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 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.

Vitiligo: An Updated Narrative Review

2020 ◽  
Vol 16 ◽  
Author(s):  
Alexander K. C. Leung ◽  
Joseph M. Lam ◽  
Kin Fon Leong ◽  
Kam Lun Hon
Keyword(s):  
Present Article ◽  
English Literature ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Calcineurin Inhibitors ◽  
Ultraviolet B ◽  
Lower Limbs ◽  
Treatment Modalities ◽  
Topical Corticosteroids ◽  
Topical Calcineurin Inhibitors

Background: Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. Objective: This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. Methods: A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included metaanalyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to the English literature. The information retrieved from the above search was used in the compilation of the present article. The information retrieved from the above search was used in the compilation of the present article. Results: Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. Conclusion: The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment of choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.

scholarly journals Clinico-bacterial correlation of bacterial index in Hansen’s disease

2016 ◽  
Vol 6 (12) ◽  
pp. 998-1000
Author(s):  
SM Jha ◽  
AKS Dangol ◽  
S Shakya ◽  
B Jha
Keyword(s):  
Clinical Manifestations ◽  
Clinical Information ◽  
Accurate Diagnosis ◽  
Cross Sectional ◽  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Tuberculoid Leprosy ◽  
Classi Cation ◽  
Leprosy Patients ◽  
Bacterial Index

Background: Leprosy has a broad spectrum of clinical manifestations. Clinical information along with Bacterial evidence is necessary to achieve accurate diagnosis. The present study was carried out to nd out clinical and bacterial correlation in various presentations according to Ridley Jopling classi cation of Hansen’s Disease. Materials and Methods: It was a hospital based cross-sectional comparative study of 72 leprosy patients over a period of 1 year and it’s clinico-Bacterial correlation was done with the help of Slit Skin Smear and clinical classi cation. Results: This study included 72 leprosy patients at various stages according to Ridley Jopling classi cation. Maximum cases belonged to Borderline Tuberculoid leprosy 28(38.88%) followed by Tuberculoid leprosy 15(20.83%). Slit Skin Smear showed 12(42.85%) of Borderline Tuberculoid and 3(20%) of Tuberculoid cases had disparity and didn’t match corresponding clinical subtype. Conclusion: Clinical features along with Bacterial index is useful in making accurate diagnosis so that appropriate treatment could be started and hence deformity and disability could be prevented. 

Clinical-epidemiological character and degree of disability in patients with Hansen's disease in the municipality of Barbacena - MG and macro-region in the period from 2001 to 2010

2014 ◽  
Vol 24 (4) ◽  
Author(s):  
Andrezza de Oliveira Mendes ◽  
Cíntia Elisa Gonçalves Costa ◽  
Rafaela de Castro Silva ◽  
Sophia Arantes Campos ◽  
Valessa Maria Gontijo Cunha ◽  
...  
Keyword(s):  
Hansen's Disease ◽  
Hansen’S Disease ◽  
Degree Of Disability

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 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

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