adolescente , Adulto , Animales , Estudios Transversales , Heces/parasitología , Femenino , Helmintiasis/complicaciones , Helmintiasis/parasitología , Humanos , Indonesia/epidemiología , Lepra Multibacilar/complicaciones , Lepra Multibacilar/microbiología , Masculino , Persona de Mediana Edad , Recuento de Huevos de Parásitos , Adulto Joven
16.
An. bras. dermatol ; 91(3): 345-349, tab, graf
Artículo en Inglés | LILACS | ID: lil-787306

RESUMEN

Abstract Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.


Asunto(s)
Humanos , Femenino , Adulto , Síndrome de Sweet/diagnóstico , Lepra Multibacilar/diagnóstico , Talidomida/uso terapéutico , Prednisona/uso terapéutico , Síndrome de Sweet/etiología , Síndrome de Sweet/patología , Síndrome de Sweet/tratamiento farmacológico , Eritema/diagnóstico , Lepra Multibacilar/complicaciones , Lepra Multibacilar/patología , Lepra Multibacilar/tratamiento farmacológico , Histiocitos/patología , Leprostáticos/uso terapéutico , Neutrófilos/patología
19.
An Bras Dermatol ; 91(5 suppl 1): 69-71, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-28300899

RESUMEN

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. This bacillus has a high predilection for skin and peripheral nerves. The scalp's anatomical properties do not favor the development of such mycobacterium. We report a case of leprosy with scalp involvement, a rare occurrence in our literature.


Asunto(s)
Lepra Multibacilar/patología , Dermatosis del Cuero Cabelludo/microbiología , Dermatosis del Cuero Cabelludo/patología , Adolescente , Alopecia/microbiología , Alopecia/patología , Biopsia , Humanos , Lepra Multibacilar/complicaciones , Masculino , Cuero Cabelludo/patología
20.
Int J Dermatol ; 54(12): 1407-13, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26227884

RESUMEN

BACKGROUND: Most countries that were previously highly endemic for leprosy have achieved elimination at the national level. OBJECTIVES: To find out the pattern, prevalence, and trends of leprosy in the post-elimination stage. METHODS: A descriptive retrospective cross-sectional study was carried out using the registered records of patients attending the leprosy clinic in Chittagong Medical College Hospital between the periods 2001 and 2011. RESULTS: The new case detection rate was declining. The prevalence rate was 0.75 at the end of 2011. Of a total of 789 patients, males (74%) outnumbered the females (26%). The age of the patients in the study group ranged from 6 years to 87 years with mean age 35.58 years ± 0.05 SEM. Paucibacillary (PB) and multibacillary (MB) cases were 314 (39.80%) and 475 (60.20%), respectively. MB percentage was increasing more among new cases in the study period, and 119 (15.08%) patients presented with grade 2 deformities. Smear positive cases were 141 (17.87%). Leprosy reaction comprised of 193 (24.46%) type 1, 68 (8.62%) type 2, and 97 (12.29%) neuritis cases. LIMITATIONS: This is a retrospective study from a single tertiary health center. CONCLUSION: MB cases with grade 2 deformities are in an upward trend, and rates of children are declining. Developing reinforced new therapies to curb reactions, deformities are very important and contact tracing, especially of children, is essential. Domiciliary treatment needs to be made available to ensure early diagnosis.


Asunto(s)
Lepra Multibacilar/epidemiología , Lepra Paucibacilar/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bangladesh/epidemiología , Niño , Estudios Transversales , Erradicación de la Enfermedad , Femenino , Humanos , Incidencia , Lepra Multibacilar/complicaciones , Lepra Multibacilar/prevención & control , Lepra Paucibacilar/complicaciones , Lepra Paucibacilar/prevención & control , Masculino , Persona de Mediana Edad , Neuritis/microbiología , Prevalencia , Estudios Retrospectivos , Centros de Atención Terciaria , Adulto Joven
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