scholarly journals Host-Related Laboratory Parameters for Leprosy Reactions

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuqian Luo ◽  
Mitsuo Kiriya ◽  
Kazunari Tanigawa ◽  
Akira Kawashima ◽  
Yasuhiro Nakamura ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Clinical Symptoms ◽  
Type I ◽  
Leprosy Reactions ◽  
Erythema Nodosum Leprosum ◽  
Precise Diagnosis ◽  
Reversal Reaction

Leprosy reactions are acute inflammatory episodes that complicate the course of a Mycobacterium leprae infection and are the major cause of leprosy-associated pathology. Two types of leprosy reactions with relatively distinct pathogenesis and clinical features can occur: type 1 reaction, also known as reversal reaction, and type 2 reaction, also known as erythema nodosum leprosum. These acute nerve-destructive immune exacerbations often cause irreversible disabilities and deformities, especially when diagnosis is delayed. However, there is no diagnostic test to detect or predict leprosy reactions before the onset of clinical symptoms. Identification of biomarkers for leprosy reactions, which impede the development of symptoms or correlate with early-onset, will allow precise diagnosis and timely interventions to greatly improve the patients' quality of life. Here, we review the progress of research aimed at identifying biomarkers for leprosy reactions, including its correlation with not only immunity but also genetics, transcripts, and metabolites, providing an understanding of the immune dysfunction and inflammation that underly the pathogenesis of leprosy reactions. Nevertheless, no biomarkers that can reliably predict the subsequent occurrence of leprosy reactions from non-reactional patients and distinguish type I reaction from type II have yet been found.

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

2021 ◽  
pp. 004947552199849
Author(s):  
Prakriti Shukla ◽  
Kiran Preet Malhotra ◽  
Parul Verma ◽  
Swastika Suvirya ◽  
Abir Saraswat ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Case Series ◽  
Lepromatous Leprosy ◽  
Sweet Syndrome ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients ◽  
Atypical Presentations ◽  
Neuropathic Ulcers

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley–Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes – spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.

Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report

2022 ◽  
pp. 004947552110686
Author(s):  
Pallavi Hegde ◽  
Deepti Jaiswal ◽  
Varsha M Shetty ◽  
Kanthilatha Pai ◽  
Raghavendra Rao
Keyword(s):  
Case Report ◽  
Erythema Nodosum ◽  
Immunological Response ◽  
Lepromatous Leprosy ◽  
Multidrug Therapy ◽  
Cutaneous Lesions ◽  
Erythema Nodosum Leprosum

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11–25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT). 1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

scholarly journals Differential Expression of IFN-γ, IL-10, TLR1, and TLR2 and Their Potential Effects on Downgrading Leprosy Reaction and Erythema Nodosum Leprosum

2019 ◽  
Vol 2019 ◽  
pp. 1-14
Author(s):  
Douglas Eulálio Antunes ◽  
Isabela Maria Bernardes Goulart ◽  
Mayara Ingrid Sousa Lima ◽  
Patrícia Terra Alves ◽  
Paula Cristina Brígido Tavares ◽  
...  
Keyword(s):  
Path Analysis ◽  
Erythema Nodosum ◽  
Interleukin 10 ◽  
Dependence Relation ◽  
Tlr2 Expression ◽  
Leprosy Reactions ◽  
Erythema Nodosum Leprosum ◽  
Immunological Mechanisms ◽  
Ifn Γ

Leprosy reactions are acute immunological events that occur during the evolution of chronic infectious disease causing neural damage and disabilities. A study using blood samples of 17 leprosy reaction patients and 17 reaction-free was carried out by means of associations between antigens, receptors, and expression of cytokines, using path analysis providing new insights into the immunological mechanisms involved in triggering leprosy reactions. Toll-like receptors (TLR) such as TLR1 and TLR2, presented balanced expression in the reaction-free multibacillary (MB) group (TLR1: 1.01±0.23, TLR2: 1.22±0.18; p=0.267). On the other hand, downgrading type 1 reaction (T1R) (TLR1: 1.24±0.17, TLR2: 2.88±0.37; p=0.002) and erythema nodosum leprosum (ENL) (TLR1: 1.93±0.17, TLR2: 2.81±0.15; p=0.004) revealed an unbalance in relation to the expression of these receptors. When the path analysis was approached, it was noted that interleukin 10 (IL-10) expression showed a dependence relation with phenolic glycolipid I (PGL-I) in downgrading T1R (direct effect=0.503>residual effect=0.364), whereas in ENL, such relationship occurred with lipoarabinomannan (LAM) (direct effect=0.778>residual effect=0.280). On the contrary, in the reaction-free leprosy group, interferon-gamma (IFN-γ) levels were dependent on the association between TLR2 and TLR1 (0.8735). The high TLR2 expression associated with IL-10 levels, in the leprosy reaction groups, may be hypothetically related to the formation of TLR2/2 homodimers and/or TLR2/6 heterodimers linked to evasion mechanisms in downgrading reactions and pathophysiology of ENL.

scholarly journals Clinical and histopathological features in lepra reaction: a study of 50 cases

2019 ◽  
Vol 5 (2) ◽  
pp. 382
Author(s):  
Urvi H. Shah ◽  
Monal M. Jadwani ◽  
Sahana P. Raju ◽  
Pranav H. Ladani ◽  
Neela V. Bhuptani
Keyword(s):  
Erythema Nodosum ◽  
Histological Findings ◽  
Persistent Problem ◽  
Histopathological Features ◽  
Erythema Nodosum Leprosum ◽  
Inflammatory Infiltrates ◽  
Foamy Macrophages ◽  
Reliable Sign

<p class="abstract"><strong>Background:</strong> Lepra reactions remain a major persistent problem in leprosy. Type 1 and type 2 (erythema nodosum leprosum-ENL) reactions are the major causes of nerve damage and permanent disabilities. Diagnosing lepra reactions correctly is important for timely institution of therapy to prevent and treat disability and morbidity. Aim and objectives<strong> </strong>of the study were<em> </em>to make detailed observations on clinical and histopathological features of type1 and type 2 lepra reactions.</p><p class="abstract"><strong>Methods:</strong> In this study we included 50 patients diagnosed during a 1-year period as lepra reactions based on clinic-histopathological corelation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 50 patients, 4 were of type 1 reaction and 46 of type 2 reaction from which recurrence was more commonly seen with type 2 reactions. The most consistent histopathological findings in type1 reaction were periadnexal inflammatory infiltrates (100%) and lymphocytes in granuloma (100%), followed by papillary dermal edema and intercellular edema within granuloma (75%). Surprisingly, folliculotropism of and lymphocytic panniculitis was seen in 50% cases. In ENL, the most common histological findings were periadnexal inflammatory infiltrates (95.6%), presence of neutrophils within the granuloma (86.9%), foamy macrophages followed by papillary dermal edema (69.5%), and neutrophilic panniculitis (43.4%). Vasculitis like changes was noted in only 46% cases.</p><p class="abstract"><strong>Conclusions:</strong> Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis are frequent in type1 reactions while neutrophilic panniculitis is common with ENL.</p>

Erythema nodosum leprosum (type 2 reaction) in a patient with neurofibromatosis type 1

2022 ◽  
Vol 15 (1) ◽  
pp. e245174
Author(s):  
Rohith George ◽  
Sydney D'Souza ◽  
Ibrahim Masoodi
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Erythema Nodosum ◽  
Genetic Disorder ◽  
Neurofibromatosis Type ◽  
Skin Changes ◽  
Erythema Nodosum Leprosum ◽  
Clinical Presentations ◽  
High Degree

Being a region endemic for leprosy, clinical practitioners in India often encounter myriad manifestations and diverse complications of the disease. However, the masking of the obvious clinical presentations due to the coexistence of a closely resembling unrelated disorder, a ‘mimicker’, would indeed pose a serious diagnostic predicament unless a high degree of clinical suspicion is maintained. Leprosy, also known as Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae complex that involves the skin and peripheral nerves. Neurofibromatosis type 1 (NF1) also known as von Recklinghausen’s disease is an autosomal dominant genetic disorder that presents with skin changes and benign peripheral nerve sheath tumours called neurofibromas. Here, we present the case of a 35-year-old man with NF1 who presented with type 2 lepra reaction (erythema nodosum leprosum, ENL) and the skin biopsy unmasked ENL nodule among the group of NF1 nodules.

scholarly journals Leprosy type 1 reactions and erythema nodosum leprosum

2008 ◽  
Vol 83 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Indira P. Kahawita ◽  
Stephen L. Walker ◽  
Diana N.J. Lockwood
Keyword(s):  
Drug Therapy ◽  
Erythema Nodosum ◽  
Significant Proportion ◽  
Nerve Damage ◽  
Successful Completion ◽  
Leprosy Reactions ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients

Leprosy reactions are a major cause of nerve damage and morbidity in a significant proportion of leprosy patients. Reactions are immunologically mediated and can occur even after successful completion of multi-drug therapy. This review focuses on the epidemiology, pathology and treatment of leprosy type 1 reactions, erythema nodosum leprosum and silent neuropathy.

851-P: Sleep and Quality of Life in Adolescents with Type 1 or Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 851-P
Author(s):  
MELISSA S. FAULKNER
Keyword(s):  
Quality Of Life ◽  
Type 2 Diabetes

Type 1 Diabetes Mellitus - Risk Factor for Cardiovascular Disease Morbidity and Mortality

2020 ◽  
Vol 17 (1) ◽  
pp. 37-54
Author(s):  
Tatyana Chalakova ◽  
Yoto Yotov ◽  
Kaloyan Tzotchev ◽  
Sonya Galcheva ◽  
Boyan Balev ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Control ◽  
Macrovascular Complications ◽  
Morbidity And Mortality ◽  
Diabetes Mellitus Risk

: Type 1 diabetes mellitus (T1DM) is a chronic disease that starts early in life and often leads to micro- and macrovascular complications. The incidence of the disease is lower than that of type 2 DM and varies in different countries and ethnic groups, and the etiological and pathogenetic factors are different from T2DM. The aim of this overview is to investigate the effect of T1DM on all-cause mortality and CVD morbidity and mortality. During the last decades, the treatment of T1DM has improved the prognosis of the patients. Still, the mortality rates are higher than those of the age- and sex-matched general population. With the prolonged survival, the macrovascular complications and cardiovascular diseases (CVD) appear as major health problems in the management of patients with T1DM. The studies on the CVD morbidity and mortality in this disease group are sparse, but they reveal that T1DM is associated with at least 30% higher mortality. In comparison to healthy people, CVDs are more common in T1DM patients and they occur earlier in life. : Furthermore, they are a major cause for death and impaired quality of life in T1DM patients. The correlation between diabetic control and the duration of T1DM is not always present or is insignificant. Nevertheless, the early detection of the preclinical stages of the diseases and the risk factors for their development is important; similarly, the efforts to improve glycemic and metabolic control are of paramount importance.

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