The Profile of Type 1 Leprosy Reaction at Leprosy Division of Dermatology and Venerology Outpatient Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Type 1 leprosy reaction is a delayed hypersensitivity reaction caused by the increased response of cellular-mediated immunity to the Mycobacterium leprae antigen on the skin and nerves with a reversal result. The clinical manifestation includes inflammation which can cause skin and nerve lesions, swell, to permanent disabilities. Purpose: To describe the demographic and clinical profile of type 1 leprosy reaction at the Leprosy Division of the Dermatology and Venerology Outpatient Clinic of Dr. Soetomo General Academic Hospital in 2017–2019. Methods: This was a descriptive study. We used secondary data from the medical records of leprosy patients at the Leprosy Division of Dermatology and Venereology outpatient clinic, Dr. Soetomo General Academic Hospital Surabaya, from January 2017 to December 2019. Result: Out of 364 patients, 65 (17.9%) had type 1 reactions. They were mostly in productive age at 35–55 years old (56.9%). The patients were predominantly male (75.4%), with normal nutritional status (98.5%) and negative bacterial index (72.3%). The most common types of leprosy were BB (Borderline) with 61.6% and BL (Borderline Lepromatous) with 20.8%. All patients took WHO (World Health Organization) MDT (Multi Drug Therapy) MB (Multi-Bacillary). Conclusion: The profile of type 1 leprosy reaction at the Leprosy Division of Dermatology and Venerology Outpatient Clinic of Dr. Soetomo General Academic Hospital in 2017–2019 shows an average data as follows: age 35–55 years, male, normal nutritional status, negative bacterial index, leprosy type BB.

RELATIONSHIP BETWEEN SERUM LEVELS OF IMMUNOGLOBULIN M-ANTI PHENOLIC GLYCOLIPID 1 AND IMMUNOGLOBULIN G-ANTI PHENOLIC GLYCOLIPID 1 WITH BACTERIA INDEX VALUES IN MULTIBACILLARY LEPROSY

Objective: This study aims to determine the relationship of serum levels of anti-phenolic glycolipid (PGL-1), immunoglobulin M (IgM), and anti-PGL-1 immunoglobulin G (IgG) with bacterial index (BI) values in multibacillary (MB) leprosy. Methods: This study was an observational study with a cross-sectional design. A total of 30 study samples were examined for a Slit Skin Smear and examined serum levels of IgM and IgG Anti PGL-1 antibodies by ELISA method. Results: The results showed the higher the BI value, the serum levels of IgM anti-PGL-1 and IgG anti-PGL-1 increased. Conclusion: There was a significant relationship between IgM anti-PGL-1 with BI value in MB leprosy (p<0.05), but there was no significant relationship between IgG anti-PGL-1 with BI value in MB leprosy (p>0.05). IgM anti-PGL-1 has more role in increasing the value of BI in MB leprosy.

Relationship between 25-Hydroxy Vitamin D Levels and Type of Morbus Hansen

Background: Morbus Hansen is a chronic granulomatous infection of Mycobacterium leprae (M. leprae) which is characterized by cardinal signs in the form of numbness of the skin, thickening of peripheral nerves and acid-fast bacteria (AFB) were found on bacterioscopic examination. WHO has classified MH into paucibasilar MH (MH-PB) and multibasilar MH (MH-MB) based on the number of skin lesions or bacterial index (IB). Vitamin D in MH is known to act as an immunomodulator. This study aims to determine the relationship between serum 25(OH)D levels with Morbus Hansen type at RSUP Dr. Mohammad Hoesin and Leprosy Hospital Dr. Rivai Abdullah Palembang. Methods: A laboratory observational study with a case series design was undertaken at the Dermatology and Venereology (DV) Polyclinic of Infectious Dermatology (DI) Mohammad Hoesin Hospital Palembang since December 2019 to January 2020. A sample of 33 patient MH met the inclusion criteria, consisting of 22 patients with Morbus Hansen (MH) type MB and 11 patients with Morbus Hansen (MH) type PB. Comparison of serum 25(OH)D levels between MB and PB type MH patients was analyzed using the Independent T Test, the relationship between serum 25(OH)D levels and MH type was analyzed using the Fisher Exact Test and the correlation between serum 25(OH)D levels with type of MH was analyzed using Spearman Rho's test. Data analysis using SPSS version 22.0. Results: In this study, there were no differences in demographic characteristics of gender, age, age category, body mass index, education and occupation between MB and PB type MH patients (p > 0.05). There were no difference in duration of therapy (p = 0.155), ENL reaction (p = 0.276) and patient status (p = 0.304) between MB and PB type MH patients, but there were differences in bacterial index (p = 0.000) and clinical spectrum (p = 0.000) between MB and PB type MH patients. There is a difference in the mean level of 25(OH)D between MB and PB type MH patients (p = 0.006), there is a significant relationship between 25 (OH)D levels and MH type patients, (OR = 9.643 ; p = 0.010) and there is a significant moderate positive correlation between levels of 25 (OH)D and the type of MH (r = 0.467; p = 0.006). Conclusion: It can be concluded that there are differences in serum 25(OH)D levels among Morbus Hansen type. In addition, there is a significant relationship between serum 25(OH)D levels with Morbus Hansen type.

Relationship between 25-Hydroxy Vitamin D Levels and Type of Morbus Hansen

Background: Morbus Hansen is a chronic granulomatous infection of Mycobacterium leprae (M. leprae) which is characterized by cardinal signs in the form of numbness of the skin, thickening of peripheral nerves and acid-fast bacteria (AFB) were found on bacterioscopic examination. WHO has classified MH into paucibasilar MH (MH-PB) and multibasilar MH (MH-MB) based on the number of skin lesions or bacterial index (IB). Vitamin D in MH is known to act as an immunomodulator. This study aims to determine the relationship between serum 25(OH)D levels with Morbus Hansen type at RSUP Dr. Mohammad Hoesin and Leprosy Hospital Dr. Rivai Abdullah Palembang. Methods: A laboratory observational study with a case series design was undertaken at the Dermatology and Venereology (DV) Polyclinic of Infectious Dermatology (DI) Mohammad Hoesin Hospital Palembang since December 2019 to January 2020. A sample of 33 patient MH met the inclusion criteria, consisting of 22 patients with Morbus Hansen (MH) type MB and 11 patients with Morbus Hansen (MH) type PB. Comparison of serum 25(OH)D levels between MB and PB type MH patients was analyzed using the Independent T Test, the relationship between serum 25(OH)D levels and MH type was analyzed using the Fisher Exact Test and the correlation between serum 25(OH)D levels with type of MH was analyzed using Spearman Rho's test. Data analysis using SPSS version 22.0. Results: In this study, there were no differences in demographic characteristics of gender, age, age category, body mass index, education and occupation between MB and PB type MH patients (p > 0.05). There were no difference in duration of therapy (p = 0.155), ENL reaction (p = 0.276) and patient status (p = 0.304) between MB and PB type MH patients, but there were differences in bacterial index (p = 0.000) and clinical spectrum (p = 0.000) between MB and PB type MH patients. There is a difference in the mean level of 25(OH)D between MB and PB type MH patients (p = 0.006), there is a significant relationship between 25 (OH)D levels and MH type patients, (OR = 9.643 ; p = 0.010) and there is a significant moderate positive correlation between levels of 25 (OH)D and the type of MH (r = 0.467; p = 0.006). Conclusion: It can be concluded that there are differences in serum 25(OH)D levels among Morbus Hansen type. In addition, there is a significant relationship between serum 25(OH)D levels with Morbus Hansen type.

Clinico-pathological study of cases of histoid leprosy

<p class="abstract"><strong>Background:</strong> Rare variants of leprosy pose a diagnostic challenge and histoid leprosy is one such form of disease with unique clinical and histopathological features. The objective of the study was to study clinical and histopathological features of histoid leprosy.</p><p class="abstract"><strong>Methods:</strong> A prospective observational study was conducted at M. R. Medical College and Basveshwar teaching and general hospital, Kalaburagi from July 2018 to October 2019. Newly diagnosed and histologically proven cases were included.<strong></strong></p><p class="abstract"><strong>Results:</strong> Histologically confirmed histoid leprosy accounted for 8 cases (7 males and 1 female). Mean age of the patients was 44.5 years. Patients presented with papules, plaques and nodules over an apparently normal skin. Bacterial index ranged from 4+ to 6+ according to Ridley index. Histopathology showed circumscribed lesion with free sub-epidermal grenz zone and spindle shaped cells.</p><p class="abstract"><strong>Conclusions:</strong> As bacillary load is very high in these patients, they can form a potential reservoir of infection in the community especially in post leprosy elimination era.</p>

Negative correlation between interleukin-2 (IL-2) serum with bacterial index in leprosy

Background: Leprosy is strongly influenced by the host immunity response. One of the cytokines that play a role in cellular immunity is IL-2. IL-2 will stimulate macrophages to activate phagocytosis and form granulomas, and this occurs in the tuberculoid type of leprosy.Objective: Aim of this study was to verify the IL-2 serum levels are negatively correlated or not with bacterial index in leprosy.Methods: This study was a cross-sectional observational analytic study involving 50 leprosy subjects (41 MB and 9 PB types). Study was conducted at Dermatolovenerology Polyclinic of Sanglah General Hospital from December 2019 to March 2020. Sample was taken using a consecutive sampling method. IL-2 serum levels were measured by ELISA. Result: The mean of IL-2 serum in PB was 75.53±10.32 pg/mL and in MB was 37.59±17.13 pg/mL. Strong negative correlation (r= -0.67; p<0.001) between serum IL-2 levels with bacterial index (CI 95%= 25.96–49.93; p<0.001) was found. Every 1 pg/mL increase in IL-2 serum levels will be accompanied by a decrease in the bacterial index of 0.039 and vice versa. Determinant coefficient shows that 42.2% of bacterial index affected by the IL-2 serum levels. Low IL-2 serum levels were the risk factor of high bacterial index 2.8 times (PR= 2.8; CI 95%= 1.444–5.519; p<0.001).Conclusion: IL-2 serum levels were found to be higher in PB than MB. There was a negative correlation between IL-2 serum levels with bacterial index. Low IL-2 serum levels were the risk factor of a high bacterial index in leprosy patients.

Clinico-Pathological Correlation in the Classification of Leprosy

INTRODUCTION:- Leprosy is one of the major health problems in Nepal, caused by Mycobacterium leprae. Histopathological examination is considered as important tool for proper classification of the disease. This study was carried out to study the histopathological features of leprosy in skin biopsies and classify based on microscopy, bacterial index to correlate with clinical presentations. MATERIAL AND METHODS:- A retrospective observational study was done at Department of Pathology of Universal College of Medical Sciences (UCMS) Bhairahawa for 2 years from 1st November 2015 to 31stOctober 2017 and total 68 cases were analysed. Cases in which histopathological diagnosis of leprosy was made or considered differential diagnosis were selected for study. Ridley and Jopling classification was used histologically to make diagnosis of leprosy. Copies of issued histopathology reports, that are preserved in the department routinely were used to obtain data pertaining to age, sex, clinical information and histopathological findings. RESULTS:- This study included 68 patients diagnosed histologically as leprosy. Histopathological examination of the skin biopsies of 68 patients revealed that, the maximum histopathological cases 28 (41.17%) are BT followed by 15 cases (22.05%) of IL (15) and 9 (13.23%) of TT. Complete parity between clinical diagnosis and histopathology was observed in 55.88 % and disparity was seen in 44.12%. CONCLUSION:- For proper classification of Leprosy, correlation of clinical and histopathological features along with bacterial index is more useful than considering any of the single parameter.