Platelet rich fibrin: A novel treatment for trophic ulcer in Hansen's disease

Patients with Hansen's disease are liable to develop non-healing trophic ulcers. The aim of this study was to determine the efficacy of autologous platelet rich fibrin (PRF) applied at weekly intervals in the management of trophic ulcers. The mean age of the patients, duration and size of ulcer were 44.3 years, 7.4 months and 6.25cm2 respectively. After the third sessions of weekly dressing, there was a significant reduction in the ulcer area (p value = 0.015). All ulcers healed by a maximum of six weeks. No adverse events were noted. PRF thus seems a feasible, safe, simple and cost-effective treatment method.

Application of the ARIMA Model to Predict Under-Reporting of New Cases of Hansen’s Disease during the COVID-19 Pandemic in a Municipality of the Amazon Region

This work aimed to apply the ARIMA model to predict the under-reporting of new Hansen’s disease cases during the COVID-19 pandemic in Palmas, Tocantins, Brazil. This is an ecological time series study of Hansen’s disease indicators in the city of Palmas between 2001 and 2020 using the autoregressive integrated moving averages method. Data from the Notifiable Injuries Information System and population estimates from the Brazilian Institute of Geography and Statistics were collected. A total of 7035 new reported cases of Hansen’s disease were analyzed. The ARIMA model (4,0,3) presented the lowest values for the two tested information criteria and was the one that best fit the data, as AIC = 431.30 and BIC = 462.28, using a statistical significance level of 0.05 and showing the differences between the predicted values and those recorded in the notifications, indicating a large number of under-reporting of Hansen’s disease new cases during the period from April to December 2020. The ARIMA model reported that 177% of new cases of Hansen’s disease were not reported in Palmas during the period of the COVID-19 pandemic in 2020. This study shows the need for the municipal control program to undertake immediate actions in terms of actively searching for cases and reducing their hidden prevalence.

HANSENÍASE: PERFIL EPIDEMIOLÓGICO REALIZADO EM UM MUNICÍPIO DO NOROESTE PAULISTA ENTRE 2014 E 2019

O presente trabalho tem como proposta traçar o perfil epidemiológico da hanseníase em um município do Noroeste Paulista no período de 2014 a 2019. A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que compromete o tecido cutâneo, mucoso e sistema nervoso periférico. Ao adentrarmos ao cenário dessa doença tão estigmatizada, discriminada e ainda desconhecida por muitos, surgiu a necessidade de se fazer um levantamento de sua prevalência no município. Foram utilizados dados sociodemográficos e epidemiológicos para que fossem observados de forma comparativa os polos estudados. Trata-se de uma abordagem quantitativa de natureza exploratória e descritiva, realizada a partir de um levantamento de dados efetuado nas Fichas de Investigação Epidemiológica da Hanseníase. O estudo mostra como a hanseníase se comporta entre a população desde a sua incidência e prevalência, faixa etária, gênero, classificação operacional e forma clínica. Este trabalho poderá contribuir com informações confiáveis a fim de melhorar o cenário epidemiológico da doença no município de Santa Fé do Sul – São Paulo. HANSEN’S DISEASE: EPIDEMIOLOGICAL PROFILE CARRIED OUT IN A MUNICIPALITY IN THE NORTHWESTERN REGION OF SÃO PAULO BETWEEN 2014 AND 2019 ABSTRACT The present paper aims to trace the epidemiological profile of Hansen’s disease in a municipality of Northwestern São Paulo in the period from 2014 to 2019. Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae, which compromises the skin tissue, mucous membranes, and the peripheral nervous system. Once we approached the scenario of this stigmatized and discriminated disease, which remains unknown to many, the urge arose to conduct a survey of its prevalence in the municipality. Sociodemographic and epidemiological data were used for comparative observation of the studied poles. This is a quantitative approach of exploratory and descriptive nature, based on a data survey carried out in the Hansen’s disease Epidemiological Investigation Forms. The research reveals how it behaves among the population from its incidence and prevalence, age group, gender, operational classification, and clinical form. This paper may contribute with reliable information to improve the epidemiological scenario of the disease in the municipality of Santa Fé do Sul - São Paulo. Keywords: Hansen's disease; Epidemiological Profile; Epidemiological monitoring; Mycobacterium leprae.

Clinical and radiological assessment of rhinomaxillary syndrome in Hansen’s disease

Background: More than four million people today live with Hansen’s disease, and 200,000 new cases are diagnosed every year. Lifetime effects of Hansen’s disease manifest as changes to bones of the face, hands and feet, resulting in physical impairment, secondary complications and facial changes that can be detrimental to quality of life, particularly among the elderly. Aims: This study aimed to perform a detailed characterization of rhinomaxillary syndrome and its clinical manifestations in older persons treated in the past for Hansen’s disease. Methods: This was a cross-sectional study to characterize rhinomaxillary syndrome among older persons (age 60+ years) resident at Pedro Fontes Hospital, Cariacica, Espírito Santo, Brazil. Computed tomography images were examined with three-dimensional reconstructions to assess alterations to maxillofacial bones according to criteria for radiological rhinomaxillary syndrome. Participants were examined to assess facial alterations according to criteria for clinical rhinomaxillary syndrome. Results: Rhinomaxillary syndrome was investigated in 16 participants (ten females and six males), median age 70 (range 60–89) years, age at diagnosis 20 (6–43) years and time since diagnosis 46 (26–70) years. Four participants fully met radiological rhinomaxillary syndrome criteria, four partially. All participants with full radiological rhinomaxillary syndrome presented with facial changes which met criteria for clinical rhinomaxillary syndrome, including “saddle nose” (loss of nasal dorsal height and shortened length of nose, due to cartilaginous and/or bone collapse), concave middle third of the face with sunken nose, maxillary retrognathia and inverted upper lip. Limitations: Clinical histories were incomplete for some participants because records were lost at the hospital over time. Conclusion: Until Hansen’s disease is eliminated from endemic countries, persons affected will continue to present with rhinomaxillofacial alterations caused by Mycobacterium leprae infection. Clinical protocols for assessment and long-term care need to include otorhinolaryngological evaluation, mainly to prevent secondary complications. When rhinomaxillofacial bone changes are suspected, this evaluation should be supported by computed tomography imaging, if available.

Wound healing and Metabolite Profiling in Collagen-Chitosan Biomaterial-treated Chronic Wounds of Hansen’s Disease Patients

Aims: Impaired wound healing causes chronic ulcers in Hansen’s disease (HD) patients which are an unrecognized clinical manifestation and requires utmost care and attention for wound management. Collagen and chitosan biopolymers when synergistically combined produce a biologically active biomaterial for wound dressings. Hence, the aim was to prepare a collagen/chitosan (COL/CS) composite and characterize for wound healing potential in HD patients. Place and Duration of Study: CSIR-Central Leather Research Institute, Sardar Patel Road, Adyar, Chennai 600021, Southern Railway Headquarters Hospital, Constable Road, Ayanavaram, Chennai 600023, and Gremaltes Hospital, India between June 2013 and July 2020. Methodology: The HD wounds were measured by Planimetry in square cm and were also assessed for morphological structure of epidermis and collagen fiber arrangement by High Resolution- Scanning electron microscopy (HR-SEM). Proton Nuclear magnetic resonance spectroscopy (1H-NMR) for metabolite identification was studied in blood plasma samples of unwounded, untreated and treated HD patients Results: Size D (wound size on day of discharge) of the wounds were appreciably lower than Size 0 (wound size before biomaterial treatment) demonstrating efficient wound healing by the biomaterial. The morphological structure of the HD wounds showed healthy epidermal layer and thick fibers of collagen matrix in the treated wounds when compared to the controls. Key metabolites of metabolic pathways such as TCA cycle, creatine cycle and protein metabolism were identified by 1H-NMR spectroscopy Conclusion: The COL/CS wound dressing is a promising biomaterial for management of chronic wounds in Hansen’s disease.

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.

1394. Autochthonous Leprosy in Missouri

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

Leprosy review

Leprosy (Hansen’s disease) can affect multiple organs and body structures. Skin signs are typically observed in the early phase of the disease, hence being the first identifiable signs to propel clinical suspicion. Leprosy predominantly affects the skin and peripheral nerves. The disease has been documented many centuries preceding the biblical era. Over many decades, the classification of Hansen’s disease has changed as modern medical science evolved. Patients with leprosy are usually subjected to discrimination, rejection from society and can suffer from social stigma, poor quality of life (QoL), low self-esteem and permanent disfigurements. Studies have shown that leprosy has a significant negative impact on the patients’ QoL. Leprosy is often not suspected by practicing clinicians because it is no longer emphasised in the medical curricula. In modern years, attention has gradually shifted from leprosy to tuberculosis (TB) and human immunodeficiency virus (HIV).