The potential role of artificial intelligence in the clinical management of Hansen's disease (leprosy).

Missed and delayed diagnoses of Hansen's disease (HD) are making the battle against it even more complex, increasing its transmission and significantly impacting those affected and their families. This strains public health systems and raises the risk of lifelong impairments and disabilities. Worryingly, the three countries most affected by HD witnessed a growth in new cases in 2022, jeopardizing the World Health Organization's targets to interrupt transmission. Artificial intelligence (AI) can help address these challenges by offering the potential for rapid case detection, customized treatment, and solutions for accessibility challenges-especially in regions with a shortage of trained healthcare professionals. This perspective article explores how AI can significantly impact the clinical management of HD, focusing on therapeutic strategies. AI can help classify cases, ensure multidrug therapy compliance, monitor geographical treatment coverage, and detect adverse drug reactions and antimicrobial resistance. In addition, AI can assist in the early detection of nerve damage, which aids in disability prevention and planning rehabilitation. Incorporating AI into mental health counseling is also a promising contribution to combating the stigma associated with HD. By revolutionizing therapeutic approaches, AI offers a holistic solution to reduce the burden of HD and improve patient outcomes.

Clinical and radiological evaluation of maxillofacial and otorhinolaryngological manifestations of Hansen's disease.

To characterize maxillofacial, otorhinolaryngological and oral manifestations of Hansen's disease (HD), we conducted a cross-sectional study in 21 current patients attending the Unidade Básica de Saúde de Jardim América, Espírito Santo, Brazil and 16 former patients resident at Pedro Fontes Hospital using data from computed tomography imaging, rhinoscopy, and oroscopy. Maxillofacial characteristics were compared with 37 controls. Differences in bone alterations across the three groups were determined mainly by severe resorption/atrophy being more frequent in former HD patients, with severe resorption/atrophy of the anterior alveolar process of maxilla in 50.0% (8/16) of former patients, 28.6% (6/21) of current patients and 10.8% (4/37) of controls and of nasal bones and aperture in 31.3% (5/16) of former patients compared with 0/21 current patients and two controls. There were no substantial differences in otorhinolaryngological and oroscopic findings between the two patient groups. HD patients had more tooth loss than the age-matched control group. Maxillofacial, otorhinolaryngological and oroscopic finding scores were strongly correlated only in current HD patients. Correlation between otorhinolaryngological and maxillofacial scores suggests that protocols for HD patient assessment and follow-up could include otorhinolaryngological evaluation, with radiological imaging where necessary, subject to replication of our findings in a larger study.

Hansen's disease and COVID-19 co-infection in Brazil.

BACKGROUND: The implications of COVID-19 co-infection in patients under treatment for Hansen's disease (HD, leprosy) remain uncertain. We aimed to describe clinical characteristics, treatments, and outcomes in patients with HD and COVID-19 in Brazil. METHODS: Cross-sectional study recruiting adult HD patients with PCR-confirmed COVID-19 from five HD treatment centers in Brazil between March 1, 2020, and March 31, 2021. At the time of this study, no patient had received COVID-19 vaccine. RESULTS: Of 1377 patients under treatment for HD, 70 (5.1%) were diagnosed with COVID-19. Of these, 41 (58.6%) had PCR-confirmed COVID-19, comprising 19 men and 22 women, aged 24-67 (median 45) years. HD was multibacillary in 39/41 patients. Eight patients ceased WHO Multi-Drug Therapy for HD, three for lack of drugs, two because of COVID-19, and three for other reasons. Of the 33 who continued treatment, 26 were on the standard regimen and seven an alternative regimen. Seventeen patients were receiving oral prednisone, including nine patients with type 1 reaction, four with type 2 reaction, three with neuritis, and one with rheumatologic disease. Twelve patients were hospitalized for COVID-19, and six patients died, of whom three had hypertension and one also had type 2 diabetes and obesity. CONCLUSIONS: COVID-19 and Hansen's disease co-infection did not appear to change the clinical picture of either disease in this cross-sectional study. The wider impact of the pandemic on persons affected by HD requires follow-up and monitoring.

Assessing signs of torture: A review of clinical forensic dermatology.

BACKGROUND: It is important for dermatologists and other physicians in refugee-receiving countries to acquire knowledge of forensic dermatology to identify lesions from torture. OBJECTIVE: Review forensic dermatology in cases of torture. RESULTS: In provision of medical assessment and care to refugees and migrants, chronic skin lesions will be the most readily identifiable signs of torture. Beatings are common, with blunt force trauma resulting in postinflammatory hyperpigmentation. Torture burns can be thermal, chemical, or electrothermal, causing distinct lesions determined by the method, duration, and intensity of exposure, and area of skin affected. Sharp instruments inflict a wide range of lesions arising from stabbing/perforation or cuts from knives. Wound healing without medical attention and in unsanitary conditions will affect the scarring process. Lesions from suspension and ligatures may occur alongside scars from other forms of torture. Differential diagnoses include self-inflicted wounds, ethnic scarification, and scars from traditional healing practices. CONCLUSION: Physicians who may encounter survivors of torture in community or specialist practice would benefit from basic training in forensic dermatology, whereas knowledge of common forms of torture and cultural practices in refugees' countries of origin is important when considering differential diagnoses of skin lesions.

Leprosy in skulls from the Paris Catacombs.

Background: The Paris Catacombs contain the remains of approximately 6 million people dating back to the 15th century, when leprosy was endemic in France.Aims: The aim of this palaeopathological study was to identify the presence of leprosy in skulls from the Paris Catacombs.Subjects and methods: Macroscopic examination of skulls in situ for bone changes secondary to oronasal soft tissue infection by leprosy. Skulls were categorised as having "probable" signs of leprosy if they had an enlarged nasal (pyriform) aperture, resorption of the anterior nasal spine, and resorption of the alveolar processes of maxilla, and as having "possible" signs of leprosy if they met one of these three criteria.Results: Skulls from 123 sections within the Catacombs (approximately 1500 remains in total) were triaged, with 367 skulls identified as suitable for examination. Of these, 74 had central facial bone alterations/abnormalities and underwent detailed examination, yielding 0.5% (2/367) classified as having probable, and 5.7% (21/367) possible signs of leprosy.Conclusions: The proportion of skulls with probable signs of leprosy gives an approximate estimate (0.5%) for the prevalence of this disease in the population of Paris (or districts of Paris) during the 15-18th centuries.

Dental and oral condition in leprosy patients from Serra, Brazil.

OBJECTIVES: To describe dental and periodontal diseases and oral lesions in newly diagnosed leprosy patients. DESIGN: Cohort study with 99 leprosy patients carried out at the Leprosy Control Programme Outpatient Clinic, Serra-ES, Brazil. A questionnaire about demographic and clinical data was used. Clinical oral examination was performed through the decayed, missing and filled teeth index (DMFT index), the use and need of prosthesis, periodontal disease and the presence of mucous membrane oral lesions. Skin and oral mucous biopsies were also undertaken. RESULTS: Decayed teeth were present in 73% of the patients, at least one lost tooth was present in 71.4%, the mean of the number of lost teeth among the patients in this survey was 88; and 603% of the patients did not have their teeth filled. Periodontal disease was present in 80.8%, and gingival bleeding in 92% of the patients. DMFT index average was 14.4. Nine out of the 63 patients presented with oral clinical lesions, however, most of them presented with unspecific chronic inflammation and typical epithelial hyperplasia. CONCLUSIONS: These newly diagnosed leprosy patients were similar in respect of oral health to the normal Brazilian population. Serious dental loss and edentulism were observed, as were a high DMFT index and frequency of periodontal diseases. These data highlight a lack of oral health prevention and treatment and poor access even when available.

Leprosy occurring as immune reconstitution syndrome.

Immune reconstitution inflammatory syndrome (IRIS) may occur in HIV-infected patients after starting highly active antiretroviral therapy (HAART). Since 2003, 19 cases were published as IRIS. Leprosy has been reported as an example of an IRIS, and it is important that this syndrome should be recognized in leprosy-endemic areas. The case definition of leprosy as IRIS is based on clinical presentation of leprosy, evidence of immune restoration and timing of onset. Case definition should include the following: (1) leprosy and/or leprosy type 1 reaction presenting within six months of starting HAART; (2) advanced HIV infection; (3) low CD4+ count before start HAART; (4) CD4+ count increasing after HAART has been started. Although pathogenic mechanisms are still unclear, it is likely that leprosy-associated IRIS will be increasingly reported in those countries endemic for both diseases and as access to HAART becomes more widely available.

Immune reconstitution syndrome associated with leprosy: two cases.

Few cases of leprosy as immune reconstitution syndrome have been reported in patients with HIV/AIDS. Two cases of leprosy as immune reconstitution syndrome in AIDS persons are described, and clinical features, diagnostic criteria and pathogenesis are discussed.

Research regarding anti-PGL-I antibodies by ELISA in wild armadillos from Brazil.

Armadillos have been involved in leprosy transmission and are considered a source of Mycobacterium leprae in numerous reports. Clinicians from certain areas of the USA consider contact with armadillos a risk factor for leprosy. However, there is a challenge associated with the role of wild armadillos perpetuating human leprosy in the American Continent. The presence of anti-PGL-I antibodies was investigated in wild nine-banded armadillos from leprosy-endemic areas in State of Espirito Santo, Brazil, by ELISA performed on serum samples from 47 armadillos. Positive ELISA was obtained from 5 (10.6%) armadillos. Infected armadillos may play some role in leprosy transmission, disseminating bacilli in the environment, perhaps making it more difficult to interrupt transmission and reduce the number of new leprosy cases. ELISA is an efficient tool for seroepidemiological investigations of Mycobacterium leprae in armadillos.

Pesquisa de anticorpos anti PGL-I através de ELISA em tatus selvagens do Brasil / Research regarding anti-PGL-I antibodies by ELISA in wild armadillos from Brazil

Tatus têm sido envolvidos na transmissão da hanseníase e considerados como fonte de Mycobacterium leprae em muitas publicações. Médicos de partes dos EUA consideram o contato com tatus um fator de risco para hanseníase. Entretanto, há um desafio associado ao papel do tatu na perpetuação da hanseníase no Continente Americano. Foi pesquisada a presença de anticorpos anti-PGL-I em tatus selvagens de áreas endêmicas em hanseníase do Estado do Espírito Santo, Brasil, através de ELISA realizado em amostras de soro de 47 animais. Elisa positivo foi encontrado em 5 (10.6%) tatus. Tatus infectados podem ter algum papel na transmissão da hanseníase disseminando bacilos no meio ambiente, talvez tornando mais difícil a interrupção da cadeia de transmissão e redução do número de casos novos de hanseníase. A técnica de ELISA é um eficiente método para investigação soroepidemiológica da presença do Mycobacterium leprae em tatus.

Armadillos have been involved in leprosy transmission and are considered a source of Mycobacterium leprae in numerous reports. Clinicians from certain areas of the USA consider contact with armadillos a risk factor for leprosy. However, there is a challenge associated with the role of wild armadillos perpetuating human leprosy in the American Continent. The presence of anti-PGL-I antibodies was investigated in wild nine-banded armadillos from leprosy-endemic areas in State of Espirito Santo, Brazil, by ELISA performed on serum samples from 47 armadillos. Positive ELISA was obtained from 5 (10.6%) armadillos. Infected armadillos may play some role in leprosy transmission, disseminating bacilli in the environment, perhaps making it more difficult to interrupt transmission and reduce the number of new leprosy cases. ELISA is an efficient tool for seroepidemiological investigations of Mycobacterium leprae in armadillos.

Adverse effects from multi-drug therapy in leprosy: a Brazilian study.

INTRODUCTION: The WHO MDT for leprosy treatment was officially introduced in Brazil in 1991 and comprises three drugs: dapsone, rifampicin and clofazimine. There are few good studies on the frequency of side-effects attributable to MDT in Brazil. METHODS: A retrospective and descriptive study carried out in a LCP in Vitória, State of Espirito Santo, Brazil. A specific and detailed protocol about side-effects was prepared and filled in from the patient records. RESULTS: One hundred ninety four patients' records were analysed looking for side-effects attributable to MDT. Side-effects were attributed to at least one MDT component in 88 (45%) patients and 85 had side-effects due to dapsone, 24 due to rifampicin and 18 due to clofazimine. 185 episodes were identified. The suspected drug was stopped in 47 out of 88 episodes (24% patients); 46 had dapsone stopped, 5 had rifampicin stopped and no-one had clofazimine stopped. CONCLUSION: Side-effects attributed to MDT is more frequent than previously described, resulting in interruption of treatment in many patients.

Characteristics of known leprosy contact in a high endemic area in Brazil.

BACKGROUND AND PURPOSE: The annual number of new cases of leprosy has not declined in Brazil over the last 15 years, indicating that transmission continues at the same level. To study transmission, we interviewed leprosy patients about their known leprosy contact (KLC). METHODS: Clinical and demographic data were collected from 506 leprosy patients in four health units in the Metropolitan Region of Vitria, State of Espírito Santo, Brazil. SPSS 9.0 was used as a database and analysis. RESULTS: Two hundred and twenty-six (44.7%) of 506 leprosy patients reported KLC, 136 (60.2%) of 226 were parents. Among 226, the mean of KLC was 1.89 (SD +/- 1.65), and 61.3% had one KLC. KLC as a household contact was reported by 92 (40.7%) out of 226, and 121 (53.5%) had no household contact. KLC were most frequently sisters and brothers in the PB cases, and sons/daughters in MB cases. Mothers occurred more frequently as a KLC than fathers. From the leprosy patients that had reported household contacts, 73% said that at the onset of their skin lesions, the KLCs were either undergoing were not yet released from treatment (RFT), and 23.45% had not begun the treatment yet. Altogether, 62.3% of 226 cases had daily contact with the KLC. CONCLUSION: In Brazil, household contacts, including the family members (mothers, sisters and brothers), as well as the social contact need to be investigated by the control programs.

Delay in the diagnosis of leprosy in the Metropolitan Region of Vitória, Brazil.

This paper reports on the time between the onset of the first lesion and diagnosis, defined as delay, and is based on results obtained by interviewers from a survey carried out amongst 450 leprosy patients in a leprosy endemic area in the Metropolitan Region of Vitória (MRV), state of Espirito Santo, Brazil. The mean age at diagnosis in all cases was 41.47 years and the median was 42.5 years. The mean age at diagnosis in MB (42.9 years) was greater than in PB (38.5 years). The mean of the delay in all cases was 25.25 months, median 12 months and range 0-360 months. The mean of the delay in MB (27.2 months) was greater than in PB (21.3 months). The results of this study suggest that although the delay in leprosy diagnosis in this region of Brazil was not too long when it was compared with other studies in endemic countries, it is still a problem: 65.4% of patients were diagnosed after a delay of 6 months. The Leprosy Control Programme in this state needs more effective health education in order to reduce the current period of delay before diagnosis.

[Record of Dasypus novemcinctus (Mammalia: Xenarthra) parasited by Tunga terasma (Siphonaptera: Tungidae) in Alegre, State of Espírito Santo, Brazil]. / Registro de Dasypus novemcinctus (Mammalia: Xenarthra) parasitado por Tunga terasma (Siphonaptera: Tungidae) em Alegre, Estado do Espírito Santo, Brasil.

During a survey of Mycobacterium leprae in wild armadillos in the State of Espírito Santo, thirty-four armadillos were captured in the municipality of Alegre (20 degrees 45'S, 41 degrees 29'W, 150m). The armadillos, Dasypus novemcinctus were examined by clinical and macroscopic examination. In four armadillos (11.7%), were found nodes in the abdomen. The nodules were identified as Tunga terasma. This is the first report of T. terasma in D. novemcinctus armadillos in the State of Espírito Santo, Brazil.

False positive reaction of the immunohistochemistry technique using anti-BCG polyclonal antibodies to identify Mycobacterium leprae in wild nine-banded armadillos.

The authors studied 66 wild nine-banded armadillos from Brazil. The ear samples were collected and Ziehl-Neelsen or Fite-Faraco stains were performed, as well as immunostaining using polyclonal BCG antibody, to avaluate the presence of the Mycobacterium leprae. The AFB were not detected by the Ziehl-Neelsen or Fite-Faraco staining, neither immunoexpression of the BCG marker. However, many normal structures from the ears of the nine-banded armadillos, such as condrocytes, condroblasts, fibroblasts and endothelial cells, and Gram positive bacteria cocci, showed false positive reaction by the BCG marker. The authors discuss the use of the immunohistochemical studies with the polyclonal BCG antibody to identify M. leprae antigens in wild armadillos.

Avaliaçäo comparativa da eficácia e toxicidade do antimoniato de N-metil-glucamina e do Estibogluconato de Sódio BP88© no tratamento da leishimaniose cutânea localizada / Evaluation of the eficacy and toxicity of N-methyl-glucamine vs BP88© Sodium Stibogluconate in the treatment of localized cutaneous leishmaniasis

Foi realizado ensaio clínico randomizado simples cego para comparar a eficácia e a toxicidade do estibogluconato de Na+ (ES) e o antimoniato de N-metil glucamina, o Glucantime®(GL). Sessenta e três pacientes foram distribuídos em um dos dois grupos: 32 pacientes foram tratados com GL e 31 pacientes com o ES. Ambos os grupos receberam 15mg Sb+5/kg/dia durante 20 dias. A toxicidade foi avaliada através do ECG, dosagens de uréia, creatinina, TGO, TGP, fosfatase alcalina, amilase, e lipase, avaliados antes do tratamento, nos dias 10 e 20 do tratamento, e 90 dias após o término do mesmo. No grupo tratado com GL 81 por cento (26/32) dos pacientes curaram, comparados com 77 por cento (24/31) no grupo do ES. Um paciente em cada grupo näo respondeu ao tratamento. TGO, TGP, amilase, e lipase foram mais elevadas no grupo que usou o ES (p < 0,05). Concluiu-se que, a eficácia de ambos os tratamentos foram similares, apesar da maior toxicidade observada no grupo tratado com ES