scholarly journals 1394. Autochthonous Leprosy in Missouri

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S782-S783
Author(s):  
Paragkumar Patel ◽  
Christian Rojas-Moreno ◽  
Taylor Nelson ◽  
Araya Zaesim ◽  
Jon Dyer
Keyword(s):  
Immune Reaction ◽  
Outdoor Exposure ◽  
Lepromatous Leprosy ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Southern Us ◽  
First Case ◽  
Facial Swelling ◽  
Mexico Border ◽  
Pre Treatment

Abstract Background Introduction: Leprosy (Hansen’s disease) is a chronic granulomatous infection of the skin/peripheral nerves caused by Mycobacterium leprae. Of 216 new cases reported in the US in 2019, 70% were in FL, LA, TX, HI, CA, GA and NY. Leprosy is considered a zoonosis in the southern US with the nine-banded armadillo as a reservoir. There have been no reported autochthonous leprosy cases in Missouri. Methods Case: 55 y/o previously healthy male noted a new rash on his arm 2 years ago. Over time it spread to his extremities/torso. Skin biopsy showed a granulomatous infiltrate, suspected granuloma annulare, but it progressed despite appropriate therapy. He noted progressive numbness of the affected areas of skin and several regional nerve distributions. In the weeks prior to his initial visit he noted facial swelling, eyelid and ear induration, worsening fatigue, diffuse arthralgia, and some vision changes. His travel history is limited to Canada, Colorado and a brief vacation to the Texas/Mexico border (no notable outdoor exposure during the latter trip; no travel outside the country). He lives in rural Missouri where he is exposed to armadillos. His dogs frequently kill them and often bring them into the yard, rolling around on/in the dead carcasses which he disposes of. He typically wears gloves when handling them and has never consumed them. On exam he had diffuse purplish-red nummular infiltrated anesthetic papules and plaques diffusely distributed over the trunk and extremities. Distinct left ulnar neuropathy was noted. He exhibited leonine facies and infiltration of the bilateral helices. Repeat biopsy showed a granulomatous infiltrate with abundant acid-fast bacilli. DNA sequencing confirmed M. leprae. He was preventatively treated with prednisone and methotrexate to minimize immune reaction, and two weeks later began a regimen of monthly rifampin, minocycline, and moxifloxacin with an anticipated duration of 24 months. Results Diagnosis lepromatous leprosy with pre-treatment immune reaction. This is potentially the first case of autochthonous leprosy in Missouri. Providers should include Hansen’s disease in the differential diagnosis of patients with dermal eruption and cutaneous neurological symptoms to avoid delays in diagnosis/care. Disclosures All Authors: No reported disclosures

scholarly journals Hansen's disease – a forgotten disease?

JRSM Open ◽  
2021 ◽  
Vol 12 (8) ◽  
pp. 205427042110359
Author(s):  
Paula Marques Ferreira ◽  
Inês Rueff Rato ◽  
Joana Rigor ◽  
Margarida Mota
Keyword(s):  
Analytical Study ◽  
Mycobacterium Leprae ◽  
Lepromatous Leprosy ◽  
Definitive Diagnosis ◽  
Lower Limbs ◽  
Biopsy Result ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Systemic Treatments ◽  
Triple Treatment

Hansen's disease, also known as leprosy, is an infection caused by the bacteria Mycobacterium leprae. The authors present the case of a 52-year-old man, born in Tondela and living in Espinho, with no pathological antecedents. The clinical picture began in April 2017, when macular lesions appeared in the lower limbs and rapidly progressed to the trunk and upper limbs, associated with complaints of pruritus but without alterations in the analytical study. After several topical and systemic treatments with glucocorticoids, antifungals, antibacterials and unsuccessful antihistamines, he was referred to an external consultation of Dermatology. He performed a biopsy of one of the lesions that revealed the definitive diagnosis: “Lepromatous Leprosy”. After the biopsy result, he started triple treatment with rifampicin, clofazimine and dapsone with improvement of the condition.

scholarly journals Humoral immunity in Hansen's Disease

1995 ◽  
Vol 113 (4) ◽  
pp. 929-934 ◽  
Author(s):  
Waldenise Cossermelli-Messina ◽  
Wilson Cossermelli
Keyword(s):  
Immune Response ◽  
Elderly Patients ◽  
Humoral Immunity ◽  
Immune Complexes ◽  
Genetic Factors ◽  
Mycobacterium Leprae ◽  
Lepromatous Leprosy ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Polar Forms

For many years immune response in leprosy has been studied. Since 1960 several reports dealing with humoral immunity have been described in the literature. Different autoantibody rates occur in leprosy. There is an increase in the prevalence of autoantibodies in elderly patients with long standing disease, in lepromatous leprosy and in those with reactional states. The diferences in rates among various studies are attributed to different methods and variations among patient samples concerning age, gender, polar forms, therapy and other elements. The prevalence of numerous antibodies, immune complexes, cryoglobulins and complement levels have been studied by many authors. This also highlights the importance of the more recent reviews of anti-Mycobacterium leprae glycolipid antibodies such as the anti-phenolic glycolipid-I antibodies in which titers are variable and depend on genetic factors.

scholarly journals Mycobacterium lepromatosis as a Second Agent of Hansen’s Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Patrícia Deps ◽  
Simon M. Collin
Keyword(s):  
United States ◽  
Case Reports ◽  
The United States ◽  
Lepromatous Leprosy ◽  
Clinical Aspects ◽  
Red Squirrels ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Mycobacterium Lepromatosis

Mycobacterium lepromatosis was identified as a new species and second causal agent of Hansen’s disease (HD, or leprosy) in 2008, 150years after the disease was first attributed to Mycobacterium leprae. M. lepromatosis has been implicated in a small number of HD cases, and clinical aspects of HD caused by M. lepromatosis are poorly characterized. HD is a recognized zoonosis through transmission of M. leprae from armadillos, but the role of M. lepromatosis as a zoonotic agent of HD is unknown. M. lepromatosis was initially associated with diffuse lepromatous leprosy, but subsequent case reports and surveys have linked it to other forms of HD. HD caused by M. lepromatosis has been reported from three endemic countries: Brazil, Myanmar, and Philippines, and three non-endemic countries: Mexico, Malaysia, and United States. Contact with armadillos in Mexico was mentioned in 2/21 M. lepromatosis HD case reports since 2008. M. lepromatosis in animals has been investigated only in non-endemic countries, in squirrels and chipmunks in Europe, white-throated woodrats in Mexico, and armadillos in the United States. To date, there have only been a small number of positive findings in Eurasian red squirrels in Britain and Ireland. A single study of environmental samples found no M. lepromatosis in soil from a Scottish red squirrel habitat. Future studies must focus on endemic countries to determine the true proportion of HD cases caused by M. lepromatosis, and whether viable M. lepromatosis occurs in non-human sources.

scholarly journals HANSEN’S DISEASE DIAGNOSED AFTER ANTI-CANCER CHEMOTHERAPY

2020 ◽  
Vol 5 (2) ◽  
pp. 20-24
Author(s):  
S. A. Hashmi ◽  
G. S. Bhadauria ◽  
K. S. Rajmohan ◽  
I. D. Khan ◽  
A. Gupta ◽  
...  
Keyword(s):  
Case Report ◽  
Cancer Chemotherapy ◽  
De Novo ◽  
Germ Cell Tumour ◽  
Lepromatous Leprosy ◽  
Histopathological Diagnosis ◽  
Left Testis ◽  
Hansen's Disease ◽  
Acid Fast Bacilli ◽  
Hansen’S Disease

Background. Leprosy or Hansen’s disease is a chronic granulomatous disease involving predominantly skin, peripheral nerves and nasal mucosa but capable of affecting any tissue or organ. Histoid leprosy is a very rare well-defined clinicopathological variant of multibacillary lepromatous leprosy, which is very difficult to diagnose due to different specific clinical and histopathological findings that mimic a fibromatous disorder. Histoid leprosy occurs generally after treatment failure and sometimes de novo. Objective. The aim of the study was to explore histoid leprosy throughout a case report. Methods. A case report of histoid leprosy diagnosed after cancer chemotherapy is presented. Results. A 25-year-old healthy male presented with multiple skin coloured, discrete, well defined, painless papules and nodules scattered over nape of neck, right side of the trunk and both arms along with numbness as well as tingling sensation over both the arms and trunk. It was a case of non-seminomatous germ cell tumour (NSGCT), left testis, diagnosed and treated with a high inguinal orchidectomy with adjuvant chemotherapy in 2016. Ziehl Neelsen (ZN) stain for Acid Fast Bacilli (Mycobacterium leprae) – a modified Fite stain method showed numerous acid-fast bacilli. Histopathological diagnosis of Hansen’s disease (Histoid) was conducted. The patient was admitted and started on triple drug multi-bacillary multi-drug therapy (MB-MDT). A remarkable improvement was noticed in the lesion status within one month of institution of the therapy. Conclusions. Histoid leprosy is a discrete infrequent form of multibacillary leprosy with distinctive clinical, bacteriological and histomorphological features. Histopathologic examination with modified Fite stain is still the mainstay of diagnosis.

scholarly journals Peripheral Neuropathy in Leprosy: Clinical Manifestations and Disability in a Colombian National Referral Center

2021 ◽  
Author(s):  
Laura Trujillo-Ramirez ◽  
María Alejandra Palacios-Ariza ◽  
Ivan Pradilla ◽  
Luis Arturo Gamboa
Keyword(s):  
Disease Onset ◽  
Clinical Manifestations ◽  
Disease Diagnosis ◽  
Lepromatous Leprosy ◽  
Nerve Trunk ◽  
Lower Limbs ◽  
Hansen's Disease ◽  
Referral Center ◽  
Hansen’S Disease ◽  
Degree Of Disability

Objective: To describe the neurological features of the physical examination in patients with Hansen’s disease who were treated in Bogotá, Colombia.Methods: We carried out a descriptive study of all patients with a Hansen’s disease diagnosis treated at a referral center between 2003-2018.Results: There were 327 eligible electronic health records (EHRs) with a final sample of 282 subjects. Leprosy was most common in males (57.45%), median age at the diagnosis was 54 years, and lesions of the lower limbs were more common (75.1%). The median time from disease onset to consult was 12 months. Most of them were classified as having lepromatous leprosy (39.7%). Pain over the median nerve trunk was the most common manifestation of disease (28%), followed by pain over the radial trunk (22%). Sensitive alterations were more common than motor ones. Specifically, the posterior tibial nerve was affected in nearly half of subjects. Dual impairment was more common in the ulnar nerve (13.8%). Some disability was apparent in 23.8% of subjects; predominantly grade 1 disability.Conclusion: Findings regarding age, leprosy type, and the frequency of individual nerve compromise were consistent with reports from other countries. Nerve trunk thickening was infrequent, which might be a consequence of subjectiveness in the examination and sample differences in sex distribution, degree of disability and time since disease onset. The frequency of morbidity and disability found in this sample, though low when compared with other series, fails to meet public health goals, including those limiting disability in younger subjects.

scholarly journals A 13-Year-Old with Coexistence of Gastric Volvulus and Leprosy: A Case Report of Two Rare Entities

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Joanna Schneider ◽  
Rhett Mays
Keyword(s):  
Gastric Volvulus ◽  
Outlet Obstruction ◽  
Skin Lesions ◽  
Lepromatous Leprosy ◽  
Marshall Islands ◽  
Hansen's Disease ◽  
Skin Changes ◽  
Hansen’S Disease ◽  
History Of

Leprosy, or Hansen’s disease, is caused by infection with Mycobacterium leprae. It is a rare diagnosis within the continental United States. We present the case of a 13-year-old immigrant from the Marshall Islands who presented with recurrent nausea, vomiting, and abdominal pain which are found to be due to intermittent gastric volvulus. Gastric volvulus is also exceedingly rare, with less than 8 pediatric cases on average per year. During her second hospitalization for recurrent acute gastrointestinal issues, nonspecific skin lesions were biopsied, revealing infection with M. leprae. The patient did not exhibit classic symptoms of leprosy but did have prominent skin changes including diffuse nodules. This case explores the pathophysiology connecting leprosy to volvulus, discussing the possible role of an inflammatory response to infection in causing gastric volvulus. The finding of lepromatous leprosy may have been unrelated but was fortuitous, as early intervention will result in avoidance of debilitating peripheral neuropathy and eventual disfiguration from Hansen’s disease. This case highlights the importance of considering rare causes of gastric outlet obstruction including gastric volvulus and of considering leprosy in the differential for patients with unusual skin lesions or paresthesias who have a history of living or traveling in endemic areas.

scholarly journals A Case Series Of Arthritis In Hansen’s Disease

2020 ◽  
Vol 3 (2) ◽  
pp. 116
Author(s):  
Hendra Gunawan ◽  
Deasy Natalia Adriana ◽  
Awalia Awalia ◽  
Joewono Soeroso
Keyword(s):  
Knee Pain ◽  
Case Series ◽  
Initial Presentation ◽  
Clinical Spectrum ◽  
Hansen's Disease ◽  
Disease Symptoms ◽  
Bilateral Knee ◽  
Hansen’S Disease ◽  
Erythema Nodosum Leprosum ◽  
First Case

Hansen’s disease or leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae. Musculoskeletal complaints might be the initial presentation of patients with Hansen’s disease. Symptoms are common with clinical spectrum ranging from mild to debilitating arthritis.  Regarding its wide clinical spectrum, a history taking especially in an endemic area like Indonesia on the possibility of Hansen’s disease cannot be ruled out in patients with arthritis. We reported 3 cases of arthritis in Hansen’s disease. First case was a 62-year-old Javanese female who had a deformity and chronic poly symmetry arthritis. Second case was a 45-year-old Javanese male with chronic bilateral knee pain as initial presentation of Hansen’s disease and the last case was 61-year-old Javanese male who had acute bilateral knee pain with erythematous maculae associated with Erythema Nodosum Leprosum. All cases responded to corticosteroid 1 mg/BW/day.

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