scholarly journals Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Denis Miyashiro ◽  
Carolina Cardona ◽  
Neusa Yuriko Sakai Valente ◽  
João Avancini ◽  
Gil Benard ◽  
...  
Keyword(s):  
Venous Insufficiency ◽  
Delayed Diagnosis ◽  
Specific Treatment ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Skin Ulcers ◽  
Wide Range ◽  
Leprosy Patients ◽  
Mean Time ◽  
Multibacillary Leprosy

Abstract 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.

scholarly journals Risk factors for physical disability in patients with leprosy disease in Yunnan, China: Evidence from a retrospective observational study

2021 ◽  
Vol 15 (11) ◽  
pp. e0009923
Author(s):  
Xiaohua Chen ◽  
Hong-bing Liu ◽  
Tie-Jun Shui ◽  
Shun Zha
Keyword(s):  
Risk Factors ◽  
Physical Disability ◽  
Physical Disabilities ◽  
Delayed Diagnosis ◽  
Skin Lesions ◽  
Nerve Damage ◽  
Advanced Age ◽  
Han Ethnicity ◽  
Leprosy Patients ◽  
Male Sex

Background Leprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear. Methodology/Principal findings We studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243). Conclusions Delayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.

scholarly journals Powerful Bactericidal Activity of Moxifloxacin in Human Leprosy

2008 ◽  
Vol 52 (9) ◽  
pp. 3113-3117 ◽  
Author(s):  
Fe Eleanor F. Pardillo ◽  
Jasmin Burgos ◽  
Tranquilino T. Fajardo ◽  
Eduardo Dela Cruz ◽  
Rodolfo M. Abalos ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Bactericidal Activity ◽  
Mycobacterium Leprae ◽  
Skin Lesions ◽  
Definite Improvement ◽  
Highly Effective ◽  
Leprosy Patients ◽  
Multibacillary Leprosy

ABSTRACT In a clinical trial of moxifloxacin in eight multibacillary leprosy patients, moxifloxacin proved highly effective. In all trial patients, a single 400-mg dose of moxifloxacin resulted in significant killing (P ≤ 0.006) of Mycobacterium leprae, ranging from 82% to 99%, with a mean of 91%. In all instances, no viable bacilli were detected with an additional 3 weeks of daily therapy, this observed rapid bactericidal activity being matched previously only by rifampin. On moxifloxacin therapy, skin lesions cleared exceedingly rapidly with definite improvement observed consistently after eight doses and progressive resolution continuing for the 56 days of the trial. Side effects, toxicities, and laboratory abnormalities were mild, not requiring discontinuation of therapy.

MO224VCAM-1 LEVELS ASSOCIATED WITH ALBUMINURIA IN MULTIBACILLARY LEPROSY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Louise Donadello Tessarolo ◽  
Gdayllon Cavalcante Meneses ◽  
Gabriela Freire Bezerra ◽  
Geraldo Bezerra da Silva Junior ◽  
Elizabeth De Francesco Daher ◽  
...  
Keyword(s):  
Clinical Care ◽  
Epidemiological Data ◽  
Skin Lesions ◽  
Cross Sectional Study ◽  
Vascular Involvement ◽  
Clinical Aspects ◽  
Cross Sectional ◽  
Leprosy Patients ◽  
Duration Of Disease ◽  
Multibacillary Leprosy

Abstract Background and Aims Leprosy may present important renal and endothelial abnormalities, and this can worse patients’ prognosis. However, renal and vascular involvement in these patients has been poor investigated. The aim of this study was to investigate if higher systemic endothelial biomarkers levels are associated with renal abnormalities and clinical aspects of leprosy. Method This is a cross-sectional study with leprosy patients before initiation of multidrug therapy enrolled in January 2017 to December 2018 in Fortaleza, northeast Brazil. Leprosy-associated clinical and epidemiological data were collected. Two groups were constructed: Paucibacillary (PB) and Multibacillary (MB) for comparisons. Serum and urine samples were obtained for laboratory analysis. In urine the following parameters were evaluated: creatinine, proteinuria and albuminuria. In serum the endothelial biomarkers were evaluated: VCAM-1 and ICAM-1, using ELISA assay. Results A total of 101 leprosy patients were included, with mean age of 48±15 years, and 71 (70%) were male. The multibacillary form occurred in 81 cases (80%), where 22 had a Virchowian form. VCAM-1 was elevated in MB group and was correlated with the bacteriological index (skin smear) (r = 0.372, p <0.01), duration of disease symptoms (r = 0.234, p = 0.04), and number of skin lesions ( r = 0.331, p <0.001). Moreover, in MB patients who presented albuminuria >15 mg/g of creatinine, VCAM-1 showed a significant correlation (r = 0.341, p <0.05) with increased albuminuria and improve the correlation with number of skin lesions (r = 0.653, p=0.003). Conclusion Multibacillary leprosy patients present high systemic levels of VCAM-1, associated with leprosy clinical features and increased albuminuria, an important marker of kidney disease progression. Further prospective studies are necessary to establish a cause-effect relation and evaluate the preventive role of these biomarkers, aiming to improve clinical care.

scholarly journals Interstitial granulomatous dermatitis: a rare case report of dermatological manifestation of rheumatoid arthritis

2020 ◽  
Vol 8 (7) ◽  
pp. 2688
Author(s):  
Jagadeesh Chandrasekaran ◽  
Neetu Mariam Alex
Keyword(s):  
Rheumatoid Arthritis ◽  
Case Report ◽  
Fungal Infections ◽  
Histopathological Examination ◽  
Specific Treatment ◽  
Granulomatous Inflammation ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Solid Organ ◽  
Granulomatous Dermatitis

Interstitial granulomatous dermatitis (IGD), a rare dermatological disorder was first described by Ackerman et al, in the year 1993. It is characterized by a heterogeneous clinical spectrum and a specific histopathological pattern. It has been described in association with a number of auto-immune disorders, drugs, fungal infections, and malignancies. It may manifest as papules, patches, plaques, nodules, annular lesions, or less frequently, as described classically, as indurated linear subcutaneous cords. This case is being reported as interstitial granulomatous dermatitis is rare dermatological manifestation of rheumatoid arthritis and presentation as large ulcerated skin lesions is further extremely rare. In this case report we describe a 67-year-old gentleman with Seropositive Rheumatoid arthritis. He presented to our hospital with complaints of multiple well defined skin lesions with pus discharge over lower limbs, trunk and upper limbs. Biopsies from left upper limb and abdomen showed focal necrobiosis with surrounding granulomatous inflammation with rare perivascular granulomas. He was subsequently diagnosed to have interstitial granulomatous dermatitis based on histopathological examination. Interstitial granulomatous dermatitis has been described to be associated with a number of autoimmune conditions and drugs. It is very important for clinicians to have knowledge about this rare skin condition as it may be heralding presentation of a serious underlying condition like lymphoproliferative disorders or solid organ malignancies. There is no specific treatment and causative disease has to be diagnosed and targeted.

scholarly journals Leprosy patients: neurotrophic factors and axonal markers in skin lesions

2012 ◽  
Vol 70 (4) ◽  
pp. 281-286 ◽  
Author(s):  
Letícia Baccaro Michellin ◽  
Jaison Antonio Barreto ◽  
Lúcia Helena Soares Camargo Marciano ◽  
Flavio Alves Lara ◽  
Maria Esther Salles Nogueira ◽  
...  
Keyword(s):  
Neurotrophic Factors ◽  
Skin Lesions ◽  
Clinical Parameters ◽  
Pgp 9.5 ◽  
Peripheral Nerve Damage ◽  
Leprosy Patients ◽  
Nociceptive Fibers ◽  
Neural Impairment ◽  
Multibacillary Leprosy

Neurotrophins are growth factors with crucial roles in neural pathophysiology. These mediators functionally modulate nociceptive fibers, and changes in neurotrophins expression have been correlated with early loss of nociception in leprosy. This study investigated the expression of NGF, BDNF, and NT3 in dermal nerves of leprosy patients. Characterization of Remak bundles was achieved by p75NTR, and axonal markers NF-L and PGP 9.5 immunostaining. Clinical parameters of neural impairment have been evaluated by Semmes-Wenstein monofilaments. Our findings demonstrated decrease of NGF in borderline leprosy, when compared to control specimens. Similar results were observed in PGP 9.5 expression (borderline: p<0.001 and lepromatous: p<0.05) and NF-L (lepromatous: p<0.05), suggesting advanced Remak bundles degeneration in multibacillary leprosy. It has also been observed positive correlation between p75NTR and PGP 9.5, indicating association between Schwann cells and axons in Remak bundles. Present data indicate that neurotrophins imbalance may participate in the establishment of peripheral nerve damage.

scholarly journals Immune Sensing and Potential Immunotherapeutic Approaches to Control Chromoblastomycosis

2020 ◽  
Vol 7 (1) ◽  
pp. 3
Author(s):  
Leandro C. D. Breda ◽  
Isabela G. Menezes ◽  
Larissa N. M. Paulo ◽  
Sandro Rogério de Almeida
Keyword(s):  
Social Stigma ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Treatment Interruption ◽  
Lower Limbs ◽  
Disease Treatment ◽  
Immune Sensing ◽  
Skin Immunology ◽  
Anti Fungal ◽  
Made In

Chromoblastomycosis (CBM) is a neglected, chronic, and progressive subcutaneous mycosis caused by different species of fungi from the Herpotrichiellaceae family. CBM disease is usually associated with agricultural activities, and its infection is characterized by verrucous, erythematous papules, and atrophic lesions on the upper and lower limbs, leading to social stigma and impacts on patients’ welfare. The economic aspect of disease treatment is another relevant issue. There is no specific treatment for CBM, and different anti-fungal drug associations are used to treat the patients. However, the long period of the disease and the high cost of the treatment lead to treatment interruption and, consequently, relapse of the disease. In previous years, great progress had been made in the comprehension of the CBM pathophysiology. In this review, we discuss the differences in the cell wall composition of conidia, hyphae, and muriform cells, with a particular focus on the activation of the host immune response. We also highlight the importance of studies about the host skin immunology in CBM. Finally, we explore different immunotherapeutic studies, highlighting the importance of these approaches for future treatment strategies for CBM.

scholarly journals Birt–Hogg–Dubé syndrome in Chinese patients: a literature review of 120 families

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Xiaowen Hu ◽  
Guofeng Zhang ◽  
Xianmeng Chen ◽  
Kai-Feng Xu
Keyword(s):  
Spontaneous Pneumothorax ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Lower Lobe ◽  
Skin Lesions ◽  
Jiangsu Province ◽  
Chinese Patients ◽  
Renal Tumors ◽  
Pulmonary Cysts ◽  
Exon 11

Abstract Objective To clarify the epidemiological and clinical features of Birt–Hogg–Dubé syndrome (BHDS) in Chinese patients. Methods We identified reports on Chinese patients with BHDS by searching the China Academic Journals Database, Wanfang Chinese Database, and PubMed databases, either in Chinese or English languages published from January 1, 2008 to December 31, 2020. Studies without sufficient clinical data were excluded and cases under 18 years old were excluded. Results Twenty papers were included and comprised 120 families with 221 cases. Most families with BHDS were reported from institutions in Beijing (66.7%) and Jiangsu Province (15.8%); 80.8% of cases were reported within the past five years. The average duration from clinical presentation to diagnosis was 9.6 years. The average age was 47.0 ± 13.9 years (range, 18–84 years) and the ratio of male to female was 1:1.6. The most common manifestations of BHDS were multiple pulmonary cysts (92.4%), spontaneous pneumothorax (71.0%), skin lesions (18.1%) and renal tumors (3.6%). Pulmonary cysts were predominantly distributed in the lower lobe on chest CT imaging. Family history of spontaneous pneumothorax was identified in 84.7% of the families and average number of pneumothoraxes was 1.8 (range, 1–6). The FLCN gene mutation c.1285dupC/delC in exon 11 was the most frequent mutation observed (17.4% of patients). The recurrence rate of pneumothorax after conservative treatment (including tube thoracostomy) was 29/41 (71%) while the pneumothorax recurred after surgical treatment (pulmonary bullectomy or pleurodesis) in only 4/37 (11%). Conclusions Although BHDS has been increasingly reported in the recent years, only minority of families were reported from institutions outside of Beijing and Jiangsu Province. The dominant clinical manifestations were pulmonary cysts associated with recurrent pneumothorax, while skin lesions and renal tumors were less commonly reported. Delayed diagnosis along with suboptimal management appear to represent critical challenges for Chinese patients with BHDS.

scholarly journals Cortical Excitability across the ALS Clinical Motor Phenotypes

2021 ◽  
Vol 11 (6) ◽  
pp. 715
Author(s):  
Thanuja Dharmadasa
Keyword(s):  
Motor Cortex ◽  
Cortical Excitability ◽  
Phenotypic Variability ◽  
Specific Treatment ◽  
Underlying Disease ◽  
Selective Vulnerability ◽  
Clinical Feature ◽  
Cortical Hyperexcitability ◽  
Wide Range

Amyotrophic lateral sclerosis (ALS) is characterized by its marked clinical heterogeneity. Although the coexistence of upper and lower motor neuron signs is a common clinical feature for most patients, there is a wide range of atypical motor presentations and clinical trajectories, implying a heterogeneity of underlying pathogenic mechanisms. Corticomotoneuronal dysfunction is increasingly postulated as the harbinger of clinical disease, and neurophysiological exploration of the motor cortex in vivo using transcranial magnetic stimulation (TMS) has suggested that motor cortical hyperexcitability may be a critical pathogenic factor linked to clinical features and survival. Region-specific selective vulnerability at the level of the motor cortex may drive the observed differences of clinical presentation across the ALS motor phenotypes, and thus, further understanding of phenotypic variability in relation to cortical dysfunction may serve as an important guide to underlying disease mechanisms. This review article analyses the cortical excitability profiles across the clinical motor phenotypes, as assessed using TMS, and explores this relationship to clinical patterns and survival. This understanding will remain essential to unravelling central disease pathophysiology and for the development of specific treatment targets across the ALS clinical motor phenotypes.

scholarly journals Imaging features and differential diagnoses of non-neoplastic diffuse mediastinal diseases

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Flavian Tabotta ◽  
Gilbert R. Ferretti ◽  
Helmut Prosch ◽  
Samia Boussouar ◽  
Anne-Laure Brun ◽  
...  
Keyword(s):  
Early Stage ◽  
Specific Treatment ◽  
Imaging Features ◽  
Mediastinal Diseases ◽  
Pictorial Review ◽  
Wide Range ◽  
Chest X Ray ◽  
Delayed Recognition ◽  
Patient’S History ◽  
Contiguous Spread

Abstract Acute or chronic non-neoplastic diffuse mediastinal diseases have multiple causes, degrees of severity, and a wide range of management. Some situations require emergency care while others do not need specific treatment. Although the diagnosis may be suspected on chest X-ray, it is mainly based on CT. A delayed recognition is not uncommonly observed. Some findings may prompt the radiologist to look for specific associated injuries or lesions. This pictorial review will successively describe the various non-neoplastic causes of diffuse mediastinal diseases with their typical findings and major differentials. First, pneumomediastinum that can be provoked by extra- or intra-thoracic triggers requires the knowledge of patient’s history or recent occurrences. Absence of any usual etiological factor should raise suspicion of cocaine inhalation in young individuals. Next, acute mediastinitis may be related to post-operative complications, esophageal perforation, or contiguous spread of odontogenic or retropharyngeal infections. The former diagnosis is not an easy task in the early stage, owing to the similarities of imaging findings with those of normal post-operative appearance during the first 2–3 weeks. Finally, fibrosing mediastinitis that is linked to an excessive fibrotic reaction in the mediastinum with variable compromise of mediastinal structures, in particular vascular and airway ones. Differential diagnosis includes tumoral and inflammatory infiltrations of the mediastinum.

scholarly journals ASCU-Net: Attention Gate, Spatial and Channel Attention U-Net for Skin Lesion Segmentation

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 501
Author(s):  
Xiaozhong Tong ◽  
Junyu Wei ◽  
Bei Sun ◽  
Shaojing Su ◽  
Zhen Zuo ◽  
...  
Keyword(s):  
Skin Lesion ◽  
Contextual Information ◽  
Skin Lesions ◽  
Medical Image Segmentation ◽  
Learning Networks ◽  
Wide Range ◽  
Accurate Performance ◽  
Relevant Field ◽  
Skin Smooth ◽  
Smooth Transitions

Segmentation of skin lesions is a challenging task because of the wide range of skin lesion shapes, sizes, colors, and texture types. In the past few years, deep learning networks such as U-Net have been successfully applied to medical image segmentation and exhibited faster and more accurate performance. In this paper, we propose an extended version of U-Net for the segmentation of skin lesions using the concept of the triple attention mechanism. We first selected regions using attention coefficients computed by the attention gate and contextual information. Second, a dual attention decoding module consisting of spatial attention and channel attention was used to capture the spatial correlation between features and improve segmentation performance. The combination of the three attentional mechanisms helped the network to focus on a more relevant field of view of the target. The proposed model was evaluated using three datasets, ISIC-2016, ISIC-2017, and PH2. The experimental results demonstrated the effectiveness of our method with strong robustness to the presence of irregular borders, lesion and skin smooth transitions, noise, and artifacts.

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