Host-Related Laboratory Parameters for Leprosy Reactions

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.

Challenging diagnosis of leprosy in a psychotic homeless patient with atypical clinical manifestations: an interesting case report

Background A decision to diagnose certain skin diseases in patient undergoing psychotic break is challenging; this includes establishing the diagnosis of leprosy. Diagnosis of leprosy is established if there is at least one of the three cardinal signs of leprosy. Histopathological examination is not a gold standard, but remains useful in atypical or clinically suspicious cases. Case presentation We report for the first time, an interesting case of leprosy with atypical clinical manifestations in a psychotic homeless male with unknown history of present illness. Upon examination, hypopigmented macules, hyperpigmented macules, and plaques were observed, with unclear sensation impairment. Peripheral nerve thickening and acid-fast bacilli from slit-skin smear were not found. Histopathological examination from hypopigmented macule on the upper right limb showed no granulomatous reaction and other histopathological features of leprosy. Although the condition did not fulfill the cardinal signs of leprosy, we found lagophthalmos, claw hands, pseudomutilation of fingers and toes. Therefore, the diagnosis of suspected leprosy was established. The patient was hospitalized and attempts to administer oral rifampicin and clofazimine were made. Several days after treatment, annular erythematous macules appeared on the patient’s face, abdomen, and back. Histopathological examination results on sample taken from erythematous macule and right sural nerve were consistent with the diagnosis of leprosy with reversal reaction. Conclusion In certain conditions, histopathological examination of the skin and nerves are a highly rewarding test in establishing a diagnosis of leprosy.

Profil Penderita Morbus Hansen (MH) di Poliklinik Kulit dan Kelamin RSUP Prof. Dr. R. D. Kandou Manado Periode Januari – Desember 2013

Morbus Hansen (MH) is still a public, social, and rehabilitation problems due to the physical disability resulted from delayed or inadequate treatment. This study was aimed to obtain the profile of MH patients at the Dermatovenerology clinic, Prof. Dr. R. D. Kandou Hospital Manado in the period of January to December 2013. This was a descriptive and retrospective study. The results showed that there were 98 MH patients consisting of 69 males (70.4%) and 29 females (29,6%). The majority of patients were 25-44 years old (47.0%) with multibacillary type (93.9%). Most patients did not show lepra reaction (67.3%); erythema nodosum leprosum (ENL) reaction was found in 29.6% of patients, and reversal reaction in 3.1% of patients. As many of 29.6% had been treated with multidrug therapy (MDT), and 10.2% did not, meanwhile, 60,2% of patients did not have any data of treatment. In conclusion, the majority of MH patients at the Dermatovenerology clinic, Prof. Dr. R. D. Kandou Hospital Manado in the period of January to December 2013 were males, aged 25-44 years, had multibacillary type with ENL reaction, and had been treated with MDT.Keywords: Morbus Hansen profile Abstrak: Morbus Hansen (MH) masih merupakan masalah kesehatan, sosial, dan rehabilitasi oleh karena kecacatan fisik yang terjadi akibat pengobatan yang terlambat atau tidak memadai. Penelitian ini bertujuan untuk mengetahui profil penderita MH di Poliklinik Kulit dan Kelamin RSUP Prof. R. D Kandou Manado periode Januari-Desember 2013. Jenis penelitian ialah deskrip-tif retrospektif. Hasil penelitian mendapatkan 98 penderita MH (6,72%) dari total 1457 pasien, terdiri dari 69 laki-laki (70,4%) dan 29 perempuan (29,6%). Mayoritas penderita berada pada rentang usia 25-44 tahun (47,0%) dengan tipe MH multibasiler (93,9%). Pada sebagian besar pen-derita tidak didapatkan reaksi lepra (67,3%); reaksi erythema nodosum leprosum (ENL) didapatkan pada 29,6% penderita dan reaksi reversal pada 3,1% penderita. Mengenai riwayat pengobatan, sebesar 29,6% telah mendapat pengobatan multidrug therapy (MDT) sebelumnya dan 10,2% belum pernah mendapatkan pengobatan MDT, namun sebesar 60,2% penderita tidak memiliki data pengobatan. Simpulan penelitian ini ialah mayoritas penderita MH di Poliklinik Kulit dan Kelamin RSUP Prof. R. D Kandou Manado periode Januari-Desember 2013 berjenis kelamin laki-laki, usia 25-44 tahun, tipe MH multibasiler, dengan reaksi ENL, dan pernah mendapat pengobatan MDT.Kata kunci: profil Morbus Hansen