Lepra Bubalorum, a Potential Reservoir of Mycobacterium leprae

In 1926, a mycobacterial skin disease was observed in water buffaloes by researchers in Indonesia. The disease was designated as skin tuberculosis, though it was hypothesized that it might be a form of leprosy or a leprosy-like disease. In a follow-up study (Ph.D. thesis Lobel, 1934, Utrecht University, Netherlands) a similar nodular skin disease was described in Indonesian water buffaloes and named “lepra bubalorum” or “nodular leprosy.” Two decades later Kraneveld and Roza (1954) reported that, so far, the diagnosis lepra bubalorum had been made in 146 cases in Indonesia. After a final series of research reports by Indonesian veterinarians in 1961, no subsequent cases were published. Based on information from these reports, it can be concluded that, even though evidence of nerve involvement in buffaloes was not reported, similarities exist between lepra bubalorum and Hansen’s disease (leprosy), i.e., nodular skin lesions with a chronic course and microscopically granulomatous reactions with AFB in globi in vacuoles. This raises the question as to whether these historical cases might indeed have been caused by Mycobacterium leprae, Mycobacterium lepromatosis or another representative of the M. leprae complex. The future use of state-of-the-art molecular techniques may answer this question and may also help to answer the question whether water buffaloes should be considered as a potential natural reservoir of the causative pathogen of Hansen’s disease.

Frequently Thickened Nerve in Hansen’s Disease

Background: Leprosy by definition is a chronic granulomatous infection of the skin and superficial nerves in the skin caused by Mycobacterium leprae and Mycobacterium lepromatosis. [1] It most commonly involves the nose, eyes, throat, and sometimes the testicles. The bacilli are most frequently transmitted via droplets, from the nose during close contact with untreated cases of leprosy. Leprosy was first mentioned in 700BC. Leprosy is common in tropical and subtropical Asia, some Pacific countries, Africa, and South America [2]. It is not known how leprosy is transmitted. Although skin lesions and nerve thickening manifest together, they also appear as separate entities. This study aims to find out the frequently thickened nerves in different spectrums of Hansen’s disease. Objectives: To determine the frequently thickened nerves in different spectrums of Hansen’s disease. Methods: This descriptive study was conducted in Chettinad Hospital and the Research Institute from June 2021 to August 2021. The patients were biopsy-proven Hansen's disease in a different spectrum of the disease, nerve thickening was obtained using palpation method. The Sample size was small due to the prevailing covid situation at the period during which the study was conducted. Results: The data collected from the examination of the different spectrum of disease, the pattern of frequently thickened nerves were evaluated. A total number of 30 patients were examined by palpation method among which 10 patients showed ulnar nerve thickening,7 patients showed greater auricular nerve thickening, 4 patients showed radial cutaneous nerve thickening, 9 patients showed sural nerve thickening. Conclusion: In our study, the most common thickened nerve was the ulnar nerve, secondary to that was the sural nerve. This study concludes the only examination done by palpation method, further diagnostic studies might increase the accuracy and specificity of the above-collected data.

Mycobacterium lepromatosis as a Second Agent of Hansen’s Disease

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.

Reconocimiento clínico de la enfermedad de Hansen

La enfermedad de Hansen o también conocida como Lepra, es una enfermedad crónica, infecciosa, transmisible, producida por el agente Mycobacterium leprae y Mycobacterium lepromatosis. Presenta un periodo de incubación en promedio de 5 años con un rango que va desde 1 a 20 años. Fue declarada un problema global mundial en el año 2000 y persiste con un numero constante de casos diagnosticados por año. Su vía de transmisión aún no se encuentra completamente dilucidada, las secreciones de las vías respiratorias superiores son la ruta de transmisión más común conocida hasta ahora. La presentación clínica y clasificación varían extensamente y estas dependen de la respuesta inmunológica del paciente a la infección. Actualmente se utilizan dos clasificaciones para agruparla: OMS y Ridley-Jopling. Es de gran importancia el reconcomiendo temprano de las lesiones y la educación continua sobre las mismas ya que permite un diagnóstico a tiempo, evitando el desarrollo de discapacidades.

Actualización en lepra. epidemiología, fisopatología, clasificación, diagnostico y tratatamiento

La lepra es una enfermedad crónica causada por el Mycobacterium leprae y Mycobacterium lepromatosis, afecta nervios periféricos, piel y ocasionalmente es sistémica. En 2000 se dejó de considerar un problema de salud pública; pero es endémica en 11 países, y en América se sigue reportando casos. Se clasifica dentro de las Enfermedades Infecciosas Desatendidas (EID). El estigma y discriminación que prevalecen en la concepción cultural, junto a la suposición errónea de su erradicación, promueven el subdiagnóstico o su detección tardía y dificulta el tratamiento. El objetivo del presente estudio fue actualizar los conocimientos previos acerca de esta enfermedad, para ello se realizó la búsqueda sistemática de literatura, utilizando descriptores y bases de datos especializadas. Finalmente, se esfectuó un narrativo de los resultados. En ElSalvador aún se reportan casos, la mayoría en San Salvador y San Miguel, la fisiopatología continúa en estudio, encontrándose cada vez más correlaciones genéticas e inmunológicas, la clasificación utilizada se mantiene desde 1980, la poliquimioterapia sigue siendo el tratamiento de elección y se espera el desarrollo de una vacuna. Se concluye que la erradicación de la lepra depende del desarrollo científico y el compromiso para lograr su detección temprana, incentivando un apropiado estudio desde la formación médica básica y evitar, por tanto, desestimarla en la práctica médica, ante dermatosis y manifestaciones clínicas compatibles con lepra.

Mycobacterium uberis Infection in the Subcutaneous Tissue of the Radius/Ulna Area of a Cow

Mycobacterium uberis (M. uberis) is a recently described non-tuberculous mycobacterium phylogenetically close to Mycobacterium leprae (M. leprae) and Mycobacterium lepromatosis (M. lepromatosis). This pathogen classically causes nodular thelitis in cattle and goats. Here, we discuss what seems to be the first described case of M. uberis infection in a novel anatomical site, in the proximal or distal position (information not available) of the radius/ulna area of a cow. As this case was discovered in the framework of bovine tuberculosis (bTB) surveillance program in France, this type of infection could interfere with the screening and diagnostic tools employed for bTB.