Science.gov

Sample records for multibacillary leprosy patients

  1. [Multibacillary leprosy in Tyrol].

    PubMed

    Pfausler, Bettina; Bösch, Sylvia; Sepp, Norbert; Schmutzhard, Erich

    2003-01-01

    Five cases of multibacillary leprosy have been diagnosed in a period of 15 years (1987-2001) at the outpatient Department of Neurology of the University Hospital Innsbruck. All patients presented with dermatological and mild to severe polyneuropathic signs and symptoms. 4/5 patients recovered fully, whereas 1 patient with an initially severe polyneuropathy showed persistent polyneuropathy as long-term sequela. The prevalence of leprosy in the catchment area of the Department of Neurology, University Hospital Innsbruck (comprising the entire province of Tyrol--650,000 inhabitants) is to be calculated as 0.5/1 million. The incidence of newly diagnosed leprosy within this province of Tyrol is 0.04/100,000/year. The aim of the presentation of these 5 patients is--beside the epidemiologic aspect--to alert all neurologists and dermatologists that this disease still exists--despite decreasing prevalence and incidence rates on a global scale; this is of particular importance since neurological long-term sequelae can only be avoided by early diagnosis.

  2. Modeling both of the number of pausibacillary and multibacillary leprosy patients by using bivariate poisson regression

    NASA Astrophysics Data System (ADS)

    Winahju, W. S.; Mukarromah, A.; Putri, S.

    2015-03-01

    Leprosy is a chronic infectious disease caused by bacteria of leprosy (Mycobacterium leprae). Leprosy has become an important thing in Indonesia because its morbidity is quite high. Based on WHO data in 2014, in 2012 Indonesia has the highest number of new leprosy patients after India and Brazil with a contribution of 18.994 people (8.7% of the world). This number makes Indonesia automatically placed as the country with the highest number of leprosy morbidity of ASEAN countries. The province that most contributes to the number of leprosy patients in Indonesia is East Java. There are two kind of leprosy. They consist of pausibacillary and multibacillary. The morbidity of multibacillary leprosy is higher than pausibacillary leprosy. This paper will discuss modeling both of the number of multibacillary and pausibacillary leprosy patients as responses variables. These responses are count variables, so modeling will be conducted by using bivariate poisson regression method. Unit experiment used is in East Java, and predictors involved are: environment, demography, and poverty. The model uses data in 2012, and the result indicates that all predictors influence significantly.

  3. Stigma, deforming metaphors and patients' moral experience of multibacillary leprosy in Sobral, Ceará State, Brazil.

    PubMed

    Nations, Marilyn K; Lira, Geison Vasconcelos; Catrib, Ana Maria Fontenelle

    2009-06-01

    In response to the call for a new Science of Stigma, this anthropological study investigates the moral experience of patients diagnosed with severe multibacillary leprosy. From 2003 to 2006, fieldwork was conducted in the so-called 'United-States-of-Sobral', in Ceará State, Northeast Brazil. Sobral is highly endemic for leprosy, despite intensified eradication efforts and a 30% increase in primary care coverage since 1999. Of 329 active leprosy cases at two public clinics, 279 multibacillary patients were identified and six information-rich cases selected for in-depth ethnographic analysis, utilizing illness narratives, key-informant interviews, home visits, participant-observation of clinical consultations and semi-structured interviews with physicians. A 'contextualized semantic interpretation' revealed four leprosy metaphors: a repulsive rat's disease, a racist skin rash, a biblical curse and lethal leukemia. Far from value-free pathology, the disease is imbued with moral significance. Patients' multivocalic illness constructions contest physicians' disease discourse. 'Skin Spot Day' discriminates more than educates. Patients' 'non-compliance' with effective multi-drug therapy is due to demoralizing stigma more than a rejection of care. 'Social leprosy' in Northeast Brazil deforms patients' moral reputations and personal dignity.

  4. A clinical and bacteriological examination of Mycobacterium leprae in the epidermis and cutaneous appendages of patients with multibacillary leprosy.

    PubMed

    Hosokawa, A

    1999-08-01

    In the specimens examined at Ryukyu University Hospital, acid-fast bacilli (AFB) were observed in the epidermis, cutaneous appendages and endothelial cells of capillaries. These specimens were taken from non-ulcerating skin lesions of patients with multibacillary leprosies such as LL and borderline lepromatous leprosy (BL). Of the 211 specimens examined, 23 (10.9%) were AFB-positive [AFB (+)] in the above mentioned skin regions. These AFB (+) samples were taken from nine leprosy patients; six cases (17 samples) of LL, two cases (5 samples) of BL, and one case (one sample) of BB. The AFB positive rate [AFB (+)-rate] in the above mentioned skin regions was high in the unmedicated LL sample (50.0%, 7/14) and low in the medicated mid-borderline leprosy (BB) samples (0.0%, 0/10). Particularly in the intraepidermal eccrine sweat duct (acrosyringium), a relatively high number of AFB were observed. The AFB (+)-rate appears likely to be higher in non-ulcering skin lesions with minor inflammation or in lesions with leprosy reaction than typical skin lesions such as papules, nodules, and infiltrated punched out skin lesions. Although the possibility that viable bacilli could be excreted from non-ulcerating skin lesions appeared to be small, these lesions were suspected of being a possible source of infection.

  5. Pauci- and Multibacillary Leprosy: Two Distinct, Genetically Neglected Diseases.

    PubMed

    Gaschignard, Jean; Grant, Audrey Virginia; Thuc, Nguyen Van; Orlova, Marianna; Cobat, Aurélie; Huong, Nguyen Thu; Ba, Nguyen Ngoc; Thai, Vu Hong; Abel, Laurent; Schurr, Erwin; Alcaïs, Alexandre

    2016-05-01

    After sustained exposure to Mycobacterium leprae, only a subset of exposed individuals develops clinical leprosy. Moreover, leprosy patients show a wide spectrum of clinical manifestations that extend from the paucibacillary (PB) to the multibacillary (MB) form of the disease. This "polarization" of leprosy has long been a major focus of investigation for immunologists because of the different immune response in these two forms. But while leprosy per se has been shown to be under tight human genetic control, few epidemiological or genetic studies have focused on leprosy subtypes. Using PubMed, we collected available data in English on the epidemiology of leprosy polarization and the possible role of human genetics in its pathophysiology until September 2015. At the genetic level, we assembled a list of 28 genes from the literature that are associated with leprosy subtypes or implicated in the polarization process. Our bibliographical search revealed that improved study designs are needed to identify genes associated with leprosy polarization. Future investigations should not be restricted to a subanalysis of leprosy per se studies but should instead contrast MB to PB individuals. We show the latter approach to be the most powerful design for the identification of genetic polarization determinants. Finally, we bring to light the important resource represented by the nine-banded armadillo model, a unique animal model for leprosy. PMID:27219008

  6. Pauci- and Multibacillary Leprosy: Two Distinct, Genetically Neglected Diseases

    PubMed Central

    Gaschignard, Jean; Grant, Audrey Virginia; Thuc, Nguyen Van; Orlova, Marianna; Cobat, Aurélie; Huong, Nguyen Thu; Ba, Nguyen Ngoc; Thai, Vu Hong; Abel, Laurent; Schurr, Erwin; Alcaïs, Alexandre

    2016-01-01

    After sustained exposure to Mycobacterium leprae, only a subset of exposed individuals develops clinical leprosy. Moreover, leprosy patients show a wide spectrum of clinical manifestations that extend from the paucibacillary (PB) to the multibacillary (MB) form of the disease. This “polarization” of leprosy has long been a major focus of investigation for immunologists because of the different immune response in these two forms. But while leprosy per se has been shown to be under tight human genetic control, few epidemiological or genetic studies have focused on leprosy subtypes. Using PubMed, we collected available data in English on the epidemiology of leprosy polarization and the possible role of human genetics in its pathophysiology until September 2015. At the genetic level, we assembled a list of 28 genes from the literature that are associated with leprosy subtypes or implicated in the polarization process. Our bibliographical search revealed that improved study designs are needed to identify genes associated with leprosy polarization. Future investigations should not be restricted to a subanalysis of leprosy per se studies but should instead contrast MB to PB individuals. We show the latter approach to be the most powerful design for the identification of genetic polarization determinants. Finally, we bring to light the important resource represented by the nine-banded armadillo model, a unique animal model for leprosy. PMID:27219008

  7. Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review.

    PubMed

    Horta-Baas, G; Hernández-Cabrera, M F; Barile-Fabris, L A; Romero-Figueroa, M del S; Arenas-Guzmán, R

    2015-09-01

    Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.

  8. A bacteriological assessment of multibacillary cases in leprosy colonies after 4 1/2 years of multidrug therapy.

    PubMed

    Naik, S S; Bhanage, N D; Sawant, K V; Ganapati, R

    1988-07-01

    In this presentation we have devised a novel way of calculating the total bacterial quantum in 100 (78 LL and 22 BL) multibacillary leprosy patients living in leprosy colonies. The calculation is based on Ridley's logarithmic scale. We have also attempted to assess the reduction in the bacterial quantum as a result of intervention through multidrug therapy (MDT). 53% of the patients rendered bacteriologically negative within two years of treatment of MDT and 94% at 54th pulse dose i.e. at 54th month. The bacterial quantum in human source as leprosy patients was calculated thus--Average BI of the group X Number of patients in each group X Multiplication factor devised as per Ridley's Bacterial Index (BI). By applying this purely arithmetic formula, it was found that 99.8% of the bacterial load is harboured in leprosy patients having BI more than 3. The introduction of MDT initiated the reduction in total bacterial quantum "based on above arithmetic scale" was achieved very fast i.e., from 100% to 5% at 12 months and to 0.4% at 24 months. We believe that if one wants to achieve leprosy control through a reduction in total bacterial quantum within a specific period, leprosy cases with BI more than 3 should be treated on priority basis. PMID:3058827

  9. Correlation between Central Memory T Cell Expression and Proinflammatory Cytokine Production with Clinical Presentation of Multibacillary Leprosy Relapse

    PubMed Central

    Esquenazi, Danuza; Alvim, Iris Maria Peixoto; Pinheiro, Roberta Olmo; de Oliveira, Eliane Barbosa; Moreira, Lilian de Oliveira; Sarno, Euzenir Nunes; Nery, Jose Augusto da Costa

    2015-01-01

    Background Despite the efficacy of multidrug therapy, surviving Mycobacterium leprae causes relapse in some leprosy patients, and these patients present signs and symptoms of disease after healing. This study focused on the cellular immune response in relapsed multibacillary patients but also included non-relapsed multibacillary cured individuals, newly diagnosed and untreated multibacillary patients, paucibacillary patients just before the beginning of treatment, and voluntary healthy individuals for comparative analysis. Methodology/Principal Findings Inhibition of CD86 expression in the blood-derived monocytes and dendritic cells of relapsed multibacillary patients, either ex vivo or after M. leprae antigen stimulation was observed by flow cytometry. In addition, no significant changes in Interferon-gamma (IFN-γ) expression were observed in 5-day culture supernatants of relapsed patients in response to M. leprae, neither before nor after treatment, as measured by ELISA. However, these patients demonstrated a significant increase in central memory CD4+ and CD8+ M. leprae-specific T cells, as assessed by multiparametric flow cytometry. The increase in frequency of central memory T cells in relapsed patients strongly correlated with the bacillary index and the number of skin lesions observed in these subjects. Moreover, cytokine multiplex analysis demonstrated significant antigen-specific production of Interlukin-1beta (IL-1b), IL-6, and Tumour Necrosis Factor (TNF) in the relapsed group with extremely low IL-10 production, which resulted in a high TNF/IL-10 ratio. Conclusions/Significance Inhibition of CD86 expression may function to reduce effector T cell responses against the M. leprae antigen. Furthermore, the predominance of central memory T cells in association with the high TNF/IL-10 ratio and no observed IFN-γ production may be related to the pathogenesis of relapse in multibacillary leprosy. Therefore, our findings may be a direct result of the clinical

  10. Disabilities in multibacillary leprosy following multidrug therapy with and without immunotherapy with Mycobacterium w antileprosy vaccine.

    PubMed

    Sharma, P; Kar, H K; Misra, R S; Mukherjee, A; Kaur, H; Mukherjee, R; Rani, R

    1999-09-01

    A vaccine based on autoclaved Mycobacterium w was administered, in addition to standard multidrug therapy (MDT), to 157 bacteriologically positive, lepromin-negative, multibacillary leprosy patients supported by a well-matched control group of 147 patients with similar type of disease who received a placebo injection in addition to MDT. The MDT was given for a minimum period of 2 years and continued until skin-smear negativity, while the vaccine/placebo was given at 3-month intervals up to a maximum of 8 doses in the initial 2 years. The overall incidence of type 1 and type 2 reactions and neuritis during treatment and follow up was nearly equal in the patients in the vaccine and placebo groups; the differences were not statistically significant. The occurrence of disabilities, such as anesthesia, trophic ulcers, claw hand and grade 3 deformities, were not different statistically in the vaccine and placebo groups, an observation valid both for deformities present at induction and for those which developed during the course of therapy and surveillance. A statistically significant difference was observed in the recovery of newly developed trophic ulcers; recovery was quicker in the vaccine group. The recovery rate for motor deformities was marginally higher in the vaccine group, although not significant (p = 0.068) statistically. There was a statistically significant reduction in the incidence of grade 3 deformities following MDT with and without immunotherapy. To conclude, the addition of vaccine to MDT did not precipitate neuritis or deformities over and above that encountered with MDT alone, although it did accelerate bacteriological clearance, histopathological upgrading, conversion to lepromin positivity, and clinical improvement.

  11. Deformity incidence in leprosy patients treated with multidrug therapy.

    PubMed

    Rao, P S; Subramanian, M; Subramanian, G

    1994-01-01

    The records of 2,285 (2,007 paucibacillary (PB) and 278 multibacillary (MB)) cases of leprosy which were declared as released from treatment (RFT) after multidrug therapy (MDT) and under surveillance as per the National Leprosy Eradication Programme (NLEP) guidelines in the rural field practice area of Central Leprosy Teaching & Research Institute (CLTRI), Chengalpattu, between September 1986 and September 1993 were analyzed for collecting data on the incidence of deformity. Of the 2,285 cases 2,053 (1,947 PB and 106 MB) did not have deformity at the commencement of treatment. Three MB cases and one PB case out of the 2,053 developed deformity (all grade II) during the course of treatment. No patient developed deformity during surveillance. Thus the deformity incidence in the population of patients was 0.681 per 1000 person-years of observation. Age, sex, type of disease, prior dapsone monotherapy and nerve involvement at the commencement of treatment appear to influence the deformity incidence. The risk of development of deformity in patients treated with MDT appear to be very low and analysis of larger data sets is suggested to corroborate the above findings as the information would be useful for planning prevention and management of deformity services. PMID:7714354

  12. Endocrine dysfunction in patients of leprosy

    PubMed Central

    Singh, Rohit Kumar; Bhasin, Rohit; Bisht, Y. S.; Kumar, K. V. S. Hari

    2015-01-01

    Background: Leprosy is a chronic granulomatous disease and affects many internal organs in addition to the skin and peripheral nerves. Endocrine dysfunction is often silent and is often missed in patients of leprosy leading to significant morbidity. We studied the presence of occult endocrine disorders in leprosy patients and compared the same with disease parameters. Materials and Methods: We evaluated 40 patients of leprosy (aged 18–70 years, any duration) in this cross-sectional, observational study. All subjects were assessed for pituitary, thyroid, adrenal, gonadal function, and dynamic testing was done when deemed necessary. The participants were divided into two groups: Group 1 (Leprosy, n = 40) and Group 2 (Controls, n = 20) and the data were analyzed with appropriate statistical tests. Results: The study participants (35 males, 5 females) had a mean age of 36.4 ± 11.3 years, and duration of the disease was 2.5 ± 5.5 years. Eleven out of 40 patients showed results consistent with an endocrine disorder, including subclinical hypothyroidism (n = 4), sick euthyroid syndrome (n = 3), growth hormone (GH) deficiency (n = 2), primary hypogonadism (n = 2) and secondary hypogonadism in one patient. One patient had partial hypopituitarism (GH deficiency and secondary hypogonadism) and none of the controls showed any hormonal dysfunction. Testosterone levels showed inverse correlation with the number of skin patches (P = 0.0006). Conclusion: Occult endocrine dysfunction is seen in a quarter of patients with leprosy. Thyroid and gonadal axes abnormalities are common, and the severity is more in lepromatous forms of the disease. Further large studies are required to confirm the findings observed in our study. PMID:25932392

  13. Significance of Histopathology in Leprosy Patients with 1–5 Skin Lesions with Relevance to Therapy

    PubMed Central

    Veena, S; Kumar, Prakash; Shashikala, P; Gurubasavaraj, H; Chandrasekhar, H R; Murugesh

    2011-01-01

    Background: Patients with 1–5 skin lesions are clinically categorized as paucibacillary for treatment purposes. For betterment and adequate treatment of patients, this grouping needs further study. Aim: To study a group of leprosy patients with 1–5 skin lesions, compare clinical details with histopathological findings and bacteriological status of the skin to evaluate the relevance of this grouping. Materials and Methods: Two-year study involving 31 patients of leprosy with 1-5 skin lesions was included in this study. A number of skin lesions were recorded. Skin biopsies were taken in all patients. The biopsies were evaluated for the type of pathology and acid fast bacilli (AFB) status. Results: Of 31 patients, 19 (61.2%) had single skin lesion, 7 (22.5%) had two lesions, 4 (12.9%) had three lesions, and only one (3.22%) had four lesions, there were no patients with five lesions. Of the 31 patients, 30 (96.7%) were clinically diagnosed as borderline tuberculoid and one patient (3.22%) has tuberculoid leprosy. Skin smears were negative for AFB in all patients. The histological diagnoses were: TT 1 (3.22%), BT 24 (77.41%), and IL 6 (19.2%). AFB were found in 2 (6.45%) out of 31 skin biopsies. Clinicopathological correlation was 76.6% in the BT group. Conclusion: Tissue biopsy findings in 1–5 skin lesions which were not considered relevant for treatment purposes until now should be given a status in the categorization and assessment of severity of the disease. The significance of finding of AFB and histopathology of multibacillary (MB) type of leprosy in tissue biopsies, in patients grouped as PB should be resolved so that patients could be given the drug therapy and duration of therapy they warrant. PMID:21701658

  14. Histoid leprosy: a prospective diagnostic study in 38 patients.

    PubMed

    Sehgal, V N; Srivastava, G

    1988-01-01

    Histoid leprosy is a fascinating expression of multibacillary leprosy, the incidence of which was 3.6%. It was seen predominantly in males of the younger age group, who were on inadequate and irregular dosage of diaminodiphenyl sulfone. Papules, cutaneous and/or subcutaneous nodules and plaques appearing over apparently normal skin were its exquisite prospective clinical features. It was invariably supported by enormous, uniformly solid staining discrete bacilli from the lesions, in contrast to their virtual absence from the surrounding normal-appearing skin. Encapsulated tumorous mass, formed primarily by spindle-shaped histocytes, displayed either in intertwining, criss-cross or whorled fashion in haematoxylin-eosin-stained sections, were supplementary. The morphology of acid-fast bacilli was, however, similar to skin-slit smears. PMID:3224729

  15. Dapsone hypersensitivity syndrome in a lepromatous leprosy patient--A Case Report.

    PubMed

    Gavilanes, Maria Catalina; Palacio, Adriana Lucia; Chellini, Patricia Rocha; Nery, José Augusto da Costa; Rego, Juliana Gonçalves

    2015-06-01

    Dapsone hypersensitivity syndrome (DHS) can be classified as a 'drug reaction with eosinophilia and systemic symptoms' (DRESS). It has a variable course, it is not dose dependent and may present with different clinical and laboratory abnormalities. In some cases it may be fatal. We describe a 31 year old man with lepromatous leprosy in whom DHS developed 4 weeks after initiation of World Health Organization multibacillary multidrug therapy (dapsone, clofazimine and rifampin). He had fever, dehydration, diffuse rash, pain on abdominal palpation and inguinal painless lymph nodes. Severe anaemia, abnormal liver function and hyperbilirubinaemia were also found. The patient was treated with prednisone 50 mg daily. There was gradual improvement in the clinical and laboratory signs. We encourage health professionals to be aware of the risk of DHS and to have in mind the development of investigative studies related to HLA and MHC in these patients. PMID:26502691

  16. Tuberculous lymphadenitis and borderline leprosy in a patient with isolated unconjugated hyperbilirubinaemia.

    PubMed

    Magazine, Rahul; Chogtu, Bharti; Manu, Mohan K; Shahul, Hameed Aboobackar

    2014-01-01

    A 35-year-old man was diagnosed with tuberculous lymphadenitis and multibacillary borderline tuberculoid leprosy. On investigation, isolated unconjugated hyperbilirubinaemia was detected and evaluation led us to conclude that the probable cause was Gilbert's syndrome. He was successfully managed by administration of chemotherapy for the treatment of both the mycobacterial infections, with no adverse effects on liver function tests. PMID:25385559

  17. Sparfloxacin in the treatment of leprosy patients.

    PubMed

    Ishii, N; Sugita, Y; Sato, I; Nakajima, H

    1997-08-01

    Seven men (age range, 20-33 years) with leprosy visited our dermatologic clinic at Yokohama City University Hospital (Table 1) and were entered into a trial of sparfloxacin (SPFX), 100-200 mg daily for up to 1 year. Five patients were Japanese Brazilians or Paraguayan from South America, and two patients were Filipinos. Examination procedures included a detailed medical history, pretreatment, clinical examinations, and body charting of the characteristic skin lesions, areas of anesthesia, and enlarged peripheral nerves. There were no deformities observed in any patient. All had presented with eruptions and neurologic problems. The diagnosis of leprosy and its type were determined by the above examination, skin smear, and histopathologic study, as well as Mitsuda reaction. The first patient came from the Philippines and presented to our clinic in 1993. There were many elevated erythemas with central healing on his whole body. Sensory nerves were impaired. His type was lepromatous (LL) leprosy. The second patient was followed for only 1 month because of a change in residence. The third and fourth patients were brothers. The fifth patient came from Paraguay. The sixth patient was from the Philippines. The seventh patient came to our clinic in April 1995.

  18. Leprosy Reactions in Patients Coinfected with HIV: Clinical Aspects and Outcomes in Two Comparative Cohorts in the Amazon Region, Brazil

    PubMed Central

    Pires, Carla Andréa Avelar; Jucá Neto, Fernando Octávio Machado; de Albuquerque, Nahima Castelo; Macedo, Geraldo Mariano Moraes; Batista, Keila de Nazaré Madureira; Xavier, Marília Brasil

    2015-01-01

    Background Leprosy, caused by Mycobacterium leprae, can lead to scarring and deformities. Human immunodeficiency virus (HIV), a lymphotropic virus with high rates of replication, leads to cell death in various stages of infection. These diseases have major social and quality of life costs, and although the relevance of their comorbidity is recognized, several aspects are still not fully understood. Methodology/Principal Findings Two cohorts of patients with leprosy in an endemic region of the Amazon were observed. We compared 40 patients with leprosy and HIV (Group 1) and 107 leprosy patients with no comorbidity (Group 2) for a minimum of 2 years. Group 1 predominantly experienced the paucibacillary classification, accounting for 70% of cases, whereas Group 2 primarily experienced the multibacillary classification (80.4% of cases). There was no significant difference in the prevalence of leprosy reactions among the two groups (37.5% for Group 1 vs. 56.1% for Group 2), and the most frequent reaction was Type 1. The appearance of Group 1 patients’ reversal reaction skin lesions was consistent with each clinical form: typically erythematous and infiltrated, with similar progression as those patients without HIV, which responded to prednisone. Patients in both groups primarily experienced a single episode (73.3% in Group 1 and 75% in Group 2), and Group 1 had shorter reaction periods (≤3 months; 93.3%), moderate severity (80%), with 93.3% of the patients in the state of acquired immune deficiency syndrome, and 46.7% presenting the reaction at the time of the immune reconstitution inflammatory syndrome. Conclusions/Significance This study used a large sample and makes a significant contribution to the clinical outcomes of patients in the reactive state with comorbid HIV and leprosy. The data indicate that these diseases, although concurrent, have independent courses. PMID:26029928

  19. Leprosy

    MedlinePlus

    ... doctor will ask you questions about your medical history and the symptoms you are experiencing. He or she will probably want to remove a tiny piece of the affected skin (called a biopsy) to check for the Mycobacterium leprae bacteria. Treatment How is leprosy treated? Leprosy is treated ...

  20. Hypopigmented macules: leprosy, atopy or pityriasis versicolor?

    PubMed

    Massone, C; Cavalchini, A; Clapasson, A; Nunzi, E

    2010-12-01

    Lepromatous leprosy (LL) represents the highest infective and multibacillary form of leprosy. Clinical manifestations are consequent to the haematogenous spread of bacilli and include macules, plaques and nodules in a symmetric distribution or a diffuse infiltration of the skin. LL may mimic many different inflammatory and neoplastic skin diseases and in a small percentage of patients, skin manifestation may be atypical. This article reports the case of a South American child with LL presenting with symmetrically distributed hypopigmented macules previously misdiagnosed as pytiriasis alba, atopic dermatitis and pityriasis versicolor. Atopy and pityriasis versicolor are common skin conditions that can be also observed in leprosy patients and that can masquerade the diagnosis of LL, especially if occurring in dark skin. Dermatologists in Europe should be aware of this unusual form of presentation of leprosy and must take in mind Hansen disease in the differential diagnosis in patients coming from endemic areas.

  1. The -308 bp TNF gene polymorphism influences tumor necrosis factor expression in leprosy patients in Bahia State, Brazil.

    PubMed

    Oliveira, Joyce Moura; Rêgo, Jamile Leão; de Lima Santana, Nadja; Braz, Marcos; Jamieson, Sarra E; Vieira, Thaillamar Silva; Magalhães, Thaís Lamêgo; Machado, Paulo Roberto Lima; Blackwell, Jenefer M; Castellucci, Léa C

    2016-04-01

    Leprosy or Hansen's disease is a debilitating chronic granulomatous disease caused by Mycobacterium leprae, with high incidence and prevalence in Brazil. The -308 bp G/A single nucleotide polymorphism (SNP rs1800629) in the tumor necrosis factor (TNF) gene promoter is a proposed risk factor for leprosy. In Brazil, Northern India, Egypt and Nepal, the common G allele was associated with leprosy. In Eastern India, Thailand and Malawi the minor A allele was the risk factor. Allele A was previously associated with high TNF. We genotyped rs1800629 in 326 leprosy cases from Bahia State, Brazil, including 72 paucibacillary (PB) and 47 multibacillary (MB) without reactions, and 69 reversal reaction (RR) and 78 erythema nodosum leprosum (ENL) with reactions. Logistic regression was used to compare patient groups with 331 healthy controls. Relative TNF mRNA was determined in peripheral blood leukocytes by QRTPCR, and serum TNF levels measured by ELISA. We found that TNF mRNA expression was higher (P=0.03) in leprosy patients compared to endemic controls, but did not differ significantly between clinical subgroups. Carriage of the minor A allele was associated (P=0.003) with low TNF mRNA across leprosy patients. Nevertheless, we found no evidence for either allele at this SNP as a risk factor for leprosy per se (OR=1.12, 95% CI 0.79-1.60, P=0.52), PB (OR=0.99, 95% CI 0.54-1.81, P=0.97), MB (OR=0.86, 95% CI 0.40-1.83, P=0.70), RR (OR=1.37, 95% CI 0.79-2.38, P=0.27) or ENL (OR=0.76, 95% CI 0.40-1.45, P=0.42) when compared to endemic controls. Further studies are required to determine whether the influence of the minor A allele on TNF mRNA levels determines response to treatment, particularly in the context of ENL reaction treatment with anti-TNF therapies and RR reactions where treatment with prednisolone is known to reduce TNF levels. Our findings contribute to understanding TNF as an important determinant of leprosy immunopathology in Brazil. PMID:26829382

  2. Leprosy.

    PubMed Central

    Hastings, R C; Gillis, T P; Krahenbuhl, J L; Franzblau, S G

    1988-01-01

    Leprosy affects over 10 million people in the world. The disease is a model of graded cell-mediated immunity, in this case to the causative organism, Mycobacterium leprae. The clinical manifestations are due to (i) bacterial progression, (ii) immunologic responses of the host, (iii) peripheral nerve damage due to either or both bacterial progression and immunologic responses of the host, and (iv) preventable secondary deformities following nerve damage, which account for most of the stigma of the disease. Treatment modalities are now available to control or minimize the effects of bacterial progression, harmful immunologic responses of the host, peripheral nerve damage, and secondary deformities. Unique biochemical characteristics of M. leprae reside in the cell wall and associated macromolecules. Some of these molecules are potent immunogens in humans, while others constitute the structural integrity of the bacillus. Proteins of M. leprae are currently under intensive investigation as a result of deoxyribonucleic acid cloning of M. leprae genes. Structure-function and antigenic relationships of M. leprae proteins should become available by using recombinant deoxyribonucleic acid procedures coupled with T- and B-cell cloning to advance our understanding of the immunologic reactions encountered in Hansen's disease. Until recently, the study of the immunology of leprosy has been stymied by the lack of immunologically specific M. leprae antigens. The definition of specific antigens and production of recombinant and synthetic immunologic reagents have fostered state-of-the-art research efforts into new immunodiagnostic procedures and development of a leprosy vaccine. Also discussed is progress in understanding of the mechanism(s) underlying the M. leprae-specific immunodeficiency associated with lepromatous leprosy, including the role of suppressor T cells and defective macrophage function. Metabolic studies of M. leprae suggest intact catabolic pathways and energy

  3. Borderline tuberculoid leprosy in childhood onset systemic lupus erythematosus patient.

    PubMed

    Lopes, V A P; Lourenço, D M R; Guariento, A; Trindade, M A; Avancini, J; Silva, C A

    2015-11-01

    Leprosy is a contagious and chronic systemic granulomatous disease caused by the bacillus Mycobacterium leprae. To our knowledge, no case of leprosy in a childhood-onset systemic lupus erythematosus (c-SLE) patient has been reported. For a period of 31 years, 312 c-SLE patients were followed at the Pediatric Rheumatology Unit of our University Hospital. One of them (0.3%) had tuberculoid leprosy skin lesions during the disease course and is here reported. A 10-year-old boy from Northwest of Brazil was diagnosed with c-SLE based on malar rash, photosensitivity, oral ulcers, lymphopenia, proteinuria, positive antinuclear antibodies, anti-double-stranded DNA, anti-Sm and anti-Ro/SSA autoantibodies. He was treated with prednisone, hydroxychloroquine and intravenous cyclophosphamide, followed by mycophenolate mofetil. At 12-years-old, he presented asymmetric skin lesions characterized by erythematous plaques with elevated external borders and hypochromic center with sensory loss. Peripheral nerve involvement was not evidenced. No history of familial cases of leprosy was reported, although the region where the patient resides is considered to be endemic for leprosy. Skin biopsy revealed a well-defined tuberculoid form. A marked thickening of nerves was observed, often destroyed by granulomas, without evidence of Mycobacterium leprae bacilli. At that time, the SLEDAI-2K score was 4 and he had been receiving prednisone 15 mg/day, hydroxychloroquine 200 mg/day and mycophenolate mofetil 3 g/day. Paucibacillary treatment for leprosy with dapsone and rifampicine was also introduced. In conclusion, we have reported a rare case of leprosy in the course of c-SLE. Leprosy should always be considered in children and adolescents with lupus who present skin abnormalities, particularly with hypoesthesic or anesthesic cutaneous lesions.

  4. Clinical and epidemiological profile of leprosy patients attended at Ceará, 2007-2011*

    PubMed Central

    Queirós, Maria Iranilda; Ramos Júnior, Alberto Novaes; Alencar, Carlos Henrique Morais; Monteiro, Lorena Dias; Sena, Amanda Lima; Barbosa, Jaqueline Caracas

    2016-01-01

    Background Leprosy is an infectious chronic condition associated with potentially serious physical, social and psychological impacts. Objectives To characterize the clinical and epidemiological profile of leprosy patients treated from 2007 to 2011 in the University Hospital of Ceará, Northeastern Brazil. Methods This is a retrospective and descriptive study. The study population consisted of residents in the state of Ceará treated in a dermatology clinic between 2007-2011. Clinical and epidemiological data analyzed were obtained from medical records and from the database of national Information System for Notifiable Diseases. Results 475 cases were analyzed, mostly women (51.8%), aged 45-59 years (35.0%) - mean of 45.2 years at diagnosis - with 6.3% of children under 15 , with low education (73.7%), white color (68.8%), residency in the city of Fortaleza (82.3%), and no defined work occupation (59.6%). At diagnosis, most patients were multibacillary (MB) (65.5%), had borderline clinical form (48.0%), and 22.7% had physical disability (8.0% with grade 2), predominantly in MB cases (p <0.001). We observe worsening of disability in 5.1% of cases post-MDT. The proportion of cases with reactional episodes was 42.7%, mainly during MDT (51.2%). Conclusion This is the first study conducted in this hospital context, revealing late diagnosis, high burden of disease, hidden endemicity, and high social vulnerability in the state of Ceará. This study reinforces the need to strengthen health care network for timely diagnosis and treatment, aiming at longitudinality of assistance. PMID:27438198

  5. Drug and Multidrug Resistance among Mycobacterium leprae Isolates from Brazilian Relapsed Leprosy Patients

    PubMed Central

    Rocha, Adalgiza da Silva; Cunha, Maria das Graças; Diniz, Lucia Martins; Salgado, Claudio; Aires, Maria Araci P.; Nery, José Augusto; Gallo, Eugênia Novisck; Miranda, Alice; Magnanini, Monica M. F.; Matsuoka, Masanori; Sarno, Euzenir Nunes; Suffys, Philip Noel

    2012-01-01

    Skin biopsy samples from 145 relapse leprosy cases and from five different regions in Brazil were submitted for sequence analysis of part of the genes associated with Mycobacterium leprae drug resistance. Single nucleotide polymorphisms (SNPs) in these genes were observed in M. leprae from 4 out of 92 cases with positive amplification (4.3%) and included a case with a mutation in rpoB only, another sample with SNPs in both folP1 and rpoB, and two cases showing mutations in folP1, rpoB, and gyrA, suggesting the existence of multidrug resistance (MDR). The nature of the mutations was as reported in earlier studies, being CCC to CGC in codon 55 in folP (Pro to Arg), while in the case of rpoB, all mutations occurred at codon 531, with two being a transition of TCG to ATG (Ser to Met), one TCG to TTC (Ser to Phe), and one TCG to TTG (Ser to Leu). The two cases with mutations in gyrA changed from GCA to GTA (Ala to Val) in codon 91. The median time from cure to relapse diagnosis was 9.45 years but was significantly shorter in patients with mutations (3.26 years; P = 0.0038). More than 70% of the relapses were multibacillary, including three of the mutation-carrying cases; one MDR relapse patient was paucibacillary. PMID:22495562

  6. Immunoprophylactic effects of the anti-leprosy Mw vaccine in household contacts of leprosy patients: clinical field trials with a follow up of 8-10 years.

    PubMed

    Sharma, Pankaj; Mukherjee, Rama; Talwar, G P; Sarathchandra, K G; Walia, R; Parida, S K; Pandey, R M; Rani, Rajni; Kar, Hemant; Mukherjee, Ashok; Katoch, Kiran; Benara, S K; Singh, Tulsi; Singh, Padam

    2005-06-01

    We report here a large scale, double blind immunoprophylactic trial of a leprosy vaccine based on Mycobacterium w (Mw) in an endemic area of Kanpur Dehat, Uttar Pradesh, India. A population of 420,823 spread over 272 villages was screened where 1226 multibacillary (MB) and 3757 paucibacillary (PB) cases of leprosy were detected. A total of 29,420 household contacts (HHC) of these patients were screened for evidence of active or inactive leprosy. After exclusion of 1622 contacts for any of the different exclusion criteria, a total of 24,060 HHC could be vaccinated for vaccine or placebo under coding (20,194 administered two doses and 3866 received single dose). The vaccine consisted of 1 x 10(9) heat killed bacilli (Mw) in normal saline for the first dose and half of the first dose, i.e. 5 x 10(8) bacilli for the second dose, given 6 months after the first dose. The placebo consisted of 1/8th dose of the normal dose of tetanous toxoid. Both placebo and vaccine were given under double-blind coding, The contacts were followed up during three surveys at 3, 6 and 9 years after the initial vaccination, for detection of post-vaccination cases (PVCs) and observing any side-effects caused as a result of vaccination. The codes were opened on 24th January 2001, after the analysis of the data following completion of the third and final follow-up survey. When only contacts received the vaccine, Mw vaccine showed a protective efficacy (PE) of 68-6% at the end of first, 59% at the end of the second and 39.3% at the end of the third follow-up survey. When both patients and contacts received the vaccine, the protective efficacy observed was 68%, 60% and 28% at the end of the first, second and third surveys, respectively. When patients, and not the contacts, received the vaccine, a PE of 42.9% in the first, 31% in the second and 3% in the third survey was shown. These results suggest that the vaccination of the contacts is more valuable in achieving the objective of

  7. Update on the epidemiology, diagnosis, and treatment of leprosy.

    PubMed

    Reibel, F; Cambau, E; Aubry, A

    2015-09-01

    Leprosy is an infectious disease that has now been reported for more than 2000 years. The leprosy elimination goal set by the World Health Organization (WHO), i.e. a global prevalence rate <1 patient per 10,000 population, was achieved in the year 2000, but more than 200,000 new case patients are still reported each year, particularly in India, Brazil, and Indonesia. Leprosy is a specific infection: (i) it is a chronic infection primarily affecting the skin and peripheral nerves, (ii) Mycobacterium leprae is one of the last bacterial species of medical interest that cannot be cultured in vitro (mainly because of its reductive genome evolution), and (iii) transmission and pathophysiological data is still limited. The various presentations of the disease (Ridley-Jopling and WHO classifications) are correlated with the patient's immune response, bacillary load, and by the delay before diagnosis. Multidrug therapy (dapsone, rifampicin, with or without clofazimine) has been recommended since 1982 as the standard treatment of leprosy; 6 months for patients presenting with paucibacillary leprosy and 12 months for patients presenting with multibacillary leprosy. The worldwide use of leprosy drugs started in the 1980s and their free access since 1995 contributed to the drastic decline in the number of new case patients. Resistant strains are however emerging despite the use of multidrug therapy; identifying and monitoring resistance is still necessary.

  8. Specific and nonspecific aspects of humoral immune response in leprosy.

    PubMed

    Kirsztajn, G M; Nishida, S K; Silva, M S; Lombardi, C; Ajzen, H; Pereira, A B

    1994-01-01

    1. We have studied some generic and specific aspects of the humoral immune response in 96 patients with leprosy (29 paucibacillary and 67 multibacillary individuals). We determined serum immunoglobulins (IgM, IgG and IgA), CH50, C1q, C3 and C4, circulating immune complexes (CIC), C-reactive protein (CRP), rheumatoid factor (RF) and antinuclear antibodies. No specific pattern of general humoral immune changes could be observed. 2. The specific immune response was studied by the detection of specific IgM anti-M. leprae antibodies. An immunoradiometric assay (IRMA) and an ELISA were compared for clinical effectiveness. IRMA showed greater sensitivity for the serodiagnosis of leprosy as compared to ELISA (88.1% vs 58.2% for multibacillary patients and 20.7% vs 10.3% for paucibacillary leprosy patients). Specificity was 96% for IRMA and 97% for ELISA. 3. Our results indicate that nonspecific changes in the humoral immune response are of little value in assessing leprosy patients and that immune assays for the detection of specific anti-M. leprae antibodies may be of value in the diagnosis, study and follow-up of these patients. PMID:8173529

  9. Culture and 'compliance' among leprosy patients in Pakistan.

    PubMed

    Mull, J D; Wood, C S; Gans, L P; Mull, D S

    1989-01-01

    In Pakistan approx. 30% of the 18,000 known leprosy patients have dropped out of their treatment programs. To investigate reasons for such widespread noncompliance, 128 diagnosed leprosy patients--59 outpatients and 69 inpatients--were interviewed in Karachi. More than half of the 'noncompliant' outpatients denied having the disease. Denial was found to be an understandable coping mechanism in view of the severe stigma associated with leprosy. The presence of close-knit extended families, in which joint decision-making was the norm and in which such a dread diagnosis could spell the end of job and marriage prospects for even distant relatives, contributed to the likelihood of denial. In such a setting, the very term 'noncompliant' appeared to be an oversimplification since it covered so many different types of culturally-constrained behavior. In addition, many of the patients who initially seemed most 'compliant' by virtue of being long-term hospital inpatients in fact owed their hospitalization to the fact that they had been markedly noncompliant in the past. Thus the usual view that adherence to a biomedical treatment regimen constitutes 'compliance' and that nonadherence to such a regimen constitutes 'noncompliance' proved inadequate for understanding the health behavior of these Third World leprosy victims. The study also showed that many patients had initially consulted traditional healers, inadequately-trained physicians, and/or untrained medical practitioners for treatment of their symptoms, which resulted in lengthy delays before they were correctly diagnosed. Further, even after the diagnosis was made and appropriate medications were prescribed by trained personnel, most patients were not told what had caused their leprosy and how the drug regimen worked to combat it: when questioned, only 4% of the 128 respondents attributed the disease to infectious organisms. In addition, patients were usually not warned in advance of the possibility of undesirable side

  10. Regional Anaesthesia Management in a Patient with Leprosy: Rare Case with Rare Application

    PubMed Central

    Uçar, Muharrem; Şanlı, Mukadder; Özkan, Ahmet Selim; Demiröz, Duygu; Erdoğan, Mehmet Ali; Durmuş, Mahmut

    2016-01-01

    Leprosy is a chronic infectious disease that is caused by Mycobacterium leprae and affects the skin and nerves. Patients with leprosy having related peripheral neuropathy and involvement of other organs may have cardiac, respiratory dysautonomia and autonomic dysfunctions. There are very few studies regarding anaesthetic management of patients suffering from leprosy. Moreover, very few studies concerning regional anaesthesia in patients with lepromatous leprosy have been reported. In this study, we aim to assess regional anaesthesia management with combined spinal epidural anaesthesia in a patient who had been followed up with a diagnosis of leprosy for a long time and was scheduled for operation because of a femoral neck fracture. PMID:27366553

  11. Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae in human archaeological samples: a possible explanation for the historical decline of leprosy

    PubMed Central

    Donoghue, Helen D.; Marcsik, Antónia; Matheson, Carney; Vernon, Kim; Nuorala, Emilia; Molto, Joseph E.; Greenblatt, Charles L.; Spigelman, Mark

    2005-01-01

    Both leprosy and tuberculosis were prevalent in Europe during the first millennium but thereafter leprosy declined. It is not known why this occurred, but one suggestion is that cross-immunity protected tuberculosis patients from leprosy. To investigate any relationship between the two diseases, selected archaeological samples, dating from the Roman period to the thirteenth century, were examined for both Mycobacterium leprae and Mycobacterium tuberculosis DNA, using PCR. The work was carried out and verified in geographically separate and independent laboratories. Several specimens with palaeopathological signs of leprosy were found to contain DNA from both pathogens, indicating that these diseases coexisted in the past. We suggest that the immunological changes found in multi-bacillary leprosy, in association with the socio-economic impact on those suffering from the disease, led to increased mortality from tuberculosis and therefore to the historical decline in leprosy. PMID:15734693

  12. Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

    PubMed

    Eichelmann, K; González González, S E; Salas-Alanis, J C; Ocampo-Candiani, J

    2013-09-01

    Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease.

  13. Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

    PubMed

    Eichelmann, K; González González, S E; Salas-Alanis, J C; Ocampo-Candiani, J

    2013-09-01

    Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease. PMID:23870850

  14. Presence of an index case in households of newly registered leprosy patients: experience from a leprosy referral centre in South India.

    PubMed

    Anjum, Vaseem; Vijayakumaran, P

    2015-12-01

    The global leprosy burden in terms of new case detection does not seem to show a declining trend. India continues to be one of the major contributors to the leprosy burden. It is well known that the presence of an index case is a risk factor for leprosy among household contacts. The Blue Peter Health and Research centre (BPHRC), a leprosy referral centre in South India, observed the presence of an index case in 27.6% of leprosy patients newly diagnosed during 2009-2013. A majority of the index cases were either parents or siblings. Early case detection is recommended in global and national strategies, but active contact screening is not in the purview of integrated leprosy services in India. Active contact screening may be considered as one of the major activities to further reduce the leprosy burden.

  15. Nocardia nova mycetoma over forehead in a lepromatous leprosy patient.

    PubMed

    Dhingra, M; Kaistha, N; Bansal, N; Solanki, L S; Chander, J; Thami, G P; van de Sande, W W

    2012-07-01

    We present a case of a 31-year-old male, a known patient with lepromatous leprosy with a type 2 lepra reaction, who presented with a slowly growing asymptomatic swelling with multiple discharging sinuses over the forehead that developed over 6 months. Smears of the serosanguinous discharge on Gram staining showed Gram-positive branching filamentous bacilli, which on culture on blood agar showed chalky-white colonies. Histology of the lesion showed suppurative granulomas with polymorphs surrounding characteristic grains. The isolate was identified as Nocardia nova by gene sequencing and the patient was started on combined antibiotic therapy that resulted in complete resolution of the infection in six months. To the best of our knowledge, this is the first report of mycetoma related to Nocardia nova in association with leprosy. PMID:22863625

  16. Problems and needs of women leprosy patients in Bombay and Goa--a preliminary report.

    PubMed

    Naik, S S; Hambarde, P S; Desai, A N

    1991-01-01

    By studying the status of 151 women leprosy patients (24 from a leprosy asylum and 127 attending urban leprosy centres at Goa and Bombay), it was noticed that a sizeable proportion experienced problems in society ascribable to the disease especially at the initial stages of the disease. However, most of them seemed to have managed to settle well in their families as housewives subsequently. Younger women leprosy patients expressed the need for financial assistance for completing their own education and for starting small scale business. The older women were more interested in educating their children.

  17. Infection by Mycobacterium leprae of household contacts of lepromatous leprosy patients from a post-elimination leprosy region of Colombia.

    PubMed

    Cardona-Castro, Nora M; Restrepo-Jaramillo, Sandra; Gil de la Ossa, Myriam; Brennan, Patrick J

    2005-11-01

    The Leprosy Control Program of Antioquia, (post-elimination leprosy state of Colombia), had registered by 1999, 56 lepromatous leprosy patients and their household contacts (HHC). Our interest was to detect Mycobacterium leprae infection in these HHC. Clinical examination, acid-fast bacillary staining (AFB) in nasal secretions, and slit skin samples, IgM anti-PGL-I in serum and Lepromine A (Mitsuda) reactivity were tested. Two hundred forty eight HHC were studied, 49% were male. After clinical examination, two HHC were diagnosed as multi bacillary patients; 13% showed positive IgM anti-PGL-I titers; Mitsuda reaction (> or = 4 mm) was positive in 59%; AFB was negative in all samples, except in the two new patients. HHC were classified according to test results. Group 1: two new multi bacillary patients. Group 2: 15 HHC seropositive, Mitsuda-negative. Group 3: 13 HHC seropositive, Mitsuda-positive. Group 4: 130 HHC seronegative, Mitsuda-positive. Group 5: 88 HHC seronegative, Mitsuda-negative. These results are an indication that the transmission of the infection is still happening in a region considered in the post elimination phase. The two new patients represent an infection source for others contacts, and groups 2 and 3 are infected HHC that could develop the disease in future. Follow up of high risk population is necessary to achieve real elimination of leprosy.

  18. Ocular findings in leprosy patients in an institution in Nepal (Khokana).

    PubMed Central

    Malla, O K; Brandt, F; Anten, J G

    1981-01-01

    A total of 466 leprosy patients in Nepal, some advanced cases, were surveyed for ocular lesions. 74.2% were found with ocular features, and 12.7% of the eyes were blind. The patients were classified in tuberculoid, borderline-borderline, and lepromatous groups. Lepromatous leprosy is responsible for major ocular complications and blindness. PMID:7236565

  19. Gender and leprosy: case studies in Indonesia, Nigeria, Nepal and Brazil.

    PubMed

    Varkevisser, Corlien M; Lever, Peter; Alubo, Ogoh; Burathoki, Kamala; Idawani, Cut; Moreira, Tatiana M A; Patrobas, Phillip; Yulizar, Media

    2009-03-01

    There appear to be regional differences in gender ratios of leprosy patients being diagnosed and treated. In Asian countries, more men than women are registered whilst in Africa female patients outnumber males. The Netherlands Leprosy Relief (NLR) therefore initiated research into factors underlying these regional gender differences. Between 1997 and 1999, leprosy control teams in Indonesia, Nigeria, Nepal and Brazil supported by social/public health scientists, conducted comparative exploratory research. They looked at three groups of potential explanatory factors: biological, socio-cultural/economic and service-related. The studies were partially quantitative (analysis of the records of patients who according to prescription could have completed treatment) and partially qualitative (interviews/focus group discussions with patients, their relatives, community members and health staff on perceptions of leprosy, its socio-economic consequences, treatment and cure). Biological factors appeared similar in the four countries: irrespective of the M/F ratio, more men than women were registered with multibacillary (MB) leprosy. Strong traditions, the low status of women, their limited mobility, illiteracy and poor knowledge of leprosy appeared to be important sociocultural factors explaining why women were under reporting. Yet, accessible, well reputed services augmented female participation and helped to diminish stigma, which in three out of the four societies seemed greater for women than for men. These positive effects could still be higher if the services would enhance community and patient education with active participation of patients and ex-patients themselves. PMID:19472853

  20. Amyloid-related serum component (protein ASC) IN LEPROSY PATIENTS.

    PubMed Central

    Kronvall, G; Husby, G; Samuel, D; Bjune, G; Wheate, H

    1975-01-01

    The presence of amyloid-related serum component, protein ASC, in serum samples from 63 leprosy patients was investigated. Protein ASC was detected in 38% of the patients. A correlation to the disease spectrum of leprosy was apparent: polar lepromatous cases, 64% positive; borderline lepromatous, 50%; borderline tuberculoid, 36%; subpolar tuberculoid, 17%; and polar tuberculoid, negative. Antibody activity against the a antigen of Mycobacterium leprae was also determined, showing a similar correlation to the disease spectrum. Serum samples from 23 apparently healthy Ethiopians serving as controls showed a protein ASC incidence of 22%. This figure is significantly higher than the frequency found by others among healthy Norwegian blood donors. Immunoglobulin M levels among patients were elevated in the borderline lepromatous and poplar lepromatous groups. The three tuberculoid groups did not differ in this respect from the control group but were all elevated as compared to a normal Caucasian serum pool. Although raised immunoglobulin M levels seemed to parallel increased frequencies of protein ASC in the patient groups as well as in controls, this correlation might be only secondary to a primary derangement in T-cell function. PMID:804451

  1. Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - Part 1*

    PubMed Central

    Lastória, Joel Carlos; de Abreu, Marilda Aparecida Milanez Morgado

    2014-01-01

    Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It is still endemic in many regions of the world and a public health problem in Brazil. The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The mechanism of transmission of leprosy consists of prolonged close contact between susceptible and genetically predisposed individuals and untreated multibacillary patients. Transmission occurs through inhalation of bacilli present in upper airway secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper understanding of the structural and biological characteristics of M. leprae, the sequencing of its genome, along with the advances in understanding the mechanisms of host immune response against the bacilli, dependent on genetic susceptibility, have contributed to the understanding of the pathogenesis, variations in the clinical characteristics, and progression of the disease. This article aims to update dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects. PMID:24770495

  2. Serum uric acid levels during leprosy reaction episodes

    PubMed Central

    Alves-Junior, Eduardo R.; Arruda, Talita A.; Lopes, Jose C.; Fontes, Cor J.F.

    2016-01-01

    Background. Leprosy reactions are acute inflammatory episodes that occur mainly in the multibacillary forms of the disease. The reactions are classified as type 1 (reverse reaction) or type 2 (erythema nodosum leprosum). Leprosy-associated oxidative stress has been widely demonstrated. Several recent studies have shown uric acid (UA) to have antioxidative effects under pathologic conditions. The objective of this study was to assess serum levels of UA in patients with leprosy reactions, with the aim of monitoring their levels before and after treatment, compared with levels in leprosy patients without reactions. Methods. The study included patients aged 18–69 years assisted at a leprosy treatment reference center in the Central Region of Brazil. Patients who were pregnant; were using immunosuppressant drugs or immunobiologicals; or had an autoimmune disease, human immunodeficiency virus infection, acquired immune deficiency syndrome, or tuberculosis were excluded. Upon recruitment, all individuals were clinically assessed for skin lesions and neural or systemic impairment. Some patients had already completed treatment for leprosy, while others were still undergoing treatment or had initiated treatment after being admitted. The treatment of the reactional episode was started only after the initial evaluation. Laboratory assessments were performed upon admission (baseline) and at approximately 30 and 60 days (time points 1 and 2, respectively). Results. A total of 123 leprosy patients were recruited between June 2012 and June 2015; among them, 56, 42, and 25 presented with type 1, type 2, and no reactions, respectively. Serum UA levels were significantly reduced in patients with type 2 leprosy reactions compared with patients in the control group and remained lower in the two subsequent assessments, after initiation of anti-reaction treatments, with similar values to those recorded before the treatment. Discussion. The decreased serum UA levels in patients with

  3. Thermographic analysis and autonomic response in the hands of patients with leprosy*

    PubMed Central

    Cavalheiro, Aretusa Lopes; da Costa, Debora Tacon; de Menezes, Ana Luiza Ferro; Pereira, Janser Moura; de Carvalho, Eliane Maria

    2016-01-01

    Background Low temperatures and slow blood flow may result from peripheral neuropathy caused by leprosy, and the simple detection of cold fingers could already be a preliminary classification for these patients. Objective To investigate whether infrared thermography would be able to measure this change in temperature in the hands of people with leprosy. Method The study assessed 17 leprosy patients who were under treatment at the National Reference Center for Sanitary Dermatology and Leprosy, Uberlândia/MG, and 15 people without leprosy for the control group. The infrared camera FLIR A325 and Therma CAM Researcher Professional 2.9 software were used to measure the temperature. The room was air-conditioned, maintaining the temperature at 25°C; the distance between the camera and the limb was 70 cm. The vasomotor reflex of patients was tested by a cold stress on the palm. Results The study showed a significant interaction between the clinical form of leprosy and temperature, where the control group and the borderline-borderline form revealed a higher initial temperature, while borderline-lepromatous and lepromatous leprosy showed a lower temperature. Regarding vasomotor reflex, lepromatous leprosy patients were unable to recover the initial temperature after cold stress, while those with the borderline-tuberculoid form not only recovered but exceeded the initial temperature. Conclusion Thermography proved a potential tool to assist in the early detection of neuropathies, helping in the prevention of major nerve damage and the installation of deformities and disabilities that are characteristic of leprosy. PMID:27438192

  4. Prospective immunological follow-up in household contacts of Mexican leprosy patients.

    PubMed

    Amezcua, M E; Escobar-Gutiérrez, A; Barba-Rubio, J; Cázares, J V; Mayén, E; Chávez-Núñez, M; Peña, R C; Rodríguez, R; Pastén, S

    1990-12-01

    A 6-year prospective study of 79 household contacts of leprosy cases was made in order to correlate the development of the disease with their specific T-cell immunity, measured by the Mitsuda test, and levels of anti-Mycobacterium leprae antibodies determined in three consecutive observations with the FLA-ABS test. Overall in the contacts, 71.7% were Mitsuda positive and 93.6% showed seropositivity, without regard to their age, sex, or leprosy type of their index case. Households were divided into lower-risk and higher-risk groups according to either the paucibacillary or multibacillary character of their index case. The lower-risk group consisted of 19 contacts of 2 tuberculoid (TT) and 5 indeterminate cases. The higher-risk group was made up of 60 household contacts of 18 active lepromatous (LL) cases. All but two contacts in the former group had a positive Mitsuda reaction; the most common antibody titer was 1:160, with a tendency to stabilize or decrease over time. In the two Mitsuda-negative contacts, increased antibody levels were observed. In the higher-risk group, 61.6% were Mitsuda positive and showed a humoral profile similar to those Mitsuda positive in the lower-risk group. In most of the Mitsuda-negative LL contacts, the antibody levels remained constant or progressively increased, suggesting a high probability of active subclinical infection. This assumption was partially supported by the finding of a new borderline lepromatous (BL) leprosy case in the Mitsuda-negative LL contact group. Nevertheless, the contribution of the close and extensive contact with a multibacilliferous case as a risk factor was difficult to evaluate because of the small size of the sample studied. PMID:2280115

  5. Primary oral tuberculosis in a patient with lepromatous leprosy: Diagnostic dilemma.

    PubMed

    Ganesan, Vithiya; Mandal, Jharna

    2016-03-01

    Pulmonary tuberculosis (TB) is the most common form of TB. Primary infection can also affect the pharynx, cervical lymph node, intestine, or oral mucosa. Historically, the observed incidence of concomitant infection with leprosy and TB is high. However, reports of concomitant infection in modern literature remain scarce. Most cases reported in the literature had borderline/lepromatous leprosy and pulmonary tuberculosis. Extrapulmonary tuberculosis is reported in only 3.2% of leprosy cases. To the best of our knowledge, this is the first case report of primary oral tuberculosis of the tongue in a patient with lepromatous leprosy with Type 2 lepra reaction. The patient was referred to Directly Observed Treatment, Short-Course clinic and started on Category I treatment. She received oral prednisolone for lepra reaction, which was subsequently tapered and stopped, however, she continued to receive other antileprotic drugs (thalidomide and clofazimine). The patient's general condition improved and she is on regular follow up. PMID:26927999

  6. Release of acid hydrolases in spectrum of human leprosy.

    PubMed

    Kumar, B; Jaswal, S; Vaishnavi, C; Thakur, M; Kaur, S; Ganguly, N K

    1992-01-01

    Release of acid hydrolases by blood monocytes (BM) of leprosy patients both before and after 6 months of chemotherapy was measured fluorimetrically. Monocyte cultures were set up for spontaneous as well as zymosan dependent enzyme release measured after 2 hrs and 24 hrs of culture. In the untreated multibacillary group (BL/LL) a significantly higher (P < 0.001) release of both B-glucuronidase (BG) and N-acetyl glucosaminidase (NAG) was observed compared to the paucibacillary group (BT/TT) and healthy controls. On comparing the BT/TT group with controls a significant decrease (P < 0.001) in zymosan dependent NAG release was observed in the former group at 2 hrs culture. After 6 months of antileprosy therapy, a significant decrease (P < 0.05) in BG release was observed from BM of multibacillary patients, whereas NAG activity increased significantly (P < 0.05) in the paucibacillary group compared to the controls. The results of the present study suggest that non-oxidative metabolic status of BM vary within the leprosy spectrum. PMID:1300357

  7. Antibodies to diverse lipids in the serum of patients with clinically cured leprosy and tuberculosis.

    PubMed

    Rojas-Espinosa, O; Arenas, R; Arce-Parades, P; Miranda-Contreras, G

    2003-01-01

    In this study we looked for the presence of antibodies to cardiolipin, cerebrosides, and whole lipids extracted from M. leprae, M. tuberculosis and M. habana, in the serum of patients with clinically cured lepromatous leprosy (sixteen) or tuberculosis (sixteen), 8 to 12 months after arresting the corresponding multi-drug therapy (MDT). Compared to healthy controls (sixteen), both leprosy and tuberculosis ex-patients had still significant levels of antibodies to the three mycobacterial lipids but no detectable levels of antibodies to cardiolipin or cerebroside lipids. Although leprosy and tuberculosis sera recognized the homologous mycobacterial lipids in a preferential fashion, all of them, on the average, reacted more strongly with the lipids of M. habana. This observation backs up, in a certain way, the proposition of using M. habana as a prospective vaccine for leprosy and tuberculosis.

  8. Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients*

    PubMed Central

    Pires, Carla Andréa Avelar; de Miranda, Mario Fernando Ribeiro; Bittencourt, Maraya de Jesus Semblano; de Brito, Arival Cardoso; Xavier, Marília Brasil

    2015-01-01

    BACKGROUND Leprosy and HIV are diseases that have a major impact on public health in Brazil. Patients coinfected with both diseases, appear to be at higher risk to develop leprosy reactions. OBJECTIVE The aim of this study is to describe the histopathological aspects of cutaneous lesions during reactional states in a group of patients with HIV-leprosy coinfection, compared to patients with leprosy, without coinfection. METHODS Two groups were established: group 1 comprised of 40 patients coinfected with HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients presenting reactional states of leprosy had their lesions biopsied and comparatively evaluated. RESULTS Reversal reaction was the most frequent feature in both groups, with dermis edema as the most common histopathological finding. Giant cells were seen in all group 1 histopathological examinations. Dermis edema was the most common finding in patients with erythema nodosum leprosum. CONCLUSION Few histopathological differences were found in both groups, with reversal reaction as the most significant one, although this fact should be analyzed considering the predominant BT clinical form in the coinfected group and BB form in the group without HIV. Larger prospective studies in patients with HIV-leprosy coinfection are needed to confirm and broaden these results. PMID:25672296

  9. Leprosy and the Human Genome

    PubMed Central

    Misch, Elizabeth A.; Berrington, William R.; Vary, James C.; Hawn, Thomas R.

    2010-01-01

    Summary: Despite the availability of effective treatment for several decades, leprosy remains an important medical problem in many regions of the world. Infection with Mycobacterium leprae can produce paucibacillary disease, characterized by well-formed granulomas and a Th1 T-cell response, or multibacillary disease, characterized by poorly organized cellular infiltrates and Th2 cytokines. These diametric immune responses confer states of relative resistance or susceptibility to leprosy, respectively, and have well-defined clinical manifestations. As a result, leprosy provides a unique opportunity to dissect the genetic basis of human in vivo immunity. A series of studies over the past 40 years suggests that host genes influence the risk of leprosy acquisition and the predilection for different clinical forms of the disease. However, a comprehensive, cellular, and molecular view of the genes and variants involved is still being assembled. In this article, we review several decades of human genetic studies of leprosy, including a number of recent investigations. We emphasize genetic analyses that are validated by the replication of the same phenotype in independent studies or supported by functional experiments demonstrating biological mechanisms of action for specific polymorphisms. Identifying and functionally exploring the genetic and immunological factors that underlie human susceptibility to leprosy have yielded important insights into M. leprae pathogenesis and are likely to advance our understanding of the immune response to other pathogenic mycobacteria. This knowledge may inform new treatment or vaccine strategies for leprosy or tuberculosis. PMID:21119019

  10. Borderline tuberculoid leprosy and type 1 leprosy reaction in a hepatitis C patient during treatment with interferon and ribavirin*

    PubMed Central

    Santos, Mônica; Franco, Emily dos Santos; Ferreira, Paulo Luis da Costa; Braga, Wornei Silva Miranda

    2013-01-01

    Hepatitis C is an inflammatory disease of the liver caused by a single-stranded RNA virus belonging to the Hepacivirus genus in the Flaviviridae family, called the hepatitis C virus. After initial infection, 70% to 85% of the patients develop chronic hepatitis C with hepatic fibrosis. In addition to specific liver changes, various extrahepatic manifestations have been associated with the hepatitis C virus infection or with medications used to treat the condition. We report the case of a patient with chronic hepatitis C who presented with the signs and symptoms of borderline tuberculoid leprosy and type 1 reaction four months after the start of treatment with a pegylated interferon/ribavirin combination. PMID:24346894

  11. Histoid leprosy with giant lesions of fingers and toes.

    PubMed

    Rodriguez, Gerzaín; Henríquez, Rafael; Gallo, Shirley; Panqueva, César

    2015-01-01

    This work was conducted at the Facultad de Medicina, Universidad de La Sabana, and at the Facultad de Medicina, Universidad Surcolombiana. Histoid leprosy, a clinical and histological variant of multibacillary leprosy, may offer a challenging diagnosis even for experts. An 83-year-old woman presented with papular, nodular and tumor-like lesions of 3 years of evolution, affecting fingers, toes, hands, thighs and knees, and wide superficial ulcers in her lower calves. Cutaneous lymphoma was suspected. A biopsy of a nodule of the knee showed a diffuse dermal infiltrate with microvacuolated histiocytes, moderate numbers of lymphocytes and plasma cells. Cutaneous lymphoma was suggested. Immunohistochemistry (IHC) showed prominent CD68-positive macrophages, as well as CD3, CD8 and CD20 positive cells. Additional sections suggested cutaneous leishmaniasis. New biopsies were sent with the clinical diagnoses of cutaneous lymphoma, Kaposi´s sarcoma or lepromatous leprosy, as the patient had madarosis. These biopsies showed atrophic epidermis, a thin Grenz zone and diffuse inflammation with fusiform cells and pale vacuolated macrophages. ZiehlNeelsen stain showed abundant solid phagocytized bacilli with no globii formation. Abundant bacilli were demonstrated in the first biopsy. Histoid leprosy was diagnosed. The patient received the WHO multidrug therapy with excellent results. We concluded that Ziehl Neelsen staining should be used in the presence of a diffuse dermal infiltrate with fusiform and vacuolated histiocytes, which suggests a tumor, and an IHC particularly rich in CD68-positive macrophages; this will reveal abundant bacilli if the lesion is leprosy. A good clinical pathological correlation is essential to establish a proper diagnosis and management of the patient.

  12. Noncompliance with the world health organization-multidrug therapy among leprosy patients in Cebu, Philippines: its causes and implications on the leprosy control program.

    PubMed

    Honrado, Elsie R; Tallo, Veronica; Balis, Angelita C; Chan, Gertrude P; Cho, Sang Nae

    2008-04-01

    The success of current World Health Organization (WHO) key strategy for leprosy elimination (ie, multidrug therapy [MDT] regimen) depends largely on the efficiency of health care delivery services and patient compliance. A high rate of noncompliance with this regimen has serious implications for the leprosy control program because it can set the stage for the emergence of drug resistance, eventually resulting in treatment failure and failure of the program. A community-based descriptive study using pretested interviews conducted in 12 leprosy endemic areas in Cebu, Philippines, showed that the noncompliance rate with the WHO-MDT regimen among 233 study subjects was 30%. The causes of noncompliance are drug-related, health care provider-triggered, or patient-inducted, or some combination of these. Recommendations on strategic interventions to obviate the cause for noncompliance are presented. PMID:18346553

  13. Presence of C1q-reactive immune complexes in patients with leprosy

    PubMed Central

    Rojas-Espinosa, O.; Mendez-Navarrete, I.; Estrada-Parra, S.

    1972-01-01

    Presence of soluble immune complexes was investigated in sera from persons with a well documented clinical diagnosis of leprosy. The complexes were detected by their reactivity with the C1q component of complement. More than 70% of the studied patients with lepromatous-leprosy had immune complexes demonstrable by this method (39/51), while only a small proportion of the healthy control group (1/35 or about 3%) had precipitable complexes. Two out of nine sera from patients with tuberculoid leprosy reacted when tested with C1q component. The presence of free-antibody to mycobacterial antigens was determined as well. The possible relationship between the presence of such immune complexes and the pathology of some reactional states of the disease is discussed. ImagesFig. 1 PMID:4630778

  14. Clinical oxidative stress during leprosy multidrug therapy: impact of dapsone oxidation.

    PubMed

    Schalcher, Taysa Ribeiro; Borges, Rosivaldo S; Coleman, Michael D; Batista Júnior, João; Salgado, Claudio G; Vieira, Jose Luiz F; Romão, Pedro R T; Oliveira, Fabio R; Monteiro, Marta Chagas

    2014-01-01

    This study aims to assess the oxidative stress in leprosy patients under multidrug therapy (MDT; dapsone, clofazimine and rifampicin), evaluating the nitric oxide (NO) concentration, catalase (CAT) and superoxide dismutase (SOD) activities, glutathione (GSH) levels, total antioxidant capacity, lipid peroxidation, and methemoglobin formation. For this, we analyzed 23 leprosy patients and 20 healthy individuals from the Amazon region, Brazil, aged between 20 and 45 years. Blood sampling enabled the evaluation of leprosy patients prior to starting multidrug therapy (called MDT 0) and until the third month of multidrug therapy (MDT 3). With regard to dapsone (DDS) plasma levels, we showed that there was no statistical difference in drug plasma levels between multibacillary (0.518±0.029 µg/mL) and paucibacillary (0.662±0.123 µg/mL) patients. The methemoglobin levels and numbers of Heinz bodies were significantly enhanced after the third MDT-supervised dose, but this treatment did not significantly change the lipid peroxidation and NO levels in these leprosy patients. In addition, CAT activity was significantly reduced in MDT-treated leprosy patients, while GSH content was increased in these patients. However, SOD and Trolox equivalent antioxidant capacity levels were similar in patients with and without treatment. These data suggest that MDT can reduce the activity of some antioxidant enzyme and influence ROS accumulation, which may induce hematological changes, such as methemoglobinemia in patients with leprosy. We also explored some redox mechanisms associated with DDS and its main oxidative metabolite DDS-NHOH and we explored the possible binding of DDS to the active site of CYP2C19 with the aid of molecular modeling software.

  15. Clinical Oxidative Stress during Leprosy Multidrug Therapy: Impact of Dapsone Oxidation

    PubMed Central

    Schalcher, Taysa Ribeiro; Borges, Rosivaldo S.; Coleman, Michael D.; Batista Júnior, João; Salgado, Claudio G.; Vieira, Jose Luiz F.; Romão, Pedro R. T.; Oliveira, Fabio R.; Monteiro, Marta Chagas

    2014-01-01

    This study aims to assess the oxidative stress in leprosy patients under multidrug therapy (MDT; dapsone, clofazimine and rifampicin), evaluating the nitric oxide (NO) concentration, catalase (CAT) and superoxide dismutase (SOD) activities, glutathione (GSH) levels, total antioxidant capacity, lipid peroxidation, and methemoglobin formation. For this, we analyzed 23 leprosy patients and 20 healthy individuals from the Amazon region, Brazil, aged between 20 and 45 years. Blood sampling enabled the evaluation of leprosy patients prior to starting multidrug therapy (called MDT 0) and until the third month of multidrug therapy (MDT 3). With regard to dapsone (DDS) plasma levels, we showed that there was no statistical difference in drug plasma levels between multibacillary (0.518±0.029 µg/mL) and paucibacillary (0.662±0.123 µg/mL) patients. The methemoglobin levels and numbers of Heinz bodies were significantly enhanced after the third MDT-supervised dose, but this treatment did not significantly change the lipid peroxidation and NO levels in these leprosy patients. In addition, CAT activity was significantly reduced in MDT-treated leprosy patients, while GSH content was increased in these patients. However, SOD and Trolox equivalent antioxidant capacity levels were similar in patients with and without treatment. These data suggest that MDT can reduce the activity of some antioxidant enzyme and influence ROS accumulation, which may induce hematological changes, such as methemoglobinemia in patients with leprosy. We also explored some redox mechanisms associated with DDS and its main oxidative metabolite DDS-NHOH and we explored the possible binding of DDS to the active site of CYP2C19 with the aid of molecular modeling software. PMID:24465659

  16. Leprosy in peripheral nerves: histopathological findings in 119 untreated patients in Nepal.

    PubMed Central

    Pedley, J C; Harman, D J; Waudby, H; McDougall, A C

    1980-01-01

    From a series of 343 nerve biopsies taken by one clinician over a period of 12 years in Nepal, this paper describes the histopathological findings in 153 biopsies from 119 patients suffering from tuberculoid, borderline (dimorphous) or lepromatous leprosy, who were untreated at the time of first presentation and diagnosis. They were taken during the course of other studies, mainly concerned with the mode of transmission of leprosy, and which included biopsies of skin, dartos muscle, nasal mucous membrane and nipple, results of which have already been published. Examination of serial sections by light microscopy revealed a density of cellular infiltration in non-lepromatous cases, or of bacilli in macrophages and Schwann cells in lepromatous cases, which was marked in degree and usually widespread from one end of the biopsy to the other. Intraneural caseation was recorded in four patients with tuberculoid or borderline-tuberculoid leprosy, and many others in this part of the spectrum showed extensive disruption of perineurial and endoneurial structure. In lepromatous patients, the numbers of bacilli in the endoneurial area not infrequently exceeded one thousand per oil immersion field. Although well known to histopathologists familiar with this disease, it is considered that the significance of these findings, in patients presenting for the first time, is not well appreciated by those working in general medicine, neurology, epidemiology, or even in leprosy control. Images PMID:7373316

  17. Quantitative lateral flow strip assays as User-Friendly Tools To Detect Biomarker Profiles For Leprosy

    PubMed Central

    van Hooij, Anouk; Tjon Kon Fat, Elisa M.; Richardus, Renate; van den Eeden, Susan J. F.; Wilson, Louis; de Dood, Claudia J.; Faber, Roel; Alam, Korshed; Richardus, Jan Hendrik; Corstjens, Paul L. A. M.; Geluk, Annemieke

    2016-01-01

    Leprosy is a debilitating, infectious disease caused by Mycobacterium leprae. Despite the availability of multidrug therapy, transmission is unremitting. Thus, early identification of M. leprae infection is essential to reduce transmission. The immune response to M. leprae is determined by host genetics, resulting in paucibacillary (PB) and multibacillary (MB) leprosy associated with dominant cellular or humoral immunity, respectively. This spectral pathology of leprosy compels detection of immunity to M. leprae to be based on multiple, diverse biomarkers. In this study we have applied quantitative user friendly lateral flow assays (LFAs) for four immune markers (anti-PGL-I antibodies, IL-10, CCL4 and IP-10) for whole blood samples from a longitudinal BCG vaccination field-trial in Bangladesh. Different biomarker profiles, in contrast to single markers, distinguished M. leprae infected from non-infected test groups, patients from household contacts (HHC) and endemic controls (EC), or MB from PB patients. The test protocol presented in this study merging detection of innate, adaptive cellular as well as humoral immunity, thus provides a convenient tool to measure specific biomarker profiles for M. leprae infection and leprosy utilizing a field-friendly technology. PMID:27682181

  18. Immunoglobulin class specific antibodies to M. leprae in leprosy patients, including the indeterminate group and healthy contacts as a step in the development of methods for sero-diagnosis of leprosy.

    PubMed Central

    Melsom, R; Harboe, M; Myrvang, B; Godal, T; Belehu, A

    1982-01-01

    IgA, IgM and IgG anti-M. leprae antibody activity was quantitated by solid phase radioimmunoassay in groups of untreated leprosy patients throughout the spectrum, in lepromatous leprosy patients treated for more than 10 years, in an indeterminate leprosy group, and in a non-leprosy control group. IgA, IgM and IgG anti-M. leprae antibody activity increased from the group of healthy individuals exposed to M. leprae but without clinical signs of leprosy to tuberculoid (BT and BT/TT) and further to lepromatous (BL to LL) leprosy. There was a considerable overlap in IgA antibody activity, while the overlap between controls and tuberculoid and lepromatous leprosy was less than 20% in the IgM and IgG assays. After more than 10 years of treatment, the IgG anti-M. leprae activity had decreased markedly, whereas there was less effect in the IgA assay and no significant change in the IgM assay. In contrast to earlier findings, the group of 'strictly indeterminate leprosy' showed signs of an active humoral immune response against M. leprae. The IgM anti-M. leprae activity was higher in indeterminate leprosy than in the control group with virtually no overlap. IgA anti-M. leprae was higher in indeterminate leprosy, but with considerable overlap with the controls. No difference between these two groups was found in the IgG assay. The results are discussed in relation to the value of the various immunoglobulin specific anti-M. leprae assays for different purposes, including development of techniques for sero-diagnosis of leprosy. PMID:7042137

  19. Patients' Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Paraná State, Brazil

    PubMed Central

    Pieri, Flávia Meneguetti; Touso, Michelle Mosna; Rodrigues, Ludmila Barbosa Bandeira; Yamamura, Mellina; Pinto, Ione Carvalho; Dessunti, Elma Mathias; Crispim, Juliane de Almeida; Ramos, Antônio Carlos Vieira; Arroyo, Luiz Henrique; Neto, Marcelino Santos; Garcia, Maria Concebida da Cunha; Popolin, Marcela Paschoal; Silveira, Tatiane Ramos dos Santos; Arcêncio, Ricardo Alexandre

    2014-01-01

    Background In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. Methodology/Principal Findings A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. Conclusions/Significance The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem. PMID:25412349

  20. Single lesion paucibacillary leprosy: baseline profile of the Brazilian Multicenter Cohort Study.

    PubMed

    Martelli, C M; Stefani, M M; Gomes, M K; Rebello, P F; Peninni, S; Narahashi, K; Maroclo, A L; Costa, M B; Silva, S A; Sacchetim, S C; Nery, J A; Salles, A M; Gillis, T P; Krahenbuhl, J L; Andrade, A L

    2000-09-01

    In Brazil, there is little information about the clinical and epidemiological characteristics of paucibacillary, single skin lesion leprosy patients (SSL-PB). Only recently has the official notification system distinguished leprosy patients with a single lesion as a clinical entity, for whom the single-dose ROM (rifampin, ofloxacin and minocycline) regimen has been recommended. In this paper, we describe the baseline clinical features and the immunological background of a multicenter cohort of SSL-PB leprosy cases enrolled between December 1997-1998. Patients were recruited at health centers located in the following regions: Southeast = Rio de Janeiro; North = Amazon and Rondônia states and Center-West = Goiás state. Eligible cases were newly detected, untreated single-lesion leprosy patients without thickened nerve involvement, and were assessed by clinical, bacilloscopic and histopathological exams. The Mitsuda skin test and anti-PGL-I serology (ELISA) were also performed. Of the 299 SSL-PB leprosy patients, 259 (86.6%) fulfilled the criteria for single-dose ROM intervention. Our results showed that patients recruited from different sites had similar features, considering the clinical and immunological profiles. There was a predominance of adults (mean age 32.4; S.D. = 16.0), and a BCG scar was detected in 76.7% of the children (< or = 15 years old). Only 7 cases were diagnosed as the multibacillary type, representing less than 3% of the patients being misclassified. Our data indicate that in Brazil SSL-PB case ascertainment based on clinical and bacilloscopic criteria can be accurately defined under a routine control program; 75.0% of SSL-PB cases were Mitsuda positive (> or = 5 mm) and seropositivity for anti-PGL-I was detected in 17.3% of the patients. These data are compatible with effective cell-mediated immunity and low bacillary load, suggesting favorable clinical outcomes for most SSL-PB participants of this cohort.

  1. Pure neuritic leprosy in patients from a high endemic region of Colombia.

    PubMed

    Rodriguez, Gerzain; Pinto, Rafael; Gomez, Yenny; Rengifo, Maria Leonor; Estrada, Olga Lucia; Sarmiento, Marta; Lopez, Fernando; Beltran-Alzate, Juan Camilo; Cardona-Castro, Nora

    2013-03-01

    Agua de Dios was a leprosarium for leprosy patients' obligatory isolation (1872-1961). Its leprosy incidence is the highest in Colombia (1.5-7/10000). Relapses are common. Government grant of US$ 200 per month subsidy is available to patients with disabilities. Spontaneous consultation with neural symptoms is frequent and simulation to get the subsidy has to be considered. We studied 36 subjects (2007-2009), with ages from 29-78, 19 of them men, with neural symptoms of 6 months to 20 years evolution. All had clinical examination, bacteriological examination, skin and nerve biopsies, electromyography (EMG), PCR for M. leprae, IgM anti-PGL1, and lepromin A. All but two are household contacts of leprosy patients. Symptoms were hypoesthesia of the hands and feet, and difficulty using hands with loss of muscular strength. None had skin lesions. Three had thickening of ulnar nerve. Lepromin was positive in all; bacteriology and biopsies were negative in all. The speed and amplitude of neural conduction were altered in 34 patients; two women had normal EMG and were considered to be feigning the disease; 21 were diagnosed as PNL by clinical, epidemiological and EMG findings; five of them had a positive PCR and one, high titers for IgM anti PGL1. Nine other subjects had diabetes and six carpal tunnel syndrome (CTS). Slow progression of disease, the lack of neural enlargement and the neural biopsies without inflammation suggest that most of these patients could have spontaneously cured PNL, as happens with other cases of paucibacillary leprosy. Diabetes and CTS are important differential diagnoses of PNL. Patients were treated with MDT and received the state subsidy.

  2. Pure neuritic leprosy in patients from a high endemic region of Colombia.

    PubMed

    Rodriguez, Gerzain; Pinto, Rafael; Gomez, Yenny; Rengifo, Maria Leonor; Estrada, Olga Lucia; Sarmiento, Marta; Lopez, Fernando; Beltran-Alzate, Juan Camilo; Cardona-Castro, Nora

    2013-03-01

    Agua de Dios was a leprosarium for leprosy patients' obligatory isolation (1872-1961). Its leprosy incidence is the highest in Colombia (1.5-7/10000). Relapses are common. Government grant of US$ 200 per month subsidy is available to patients with disabilities. Spontaneous consultation with neural symptoms is frequent and simulation to get the subsidy has to be considered. We studied 36 subjects (2007-2009), with ages from 29-78, 19 of them men, with neural symptoms of 6 months to 20 years evolution. All had clinical examination, bacteriological examination, skin and nerve biopsies, electromyography (EMG), PCR for M. leprae, IgM anti-PGL1, and lepromin A. All but two are household contacts of leprosy patients. Symptoms were hypoesthesia of the hands and feet, and difficulty using hands with loss of muscular strength. None had skin lesions. Three had thickening of ulnar nerve. Lepromin was positive in all; bacteriology and biopsies were negative in all. The speed and amplitude of neural conduction were altered in 34 patients; two women had normal EMG and were considered to be feigning the disease; 21 were diagnosed as PNL by clinical, epidemiological and EMG findings; five of them had a positive PCR and one, high titers for IgM anti PGL1. Nine other subjects had diabetes and six carpal tunnel syndrome (CTS). Slow progression of disease, the lack of neural enlargement and the neural biopsies without inflammation suggest that most of these patients could have spontaneously cured PNL, as happens with other cases of paucibacillary leprosy. Diabetes and CTS are important differential diagnoses of PNL. Patients were treated with MDT and received the state subsidy. PMID:23741881

  3. T-Cell Recognition of Mycobacterial GroES Peptides in Thai Leprosy Patients and Contacts

    PubMed Central

    Chua-Intra, Boosbun; Peerapakorn, Somchai; Davey, Nick; Jurcevic, Stipo; Busson, Marc; Vordermeier, H. Martin; Pirayavaraporn, Charoon; Ivanyi, Juraj

    1998-01-01

    We report here the mapping of T-cell-stimulatory determinants of the GroES 10-kDa heat shock protein homologues from Mycobacterium leprae and Mycobacterium tuberculosis, which are known as major immunogens in mycobacterial infections. Peripheral blood mononuclear cells (PBMC) from treated tuberculoid leprosy or lepromatous leprosy patients and from healthy household or hospital staff contacts of the patients were cultured with 20 16-mer peptides covering the entire sequences of both M. leprae and M. tuberculosis GroES. The total number of recognized peptides was found to be the largest in family contacts, while responder frequencies to the individual tested peptides varied (5 to 80%) with specificity between the patient and contact groups. Proliferative responses to some peptides showed positive or negative associations of low statistical significance with DR and DQ alleles, though responses to most GroES peptides were genetically permissive. Notably, the sequence of the 25–40 peptide of M. leprae, but not that of M. tuberculosis, was more frequently stimulatory in tuberculoid leprosy patients than in either group of sensitized healthy contacts. This peptide bound to a number of HLA-DR molecules, of which HLA-DRB5*0101 had the strongest affinity. The epitope core binding to this allele was localized to the 29-to-37 sequence, and its key residue was localized to the M. leprae-specific glutamic acid at position 32. This epitope may be of interest for the development of a blood test- or skin test-based diagnostic reagent for tuberculoid leprosy, subject to further clinical evaluation in untreated patients. PMID:9746595

  4. Detection of Mycobacterium gilvum first time from the bathing water of leprosy patient from Purulia, West Bengal.

    PubMed

    Lavania, Mallika; Turankar, Ravindra; Singh, Itu; Nigam, Astha; Sengupta, Utpal

    2014-12-01

    In this present study for the first time the authors are reporting the isolation of Mycobacterium gilvum from the accumulated water in the drain connected to the bathing place of leprosy patients residing in an endemic region. The identification and characterization of this isolate was carried out by various conventional and molecular tests, including 16S rDNA sequencing. These findings might shed further light and association with amoeba in the leprosy endemic area of this rare Mycobacterium species. PMID:26786629

  5. Role of Toll-Interacting Protein Gene Polymorphisms in Leprosy Mexican Patients

    PubMed Central

    Montoya-Buelna, Margarita; Tovar-Cuevas, Alvaro J.; Alvarado-Navarro, Anabell; Valle, Yeminia; Padilla-Gutierrez, Jorge R.; Muñoz-Valle, Jose F.; Figuera-Villanueva, Luis E.

    2013-01-01

    Background. Leprosy is a debilitating infectious disease of human skin and nerves. Genetics factors of the host play an important role in the disease susceptibility. Toll-interacting protein (TOLLIP) is an inhibitory adaptor protein within the toll-like receptor (TLR) pathway, which recognizes structurally conserved molecular patterns of microbial pathogens, initiating immune responses. The objective of this study was to investigate the association of variants in the TOLLIP gene with susceptibility to leprosy in Mexican patients. Methods. TOLLIP polymorphisms were studied using a case-control design of Mexican patients with lepromatous leprosy (LL). The polymorphisms of TOLLIP at loci −526 C>G (rs5743854), 1309956C>T (rs3750920), 1298430C>A (rs5744015), and 1292831 G>A (rs3750919) were analyzed by PCR, with sequence-specific primers in LL patients and healthy subjects (HS) as controls. Results. Genotype distributions were in Hardy Weinberg equilibrium for all sites except for rs3750920. Neither genotype nor allele frequencies were statistically different between LL patients and controls (P > 0.05). The maximum pairwise D' coefficient reached was 0.44 of linkage (P = 0.01) for all the polymorphisms except for rs5743854. The three loci haplotype comparison yielded no significant differences between groups. Conclusions. Just the individuals with genotype C/C of rs3750920 have a trend of protective effect to developing LL. PMID:24294608

  6. Identifying Leprosy and Those at Risk of Developing Leprosy by Detection of Antibodies against LID-1 and LID-NDO

    PubMed Central

    Amorim, Francianne M.; Nobre, Maurício L.; Ferreira, Leonardo C.; Nascimento, Larissa S.; Miranda, Alesson M.; Monteiro, Glória R. G.; Dupnik, Kathryn M.; Duthie, Malcolm S.; Reed, Steven G.; Jeronimo, Selma M. B.

    2016-01-01

    Leprosy is caused by Mycobacterium leprae infection and remains a major public health problem in many areas of the world. Challenges to its timely diagnosis result in delay in treatment, which is usually associated with severe disability. Although phenolic glycolipid (PGL)-I has been reported as auxiliary diagnostic tool, currently there is no serological assay routinely used in leprosy diagnosis. The aim of this study was to evaluate the effectiveness of two related reagents, LID-1 and LID-NDO, for the detection of M. leprae infection. Sera from 98 leprosy patients, 365 household contacts (HHC) and 98 endemic controls from Rio Grande do Norte, Brazil, were evaluated. A subgroup of the HHC living in a hyperendemic area was followed for 7–10 years. Antigen-specific antibody responses were highest in multibacillary (MB) at the lepromatous pole (LL/BL) and lowest in paucibacillary (PB) at the tuberculoid pole (TT/BT). A positive correlation for both anti-LID-1 and anti-LID-NDO antibodies was found with bacterial burden (LID-1, r = 0.84, p<0.001; LID-NDO, r = 0.82, p<0.001), with higher sensitivity than bacilloscopy. According to Receiver Operating Curve, LID-1 and LID-NDO performed similarly. The sensitivity for MB cases was 89% for LID-1 and 95% for LID-NDO; the specificity was 96% for LID-1 and 88% for LID-NDO. Of the 332 HHC that were followed, 12 (3.6%) were diagnosed with leprosy in a median time of 31 (3–79) months after recruitment. A linear generalized model using LID-1 or LID-NDO as a predictor estimated that 8.3% and 10.4% of the HHC would become a leprosy case, respectively. Together, our findings support a role for the LID-1 and LID-NDO antigens in diagnosing MB leprosy and identifying people at greater risk of developing clinical disease. These assays have the potential to improve the diagnostic capacity at local health centers and aid development of strategies for the eventual control and elimination of leprosy from endemic areas. PMID:27658042

  7. Detection of Mycobacterium leprae in saliva and the evaluation of oral sensitivity in patients with leprosy

    PubMed Central

    da Rosa, Fernanda Borowsky; de Souza, Victor Costa; de Almeida, Tatiana Amaral Pires; do Nascimento, Valdinete Alves; Vásquez, Felicien Gonçalves; Cunha, Maria da Graça Souza; Naveca, Felipe Gomes

    2013-01-01

    The aim of this study was to investigate sensitivity disorders in the oral cavity related to the presence of Mycobacterium leprae in the saliva of treatment-naïve patients with leprosy in the state of Amazonas, Brazil. A cross-sectional study was conducted involving 45 subjects with leprosy. The subjects were interviewed to evaluate the sensitivity of the oral cavity. For the detection of M. leprae, saliva and slit-skin smear samples were collected. The samples were analysed using a bacteriological index (BI) protocol and the real-time quantitative polymerase chain reaction (qPCR). The results indicated that 15 of the 45 (33.3%) subjects with leprosy showed decreased oral sensitivity, which confirmed the importance of the oral cavity sensitivity evaluation. There was not a direct relationship between the presence of M. leprae in saliva and changes in oral sensitivity. Positive saliva qPCR results from six (31.6%) of 19 paucibacillary (PB) patients suggested the possibility of a new site for sample collection. Positive results using these diagnostic techniques (BI, slit-skin smear and saliva qPCR) increased to 55.5%, thus opening the possibility of combining these different techniques to increase the rate of positive diagnoses, especially in PB patients. PMID:23903971

  8. Leprosy in a University Hospital in Southern Brazil*

    PubMed Central

    de Lima, Adma Silva; Pinto, Karin Cristine; Bona, Míryan Priscilla Santos; de Mattos, Suelen Mayara Lopes; Hoffmann, Marina Portiolli; Mulinari-Brenner, Fabiane Andrade; Ottoboni, Vanessa Cristhine Dallolmo

    2015-01-01

    BACKGROUND Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years. OBJECTIVES To evaluate the epidemiological profile of patients followed at a University Hospital. MATERIALS AND METHODS This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010. RESULTS The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension. CONCLUSIONS This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication. PMID:26560210

  9. Pathogen-Specific Epitopes as Epidemiological Tools for Defining the Magnitude of Mycobacterium leprae Transmission in Areas Endemic for Leprosy

    PubMed Central

    Spencer, John S.; Hacker, Mariana A. V. B.; Costa, Luciana S.; Carvalho, Fernanda M.; Geluk, Annemieke; van der Ploeg-van Schip, Jolien J.; Pontes, Maria A. A.; Gonçalves, Heitor S.; de Morais, Janvier P.; Bandeira, Tereza J. P. G.; Pessolani, Maria C. V.; Brennan, Patrick J.; Pereira, Geraldo M. B.

    2012-01-01

    During recent years, comparative genomic analysis has allowed the identification of Mycobacterium leprae-specific genes with potential application for the diagnosis of leprosy. In a previous study, 58 synthetic peptides derived from these sequences were tested for their ability to induce production of IFN-γ in PBMC from endemic controls (EC) with unknown exposure to M. leprae, household contacts of leprosy patients and patients, indicating the potential of these synthetic peptides for the diagnosis of sub- or preclinical forms of leprosy. In the present study, the patterns of IFN-γ release of the individuals exposed or non-exposed to M. leprae were compared using an Artificial Neural Network algorithm, and the most promising M. leprae peptides for the identification of exposed people were selected. This subset of M. leprae-specific peptides allowed the differentiation of groups of individuals from sites hyperendemic for leprosy versus those from areas with lower level detection rates. A progressive reduction in the IFN-γ levels in response to the peptides was seen when contacts of multibacillary (MB) patients were compared to other less exposed groups, suggesting a down modulation of IFN-γ production with an increase in bacillary load or exposure to M. leprae. The data generated indicate that an IFN-γ assay based on these peptides applied individually or as a pool can be used as a new tool for predicting the magnitude of M. leprae transmission in a given population. PMID:22545169

  10. Distinct histopathological patterns in single lesion leprosy patients treated with single dose therapy (ROM) in the Brazilian Multicentric Study.

    PubMed

    Costa, M B; Cavalcanti Neto, P F; Martelli, C M; Stefani, M M; Maceira, J P; Gomes, M K; Schettini, A P; Rebello, P F; Pignataro, P E; Ueda, E S; Narahashi, K; Scollard, D M

    2001-09-01

    This paper aims to describe the histomorphologic features of skin biopsies of single lesion leprosy patients recruited at outpatient clinics in four Brazilian states in the Northeast (Amazonas and Rondonia), Southeast (Rio de Janeiro) and Center-West (Goiás) between October 1997 and December 1998. Patients clinically diagnosed as single skin lesion paucibacillary (SSL-PB) leprosy had a standard 4-mm punch biopsy taken from the lesion before rifampin, ofloxacin, minocycline (ROM) therapy. The features of the cellular inflammatory infiltrates, the presence of nerve involvement and acid-fast bacilli (AFB) were used to categorize SSL-PB biopsies into different histopathological groups. Two-hundred-seventy-eight (93.0%) out of 299 patients had a skin biopsy available. Seven single lesion patients were diagnosed as BL or LL leprosy types (MB) by the histopathological exams and 12 cases were excluded due to other skin diseases. Therefore, 259 patients had skin lesions with histomorphological features compatible with PB leprosy categorized as follows: 33.6% (N = 87) of the biopsies represented well-circumscribed epithelioid cell granuloma (Group 1); 21.6% (N = 56) less-circumscribed epithelioid cell granuloma (Group 2); 12.0% (N = 31) were described as mononuclear inflammatory infiltrate permeated with epithelioid cells (Group 3), and 29.7% (N = 77) had perivascular/periadnexal mononuclear inflammatory infiltrate (Group 4). Minimal/no morphological alteration in the skin was detected in only 8 (3.1%) SSL-PB patients categorized as Group 5, who were considered to have leprosy by clinical parameters. SSL-PB leprosy patients recruited in a multicentric study presented histomorphology readings comprising the whole PB leprosy spectrum but also a few MB cases. These results indicate heterogeneity among SSL-PB patients, with a predominance of well-circumscribed and less-circumscribed epithelioid cell granulomas (Groups 1 and 2) in the sites studied and the heterogeneity of local

  11. Leprosy in Malaysia.

    PubMed

    Jayalakshmi, P

    1994-06-01

    Leprosy is a chronic infectious disease and is still a public health problem in Malaysia. In 1926, the Leper Enactment Act was established which required compulsory notification and isolation of leprosy patients. As a result, the National Leprosy Control Centre (NLCC) was built in Sungai Buloh, Selangor. In 1969, the National Leprosy Control programme was launched with the objective of early case finding and decentralisation of treatment of leprosy. The treatment of leprosy patients is integrated with basic Medical and Health services in Malaysia. With the implementation of multiple drug therapy in 1985, the National prevalence rate of leprosy has reduced from 5.7 per 10,000 in 1983 to 1.7 per 10,000 in 1992. The Research Unit in NLCC was established in 1950, where cultivation of Mycobacterium leprae using mouse foot-pad technique is done. This technique is used for assessment of efficacy of chemotherapeutic agents in leprosy. Research activites are also done in collaboration with the Institute for Medical Research in Kuala Lumpur such as isolation of Mycobacterium leprae antigen using T cell clones and phenolic glycolipid antigen.

  12. [Borderline leprosy as a rare differential diagnosis].

    PubMed

    Trawinski, Henning; Brüning, Jan-Hinnerk; Baum, Petra; Ziemer, Mirjana; Schubert, Stefan; Lübbert, Christoph

    2016-06-01

    History and clinical findings | A 42-year-old migrant from Brazil presented with persistent sensory disturbances, skin discolorations and local alopecia in the upper limbs. Decisive for the presentation in our Tropical Medicine Clinic were new occurrences of severe pain and redness and swelling in the area of the lesions that had already been assessed by a number of medical specialists without a clear diagnosis could be made. Investigations and diagnosis | The histological analysis of skin biopsies showed perivascular, perineural, periadnexial lymphocytic and granulomatous dermatitis. In a direct microbiological preparation individual acid fast bacilli could be detected (Ziehl-Neelsen stain). The electroneurographical examination demonstrated a sensitive peripheral-neurogenic damage with emphasis on the right median nerve and the left ulnar and radial nerves. Thermography revealed an increased heating or cooling threshold. The serological investigation by ELISA for IgM antibodies against the phenolic glycolipid (PGL-1) was positive (titer 1 : 1200). In summary, the diagnosis of borderline leprosy (infection with Mycobacterium leprae) with transition to multibacillary leprosy (according to WHO) and leprosy reaction type 1 was made. Treatment and course | We initiated an oral antimycobacterial therapy (multidrug therapy, MDT) with rifampin, clofazimine and dapsone for 12 months (WHO regimen for multibacillary leprosy). Leprosy reaction type 1 was treated with prednisolone and by increasing the dose of clofazimine. Analgesic therapy on demand was carried out with nonsteroidal anti-inflammatory drugs (ibuprofen). MDT and successful management of leprosy reaction lead to a rapid improvement of symptoms. Conclusions | Leprosy is an infectious disease occurring only rarely in Germany (average incidence of 1-2 cases per year) that is diagnosed almost exclusively among migrants. Main symptoms comprise non-itchy, reddish, touch insensitive skin lesions or nerve deficits. The

  13. Evaluation of Apoptosis in Skin Biopsies of Patients of Borderline Leprosy and Lepra Type 1 Reaction

    PubMed Central

    Patnaik, Nivedita; Agarwal, Sarla; Sharma, Sonal; Sharma, Satendra; Pandhi, Deepika

    2015-01-01

    Background: The role of apoptosis is not clear in leprosy and lepra reactions. Objectives: To evaluate frequency of apoptosis in skin lesions of borderline leprosy and Type 1 lepra reaction. Methods: Sixty patients with borderline leprosy (30 with clinically diagnosed Type 1 reaction (T1R) (Group I) and 30 without clinical evidence of reaction (Group II)) were analyzed in this prospective study. Apoptosis was detected by two different methods for comparison, that is, histopathologic examination (HPE) and deoxyribonucleic acid (DNA) fragmentation and electrophoresis. Quantification of apoptotic bodies/10 high power fields (HPF) was also done. Results: Out of 30 cases, apoptosis was detected in 29 cases in Group I and 24 cases in Group II by HPE (P = 0.103), whereas, with the use of DNA electrophoresis it was detected in 24 cases in Group I and 18 cases in Group II (P = 0.091). On quantitative estimation it was found that number of apoptotic bodies are higher in Group I in comparison to Group II (2.77 vs 1.99), which is statistically significant. Conclusions: There was moderate agreement (κ = 0.47) between the two methods of apoptosis detection. Apoptosis was seen more in patients with T1R both qualitatively (statistically nonsignificant) and quantitatively (statistically significant). Clinical significance of this novel finding is that apoptosis can be used as one of the variables for diagnosis of T1R to increase detection rate. PMID:25657399

  14. Interleukin-1 released by blood-monocyte-derived macrophages from patients with leprosy.

    PubMed Central

    Ridel, P R; Jamet, P; Robin, Y; Bach, M A

    1986-01-01

    In highly purified blood-monocyte-derived macrophages collected from patients with leprosy and from healthy individuals and cultured in vitro with mycobacterial antigens such as Mycobacterium bovis BCG or Mycobacterium leprae, we nonspecifically induced the synthesis of interleukin-1. Normally, all supernatants from cultured macrophages of all subjects tested produced similar amounts of interleukin-1. However, only in patients with lepromatous leprosy, M. leprae, but not BCG, induced high-level synthesis of prostaglandin E2, which acted as a suppressor factor in the mouse thymocyte proliferative assay used to measure the interleukin-1 content of the supernatants. Normal interleukin-1 content of those supernatants was demonstrated by blocking the prostaglandin E2 synthesis by the addition of indomethacin to the medium throughout the experimental procedure. We also tested the efficiency of a combination of BCG and M. leprae in reducing the prostaglandin E2 synthesis, but with the methodology used, we did not observe any beneficial effect of such a combination. These results demonstrate the possible role of M. leprae in the induction of at least one of the suppressive monokines and are additional arguments for the involvement of macrophages in the suppression of the specific cell-mediated immunity to M. leprae observed in lepromatous leprosy. PMID:3514458

  15. Serological tests in leprosy. The sensitivity, specificity and predictive value of ELISA tests based on phenolic glycolipid antigens, and the implications for their use in epidemiological studies.

    PubMed

    Burgess, P J; Fine, P E; Ponnighaus, J M; Draper, C

    1988-08-01

    This paper examines the sensitivity and specificity of two ELISA assays for IgM antibodies to Mycobacterium leprae, one employing natural phenolic glycolipid and the other employing a synthetic disaccharide glycoconjugate as antigen. Estimates of sensitivity and specificity are derived, based on a panel of sera from leprosy cases in Malawi and various non-leprosy controls from the UK. Though both assays were able to identify a high proportion of multibacillary patients, neither was able to detect a high proportion of paucibacillary patients without considerable loss of specificity. The implications of the inverse relationship between sensitivity and specificity are discussed with reference to the predictive value of such tests in such areas as Malawi, where the large majority of cases are paucibacillary.

  16. Primary Motor Cortex Representation of Handgrip Muscles in Patients with Leprosy

    PubMed Central

    Rangel, Maria Luíza Sales; Sanchez, Tiago Arruda; Moreira, Filipe Azaline; Hoefle, Sebastian; Souto, Inaiacy Bittencourt; da Cunha, Antônio José Ledo Alves

    2015-01-01

    Background Leprosy is an endemic infectious disease caused by Mycobacterium leprae that predominantly attacks the skin and peripheral nerves, leading to progressive impairment of motor, sensory and autonomic function. Little is known about how this peripheral neuropathy affects corticospinal excitability of handgrip muscles. Our purpose was to explore the motor cortex organization after progressive peripheral nerve injury and upper-limb dysfunction induced by leprosy using noninvasive transcranial magnetic stimulation (TMS). Methods In a cross-sectional study design, we mapped bilaterally in the primary motor cortex (M1) the representations of the hand flexor digitorum superficialis (FDS), as well as of the intrinsic hand muscles abductor pollicis brevis (APB), first dorsal interosseous (FDI) and abductor digiti minimi (ADM). All participants underwent clinical assessment, handgrip dynamometry and motor and sensory nerve conduction exams 30 days before mapping. Wilcoxon signed rank and Mann-Whitney tests were performed with an alpha-value of p<0.05. Findings Dynamometry performance of the patients’ most affected hand (MAH), was worse than that of the less affected hand (LAH) and of healthy controls participants (p = 0.031), confirming handgrip impairment. Motor threshold (MT) of the FDS muscle was higher in both hemispheres in patients as compared to controls, and lower in the hemisphere contralateral to the MAH when compared to that of the LAH. Moreover, motor evoked potential (MEP) amplitudes collected in the FDS of the MAH were higher in comparison to those of controls. Strikingly, MEPs in the intrinsic hand muscle FDI had lower amplitudes in the hemisphere contralateral to MAH as compared to those of the LAH and the control group. Taken together, these results are suggestive of a more robust representation of an extrinsic hand flexor and impaired intrinsic hand muscle function in the hemisphere contralateral to the MAH due to leprosy. Conclusion Decreased

  17. Social Participation of Diabetes and Ex-Leprosy Patients in the Netherlands and Patient Preference for Combined Self-Care Groups

    PubMed Central

    de Vries, Henry J. C.; de Groot, Roos; van Brakel, Wim H.

    2014-01-01

    Introduction: Earlier, we showed that neuropathic complications limit social participation of ex-leprosy patients, even in a non-endemic leprosy setting like the Netherlands. Self-care groups for ex-leprosy patients can strengthen self-worth of participants, prevent further handicap, and enable the exchange of coping strategies. For non-endemic leprosy settings with a very low rate of leprosy patients, a self-care group exclusively for (ex)leprosy patients is not likely to be feasible. A combined group with patients facing comparable morbidity would be more efficient than disease-specific self-care groups. Here, we studied the comparability in social constraints of diabetic patients and ex-leprosy patients. Moreover, we investigated if combined self-care groups for ex-leprosy patients and diabetic patients would be desirable and acceptable for possible participants. Methods: Social participation was studied based on in-depth interviews and Participation Scale information collected from 41 diabetic patients and compared with the data of 31 ex-leprosy patients from a prior study. Moreover, we made an inventory of potential strengths and limitations and attitudes toward combined self-care groups for diabetic patients with neuropathy. Results: The following themes emerged among diabetic patients: disease confrontation, dependency, conflict with partner or relatives, feelings of inferiority, stigma, abandoning social activities, fear of the future, lack of information, and hiding the disease. These themes were very similar to those voiced by the previously interviewed ex-leprosy patients. The latter more often mentioned stigma and disease ignorance among Dutch health care workers. Whereas ex-leprosy patients perceived stigma on multiple fronts, diabetic patients only mentioned feeling inferior. Diabetic patients experienced some form of participation restriction in 39% of the cases as opposed to 71% of the ex-leprosy patients. Diabetic patients did acknowledge the

  18. Politics of leprosy segregation in Japan: the emergence, transformation and abolition of the patient segregation policy.

    PubMed

    Sato, Hajime; Narita, Minoru

    2003-06-01

    The segregation of leprosy patients, a practice introduced early in the 20th century, was maintained in Japan after World War II. It locked in the viability of subsequent policy choices, and patients' isolation was sustained long after it was proven to be scientifically unnecessary. For leprologists and leprosarium directors, there was little opportunity to conceptualize and test the epidemiological validity and effectiveness of outpatient services as alternatives to the existing policy, since most of the patients were already hospitalized. Since leprosy was no longer a threat to the general public, bureaucratic officials, as well as legislators, lacked strong incentives to reformulate the overall policy. Within the Ministry of Health and Welfare, daily tasks were largely transferred to the section for leprosarium management, and the search for other options lost importance. For patients, long institutionalization elevated their dependency on life in leprosaria. These conditions must be emphasized as policy legacies, the results of past policies, since they posed obstacles to effective policy innovation in accordance with changing scientific knowledge. To make policies reflective of scientific knowledge, it is essential to understand and foresee the effect of policy legacy, when introducing and appraising public health policies. PMID:12742615

  19. [The originality and creativity of leprosy sequelae patients in regard to dental care].

    PubMed

    Nakagawa, Masatsugu; Shimizu, Akemi

    2016-01-01

    Leprosy sequelae patients surmount the inconvenience by the handicap. When people with the handicap are able to do the same act as healthy people, we may not pay attention to the originality and creativity for it. Therefore, we are not able to notice some risks which are hidden. We turned our attention to the denture in the oral region. The methods of putting in and taking out the denture of leprosy sequelae patients are characteristic. Even a partial denture, there are many patients who take out their denture using only their tongue, without touching a clasp with a finger. And they put in the denture by biting. But we had never not announced the details of their methods. So, we investigated how to handle their denture in National Sanatorium Nagashima Aiseien. We explain their methods and show the results. On the other hand, there are a lot of cases of the denture breakage in National Sanatorium Nagashima Aiseien. We think most of these matters occur due to their handicaps. We researched on the cases with dentures broken. In addition, we also describe our countermeasure. PMID:27008825

  20. Pulmonary Tuberculosis and Lepromatous Leprosy Coinfection

    PubMed Central

    Sendrasoa, F. A.; Ranaivo, I. M.; Raharolahy, O.; Andrianarison, M.; Ramarozatovo, L. S.; Rapelanoro Rabenja, F.

    2015-01-01

    Simultaneous occurrence of leprosy and pulmonary tuberculosis is reported infrequently in the modern era. We report a case of pulmonary tuberculosis diagnosed in patient being treated with glucocorticoids for complications of leprosy (type II reaction). Physicians should recognize that the leprosy patients treated with glucocorticoid may develop tuberculosis. PMID:26504603

  1. Vitamin D receptor expression levels determine the severity and complexity of disease progression among leprosy reaction patients

    PubMed Central

    Mandal, D.; Reja, A.H.H.; Biswas, N.; Bhattacharyya, P.; Patra, P.K.; Bhattacharya, B.

    2015-01-01

    We studied the roles of vitamin D and its receptor, VDR, in the progression of leprosy. The majority of individuals with leprosy from Kolkata, India, with a type 1 or type 2 reaction have low levels of vitamin D3 in serum samples. Interestingly, individuals with a type 2 reaction associated with neuritis/erythema nodosum leprosum had very low VDR mRNA expression levels, ranging from 5% to 10%, compared to that of healthy control subjects; these patients also had a high bacilli index, ranging from 3+ to 5+. This is the first report to indicate that VDR expression levels may determine the complexity and severity of the progression of leprosy. PMID:26106480

  2. Epidermotropism of lepra bacilli in a patient with histoid Hansen's disease

    PubMed Central

    Vora, Rita V.; Pilani, Abhishek

    2014-01-01

    Histoid leprosy is a rare form of multibacillary leprosy with distinct clinical and histopathological features. It is a variant of lepromatous leprosy with a very high bacillary load. It appears in patients as relapse after dapsone monotherapy and resistance or rarely, “de novo.” Although leprosy is slowly declining the exact mode of transmission is unclear. At least until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. Transmission by the respiratory route is also gaining ground. There are other possibilities such as transmission through insects, which cannot be completely ruled out. However, the present case report possibly suggests the role of skin as a portal of both exit and entry for the bacillus in histoid leprosy transmission. De novo form of histoid leprosy has numerous solid staining bacteria inside the epidermis. The reports show that these bacilli can be eliminated from the intact epidermis, which indicate an unusual role of the skin in the transmission of leprosy. PMID:25396142

  3. Epidermotropism of lepra bacilli in a patient with histoid Hansen's disease.

    PubMed

    Vora, Rita V; Pilani, Abhishek

    2014-10-01

    Histoid leprosy is a rare form of multibacillary leprosy with distinct clinical and histopathological features. It is a variant of lepromatous leprosy with a very high bacillary load. It appears in patients as relapse after dapsone monotherapy and resistance or rarely, "de novo." Although leprosy is slowly declining the exact mode of transmission is unclear. At least until recently, the most widely held belief was that the disease was transmitted by contact between cases of leprosy and healthy persons. Transmission by the respiratory route is also gaining ground. There are other possibilities such as transmission through insects, which cannot be completely ruled out. However, the present case report possibly suggests the role of skin as a portal of both exit and entry for the bacillus in histoid leprosy transmission. De novo form of histoid leprosy has numerous solid staining bacteria inside the epidermis. The reports show that these bacilli can be eliminated from the intact epidermis, which indicate an unusual role of the skin in the transmission of leprosy. PMID:25396142

  4. Influence of Genetic Ancestry on INDEL Markers of NFKβ1, CASP8, PAR1, IL4 and CYP19A1 Genes in Leprosy Patients

    PubMed Central

    Pinto, Pablo; Salgado, Claudio; Santos, Ney Pereira Carneiro; Santos, Sidney; Ribeiro-dos-Santos, Ândrea

    2015-01-01

    Background Leprosy is an insidious infectious disease caused by the obligate intracellular bacteria Mycobacterium leprae, and host genetic factors can modulate the immune response and generate distinct categories of leprosy susceptibility that are also influenced by genetic ancestry. Methodology/Principal Findings We investigated the possible effects of CYP19A1 [rs11575899], NFKβ1 [rs28362491], IL1α [rs3783553], CASP8 [rs3834129], UGT1A1 [rs8175347], PAR1 [rs11267092], CYP2E1 [INDEL 96pb] and IL4 [rs79071878] genes in a group of 141 leprosy patients and 180 healthy individuals. The INDELs were typed by PCR Multiplex in ABI PRISM 3130 and analyzed with GeneMapper ID v3.2. The NFKβ1, CASP8, PAR1 and IL4 INDELs were associated with leprosy susceptibility, while NFKβ1, CASP8, PAR1 and CYP19A1 were associated with the MB (Multibacilary) clinical form of leprosy. Conclusions/Significance NFKβ1 [rs28362491], CASP8 [rs3834129], PAR1 [rs11267092] and IL4 [rs79071878] genes are potential markers for susceptibility to leprosy development, while the INDELs in NFKβ1, CASP8, PAR1 and CYP19A1 (rs11575899) are potential markers for the severe clinical form MB. Moreover, all of these markers are influenced by genetic ancestry, and European contribution increases the risk to leprosy development, in other hand an increase in African contribution generates protection against leprosy. PMID:26367014

  5. Human Polymorphisms as Clinical Predictors in Leprosy

    PubMed Central

    Prado Montes de Oca, Ernesto

    2011-01-01

    Genetic and serum markers in human host can predict leprosy susceptibility per se as well as be useful in classification and/or prediction of clinical variants and immunological responses in leprosy. Adequate and timely assessment of potential risks associated with these 38 host leprosy genes could diminish epidemiological burden and improve life quality of patients with this still prevalent mycobacterial disease. PMID:22220182

  6. Enoyl-Coenzyme A Hydratase and Antigen 85B of Mycobacterium habana Are Specifically Recognized by Antibodies in Sera from Leprosy Patients

    PubMed Central

    Serafín-López, J.; Talavera-Paulin, M.; Amador-Molina, J. C.; Alvarado-Riverón, M.; Vilchis-Landeros, M. M.; Méndez-Ortega, P.; Fafutis-Morris, M.; Paredes-Cervantes, V.; López-Santiago, R.; León, C. I.; Guerrero, M. I.; Ribas-Aparicio, R. M.; Mendoza-Hernández, G.; Carreño-Martínez, C.; Estrada-Parra, S.; Estrada-García, I.

    2011-01-01

    Leprosy is an infectious disease caused by Mycobacterium leprae, which is a noncultivable bacterium. One of the principal goals of leprosy research is to develop serological tests that will allow identification and early treatment of leprosy patients. M. habana is a cultivable nonpathogenic mycobacterium and candidate vaccine for leprosy, and several antigens that cross-react between M. leprae and M. habana have been discovered. The aim of the present study was to extend the identification of cross-reactive antigens by identifying M. habana proteins that reacted by immunoblotting with antibodies in serum samples from leprosy patients but not with antibodies in sera from tuberculosis (TB) patients or healthy donors (HDs). A 28-kDa antigen that specifically reacted with sera from leprosy patients was identified. To further characterize this antigen, protein spots were aligned in two-dimensional polyacrylamide gels and Western blots. Spots cut out from the gels were then analyzed by mass spectrometry. Two proteins were identified: enoyl-coenzyme A hydratase (lipid metabolism; ML2498) and antigen 85B (Ag85B; mycolyltransferase; ML2028). These proteins represent promising candidates for the design of a reliable tool for the serodiagnosis of lepromatous leprosy, which is the most frequent form in Mexico. PMID:21613461

  7. Brazilian Society of Dermatology against leprosy*

    PubMed Central

    Lastória, Joel Carlos; de Abreu, Marilda Aparecida Milanez Morgado

    2016-01-01

    The Brazilian Society of Dermatology promoted a national campaign against leprosy in 2012, involving their State Regional, Accredited Services of Dermatology and Referral Services in Leprosy. Consisted of clarification to the population about the disease and a day of medical voluntary service. Ninety services (57 Accredited Services and 33 Reference Services) participated, distributed in 23 states. The campaign examined 3,223 people and 421 new cases were diagnosed, 54,4% female, 74,3% between 19 and 64 years and 8,3% in children under 15 years. Of the 217 classified cases, 58,5% was paucibacillary and 41,5% was multibacillary. The results were posted on the Brazilian Society of Dermatology website. PMID:27438217

  8. Asymmetric Nerve Enlargement: A Characteristic of Leprosy Neuropathy Demonstrated by Ultrasonography

    PubMed Central

    Marques Jr., Wilson; Foss, Norma Tiraboschi

    2015-01-01

    Background Neurological involvement occurs throughout the leprosy clinical spectrum and is responsible for the most feared consequences of the disease. Ultrasonography (US) provides objective measurements of nerve thickening and asymmetry. We examined leprosy patients before beginning multi-drug therapy aiming to describe differences in US measurements between classification groups and between patients with and without reactions. Methodology/Principal Findings Eleven paucibacillary (PB) and 85 multibacillary (MB) patients underwent nerve US. Twenty-seven patients had leprosy reactions (type 1, type 2 and/or acute neuritis) prior to US. The ulnar (at the cubital tunnel–Ut–and proximal to the tunnel–Upt), median (M) and common fibular (CF) nerves were scanned to measure cross-sectional areas (CSAs) in mm2 and to calculate the asymmetry indexes ΔCSA (absolute difference between right and left CSAs) and ΔUtpt (absolute difference between Upt and Ut CSAs). MB patients showed greater (p<0.05) CSAs than PB at Ut (13.88±11.4/9.53±6.14) and M (10.41±5.4/6.36±0.84). ΔCSAs and ΔUtpt were similar between PB and MB. The CSAs, ΔCSAs and ΔUtpt were similar between PB patients with reactions compared to PB patients without reactions. MB patients with reactions showed significantly greater CSAs (Upt, Ut and M), ΔCSAs (Upt and Ut) and ΔUtpt compared to MB patients without reactions. PB and MB showed similar frequencies of abnormal US measurements. Patients with reactions had higher frequency of nerve thickening and similar frequency of asymmetry to those without reactions. Conclusions/Significance This is the first study to investigate differences in nerve involvement among leprosy classification groups using US before treatment. The magnitude of thickening was greater in MB and in patients with reactions. Asymmetry indexes were greater in patients with reactions and did not significantly differ between PB and MB, demonstrating that asymmetry is a characteristic of

  9. Comparison of Bacillary Index on Slit Skin Smear with Bacillary Index of Granuloma in Leprosy and its Relevance to Present Therapeutic Regimens

    PubMed Central

    Kumaran, Sendhil M; Bhat, Ishwara P; Madhukara, J; Rout, Pritilata; Elizabeth, J

    2015-01-01

    Background: As the world moves toward elimination of leprosy, persistence of infective cases in endemic pockets remains a significant problem. The use of clinical criteria to decide the paucibacillary (PB) versus multibacillary (MB) regimens has greatly simplified therapy at the field setting. However, a small but significant risk of under-treatment of so-called “PB” cases which actually have significant bacillary load exists. This study was undertaken to assess this risk and compare two methods of assessment of bacillary load, namely bacillary index on slit skin smear (BIS) versus bacillary index of granuloma (BIG). Aims: To compare BIS with BIG on skin biopsy in consecutive untreated cases of leprosy. Materials and Methods: This prospective study was conducted over a period of 12 months, wherein new untreated patients with leprosy were consecutively recruited. After a thorough clinical examination, each patient underwent slit skin smear (SSS) where the BIS was calculated. The same patient also underwent a skin biopsy from a clinical lesion where, the BIG was calculated. SSS and skin biopsy for BIS and BIG respectively were repeated for all patients at the end of therapy for comparison. All patients received therapy according to World Health Organization-Multidrug Therapy Guidelines. Results: The BIG was positive in all cases where the BIS was positive. Significantly, BIG was positive in three cases of borderline tuberculoid leprosy with <5 lesions who received PB regimen, whereas the BIS was negative in all three cases. Conclusion: This study suggests that BIG may be a better indicator of the true bacillary load in leprosy as compared to BIS. Its role in management is significant, at least in tertiary care centers to prevent “under-treatment” of so called PB cases, which may actually warrant MB regimens. PMID:25657397

  10. Annular bullous lesions with atypical erythema multiforme in leprosy.

    PubMed

    Shah, Aishani; Mahajan, Rashmi; Ninama, Kishan; Bilimoria, Freny

    2014-09-01

    Erythema nodosum leprosum (ENL) is an immune complex-mediated reaction that may complicate the course of multibacillary leprosy. Bullous lesions in Type II reaction, though reported, are exceedingly rare. We report the case of a 32 year old female patient who presented initially at our OPD with erythema nodosum. Cutaneous examination revealed impaired sensation over dorsum of right foot and thickened right lateral popliteal nerve. Slit skin smear (SSS) from ear lobes revealed AFB with a bacteriological index of 2+. She was started on MDT, tablet ofloxacin 200 mg twice a day, and 30 mg oral prednisolone. Two months later, she presented with generalised pruritus, large target lesions over the back, and hemorrhagic bullae over lower extremities and annular pattern of bullae, over both arms. A SSS was repeated which was positive for AFB. Histopathology from bullous lesions was consistent with ENL. Direct Immunofluorescence (DIF) study was negative. Our patient improved rapidly after she was started on thalidomide 100 mg twice daily, with withdrawal of ofloxacin. Erythema Multiforme (EMF) and annular bullous lesions have been reported in patients on treatment with ofloxacin. This case is being presented due to the unusual and varied manifestation of Type II lepra reaction in a 34 year old female patient. PMID:25509721

  11. Association of the solute carrier family 11 member 1 gene polymorphisms with susceptibility to leprosy in a Brazilian sample

    PubMed Central

    Brochado, Maria José Franco; Gatti, Maria Fernanda Chociay; Zago, Marco Antônio; Roselino, Ana Maria

    2016-01-01

    Natural resistance-associated macrophage protein 1/solute carrier family 11 member 1 gene (Nramp1/Slc11a1) is a gene that controls the susceptibility of inbred mice to intracellular pathogens. Polymorphisms in the human Slc11a1/Nramp1 gene have been associated with host susceptibility to leprosy. This study has evaluated nine polymorphisms of the Slc11a1/Nramp1 gene [(GT)n, 274C/T, 469+14G/C, 577-18G/A, 823C/T, 1029 C/T, 1465-85G/A, 1703G/A, and 1729+55del4] in 86 leprosy patients (67 and 19 patients had the multibacillary and the paucibacillary clinical forms of the disease, respectively), and 239 healthy controls matched by age, gender, and ethnicity. The frequency of allele 2 of the (GT)n polymorphism was higher in leprosy patients [p = 0.04, odds ratio (OR) = 1.49], whereas the frequency of allele 3 was higher in the control group (p = 0.03; OR = 0.66). Patients carrying the 274T allele (p = 0.04; OR = 1.49) and TT homozygosis (p = 0.02; OR = 2.46), such as the 469+14C allele (p = 0.03; OR = 1.53) of the 274C/T and 469+14G/C polymorphisms, respectively, were more frequent in the leprosy group. The leprosy and control groups had similar frequency of the 577-18G/A, 823C/T, 1029C/T, 1465-85G/A, 1703G/A, and 1729+55del4 polymorphisms. The 274C/T polymorphism in exon 3 and the 469+14G/C polymorphism in intron 4 were associated with susceptibility to leprosy, while the allele 2 and 3 of the (GT)n polymorphism in the promoter region were associated with susceptibility and protection to leprosy, respectively. PMID:26814595

  12. Health information system model for monitoring treatment and surveillance for leprosy patients in indonesia (case study in Pekalongan District, Central Java, Indonesia).

    PubMed

    Rachmani, Enny; Kurniadi, Arif; Hsu, Chien Yeh

    2013-01-01

    After India and Brazil, Indonesia has the third highest incidence/prevalence of leprosy in the world. Every year thousands of new cases and case with grade-2 disability are reported and, while the recovery rate lingers only 80-90 %. Therefore, more than 10 % of leprosy patients drop out of treatment and can be a source of new infections in the community. Our research was aimed at determining apparent difficulties in the leprosy control program as well as how a health information system (HIS) could assist the Indonesian leprosy control program. We used qualitative method with deep interview and observation of document. One of the difficulties which the Indonesian leprosy control program faces is discontinuity of patient's data due to rotating staff as well as the treatment monitoring and queries patients which should be monitored after treatment has ceased. Technology implementation is feasible through short message service (sms) reminders and web base applications. The leprosy control program urgently needs to implement continuous monitoring and recording of patients because of the particular characteristics of this contagious disease.

  13. The Use of Ozone in High Frequency Device to Treat Hand Ulcers in Leprosy: a Case Study.

    PubMed

    Reis, Felipe J J; Correia, Helia; Nagen, Roberto; Gomes, Maria Kátia

    2015-09-01

    Leprosy leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Autonomic dysfunctions may result in dryness and cracking of the skin. In this study, we present the use of ozone provided by a high-frequency device to treat hand ulcers (wounds) in an 80-year-old man who was diagnosed as multibacillary in 2007. In the first visit, the patient was evaluated and received verbal and written instructions about self-care. Treatment consisted of five sessions, once per week. The ozone provided by a high-frequency device seemed to be useful in the treatment of ulcers, thus, contributing to the healing process. Research that investigates the use of high frequencies in the treatment of ulcers associated or not with other interventions (self-care strategies, protective clothing, adapted tools and footwear adaptation) is strongly recommended.

  14. The Use of Ozone in High Frequency Device to Treat Hand Ulcers in Leprosy: a Case Study

    PubMed Central

    Reis, Felipe J.J.; Correia, Helia; Nagen, Roberto; Gomes, Maria Kátia

    2015-01-01

    Leprosy leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Autonomic dysfunctions may result in dryness and cracking of the skin. In this study, we present the use of ozone provided by a high-frequency device to treat hand ulcers (wounds) in an 80-year-old man who was diagnosed as multibacillary in 2007. In the first visit, the patient was evaluated and received verbal and written instructions about self-care. Treatment consisted of five sessions, once per week. The ozone provided by a high-frequency device seemed to be useful in the treatment of ulcers, thus, contributing to the healing process. Research that investigates the use of high frequencies in the treatment of ulcers associated or not with other interventions (self-care strategies, protective clothing, adapted tools and footwear adaptation) is strongly recommended. PMID:26543396

  15. The Use of Assistive Technology to Promote Care of the Self and Social Inclusion in Patients with Sequels of Leprosy

    PubMed Central

    2016-01-01

    Background This study is about the contribution of occupational therapy inside a rehabilitation group, and we focus on the autonomy of patients with disabilities due to leprosy. There are few studies on the use of assistive technology by leprosy patients; to our knowledge, none of them aim to have a subjective approach of care. Our purpose was to analyze the repercussions of assistive technology on autonomy of care of the self in patients with sequels of leprosy. Methods A qualitative, descriptive exploratory study with a semi-structured interview and a field observation as a research method was conducted between November 2014 and February 2015 at a University Hospital in Rio de Janeiro. Findings Eight patients from the service of Occupational Therapy were interviewed, and 44 hours of observation were performed. Interviews followed a semi-structured script and a field journal was used to take notes. Analysis was conducted by the hermeneutic approach. Costs were obtained after a global cost analysis of the fixed and variable expenses and direct and indirect costs to the manufactured products with an amount of 100 dollars. Results were grouped according to the following categories: contribution of the adapted devices for the care of the self and feelings and sensations provoked by the use of self-help devices. The reports revealed feelings, perceptions and meaningful contents about the social, familiar and individual dimensions, also the stigma coupled with leprosy. However, forms of re-signification were elaborated. Conclusions Assistive technology empowers the subject to perform care of the self and promotes social inclusion. PMID:27124408

  16. Identification of serological biomarkers of infection, disease progression and treatment efficacy for leprosy.

    PubMed

    Spencer, John S; Duthie, Malcolm S; Geluk, Annemieke; Balagon, Marivic F; Kim, Hee Jin; Wheat, William H; Chatterjee, Delphi; Jackson, Mary; Li, Wei; Kurihara, Jade N; Maghanoy, Armi; Mallari, Irene; Saunderson, Paul; Brennan, Patrick J; Dockrell, Hazel M

    2012-12-01

    Although leprosy is curable with drug treatment, the identification of biomarkers of infection, disease progression and treatment efficacy would greatly help to reduce the overall prevalence of the disease. Reliable biomarkers would also reduce the incidence of grade-2 disability by ensuring that those who are most at risk are diagnosed and treated early or offered repeated treatments in the case of relapse. In this study, we examined the reactivity of sera from lepromatous and tuberculoid leprosy patients (LPs) against a panel of 12 recombinant Mycobacterium leprae proteins and found that six proteins were strongly recognised by multibacillary (MB) patients, while only three were consistently recognised by paucibacillary patients. To better understand the dynamics of patient antibody responses during and after drug therapy, we measured antibody titres to four recombinant proteins, phenolic glycolipid-I and lipoarabinomannan at baseline and up to two years after diagnosis to investigate the temporal changes in the antibody titres. Reactivity patterns to individual antigens and decreases in antibody titres were patient-specific. Antibody titres to proteins declined more rapidly vs. those to carbohydrate and glycolipid antigens. Compared to baseline values, increases in antibody titres were observed during reactional episodes in one individual. Additionally, antibody responses against a subset of antigens that provided a good prognostic indicator of disease progression were analysed in 51 household contacts of MB index cases for up to two years. Although the majority of these contacts showed no change or exhibited decreases in antibody titres, seven individuals developed higher titres towards one or more of these antigens and one individual with progressively higher titres was diagnosed with borderline lepromatous leprosy 19 months after enrolment. The results of this study indicate that antibody titres to specific M. leprae antigens can be used to monitor treatment

  17. Changes in plantar load distribution and gait pattern following foot drop correction in leprosy affected patients.

    PubMed

    Karmakar, Mrinmoy; Joshua, Jerry; Mahato, Nidhu

    2015-09-01

    This study was done to compare the changes in plantar load (weight distribution) and gait patterns before and after tibialis posterior transfer surgery in people affected by leprosy. Changes in gait patterns were observed and proportionate changes in plantar load were quantified using data captured by a baropodometer. All the eight patients who underwent tibialis posterior transfer surgery in 2013 in our hospital were included in the study. In addition to the regular pre-operative and post-operative assessments, the patients also underwent baropodometric evaluation. There was a significant change in plantar load at the heel, lateral border and forefoot. Using the foot pressure scan, it was noted that the progression of the centre of mass (displayed graphically as 'the gait line') was also affected by the altered pattern of weight distribution. This study reiterates the importance of tibialis posterior transfer because: it restores the normal gait pattern of 1, 2, 3 (where 1 is heel strike, 2 is mid foot contact and 3 is forefoot contact) and provides a more uniform distribution of planter load. PMID:26665356

  18. The involvement of endothelial mediators in leprosy

    PubMed Central

    Nogueira, Maria Renata Sales; Latini, Ana Carla Pereira; Nogueira, Maria Esther Salles

    2016-01-01

    Leprosy is a chronic infectious disease that requires better understanding since it continues to be a significant health problem in many parts of the world. Leprosy reactions are acute inflammatory episodes regarded as the central etiology of nerve damage in the disease. The activation of endothelium is a relevant phenomenon to be investigated in leprosy reactions. The present study evaluated the expression of endothelial factors in skin lesions and serum samples of leprosy patients. Immunohistochemical analysis of skin samples and serum measurements of VCAM-1, VEGF, tissue factor and thrombomodulin were performed in 77 leprosy patients and 12 controls. We observed significant increase of VCAM-1 circulating levels in non-reactional leprosy (p = 0.0009). The immunostaining of VEGF and tissue factor was higher in endothelium of non-reactional leprosy (p = 0.02 for both) than healthy controls. Patients with type 1 reaction presented increased thrombomodulin serum levels, compared with non-reactional leprosy (p = 0.02). In type 2 reaction, no significant modifications were observed for the endothelial factors investigated. The anti-inflammatory and antimicrobial activities of the endotfhelial factors may play key-roles in the pathogenesis of leprosy and should be enrolled in studies focusing on alternative targets to improve the management of leprosy and its reactions. PMID:27706378

  19. Leprosy mimicry of lupus vulgaris and misdiagnosis of leprosy--a case report.

    PubMed

    Mandal, B C; Bandyopadhyay, G

    2012-01-01

    Leprosy and tuberculosis (TB) both are still rampant in India. Leprosy predominantly presents through skin manifestations whereas cutaneous manifestations of TB though not so frequent but are not rare. Lupus vulgaris (LV), the commonest of all cutaneous manifestations of TB, mimics leprosy very closely and may prompt the examiner to misdiagnose leprosy, especially, by health workers (HW), in a field situation, where leprosy is diagnosed and treated on clinical basis alone as per NLEP guidelines. Because of existing stigmata, such wrong diagnosis can put the patient and the party under psychological stress and creates unnecessary complications.

  20. Haplotypes of the IL10 Gene as Potential Protection Factors in Leprosy Patients

    PubMed Central

    Garcia, Patricia; Alencar, Dayse; Pinto, Pablo; Santos, Ney; Salgado, Claudio; Sortica, Vinicius A.; Hutz, Mara H.; Santos, Sidney

    2013-01-01

    Leprosy is an infectious disease caused by Mycobacterium leprae characterized by dermatoneurological signs and symptoms that has a large number of new cases worldwide. Several studies have associated interleukin 10 with susceptibility/resistance to several diseases. We investigated haplotypes formed by three single nucleotide polymorphisms (SNPs) located in the IL10 gene (A-1082G, C-819T, and C-592A) in order to better understand the susceptibility to and severity of leprosy in an admixed northern Brazil population, taking into account estimates of interethnic admixture. We observed the genotypes ACC/ACC (P = 0.021, odds ratio [OR] [95% confidence interval (CI)] = 0.290 [0.085 to 0823]) and ACC/GCC (P = 0.003, OR [95% CI] = 0.220 [0.504 to 0.040]) presenting significant results for protection against leprosy development, framed in the profiles of low and medium interleukin production, respectively. Therefore, we suggest that genotypes A-1082G, C-819T, and C-592A formed by interleukin-10 polymorphisms are closely related to protection of the leprosy development in an admixed northern Brazil population, in particular ACC/ACC and ACC/GCC genotypes. PMID:23966553

  1. Leg ulcer in lepromatous leprosy - Case report*

    PubMed Central

    Fernandes, Tania Rita Moreno de Oliveira; dos Santos, Talita Suzany Siqueira; Lopes, Ramon Rodrigues de Macedo

    2016-01-01

    In Brazil, leprosy is a widespread infectious and contagious disease. Clinicians and specialists view leprosy broadly as a systemic infection, since, in its manifestations, it mimics many conditions, such as rheumatic, vascular, ENT, neurological and dermatological diseases. There are few studies that characterize the factors associated with ulcers in leprosy. These injuries should be prevented and treated promptly to avoid serious problems like secondary infections, sepsis, carcinomatous degeneration and amputations. We describe a patient with ulcers on his legs, involving late diagnosis of lepromatous leprosy.

  2. Serology in leprosy

    PubMed Central

    de Almeida, J. Oliveira

    1970-01-01

    A critical survey of the literature on serology in leprosy has shown that sera taken from lepromatous patients display some striking differences in comparison with sera from tuberculoid patients. The tests most frequently employed were complement-fixation, haemagglutination, electrophoresis, precipitation and immunofluorescence, together with a variety of antigens not only from lepromas but also from Mycobacterium tuberculosis and other actinomycetales. With the exception of the Rubino test, all these serological tests are lacking in specificity for leprosy since leprous sera have a broad range of reactivity with different antigens, including those employed in the serological diagnosis of syphilis. Some features of the leprous sera could be related to a hypersensitivity state involving circulating immune complexes, low levels of complement and the presence of antibodies similar to those found in sera from patients with autoimmune diseases. PMID:20604357

  3. Borderline Tuberculoid Leprosy Associated with Histoid Leprosy

    PubMed Central

    Rao, Angoori Gnaneshwar

    2016-01-01

    Coexistence of two immunologically diverse forms of leprosy in an individual is very rare. Herein, we report a case of association of borderline tuberculoid (BT) leprosy with histoid leprosy (HL) in a young immune competent male. He was diagnosed as a case of BT leprosy 10 years ago and now presented with multiple papules and nodules. Histopathological examination of biopsy taken from patch and nodule showed features of BT and HL, respectively. PMID:27688462

  4. Borderline Tuberculoid Leprosy Associated with Histoid Leprosy.

    PubMed

    Rao, Angoori Gnaneshwar

    2016-01-01

    Coexistence of two immunologically diverse forms of leprosy in an individual is very rare. Herein, we report a case of association of borderline tuberculoid (BT) leprosy with histoid leprosy (HL) in a young immune competent male. He was diagnosed as a case of BT leprosy 10 years ago and now presented with multiple papules and nodules. Histopathological examination of biopsy taken from patch and nodule showed features of BT and HL, respectively. PMID:27688462

  5. T cell response to purified filtrate antigen 85 from Mycobacterium bovis Bacilli Calmette-Guérin (BCG) in leprosy patients.

    PubMed Central

    Launois, P; Huygen, K; De Bruyn, J; N'Diaye, M; Diouf, B; Sarthouj, L; Grimaud, J; Millan, J

    1991-01-01

    T cell proliferation and IFN-gamma production of peripheral blood mononuclear cells from 25 healthy controls and 39 leprosy patients were tested against BCG-bacilli and culture filtrate. Mycobacterium leprae and purified antigen 85 (the major secreted 30-32 kD protein antigen) from M. bovis strain BCG. In lepromin negative healthy controls, blastogenesis was low to M. leprae and completely negative to antigen 85. IFN-gamma levels were very low, close to detection limits. In all lepromin positive controls, significant proliferation and IFN-gamma secretion was found in response to M. leprae and antigen 85. In the group of lepromatous leprosy (LL) patients, 25/29 of patients (with either positive (13) or negative (12) lymphoproliferative response to BCG) were unreactive to M. leprae or to antigen 85. Four LL patients with positive T cell response to BCG responded with detectable lymphoproliferative response and IFN-gamma secretion to antigen 85. All tuberculoid (TT) leprosy patients responded to BCG, M. leprae and antigen 85. Hence, T cells from leprosy patients and controls demonstrate a marked parallelism of responsiveness towards whole M. leprae and purified antigen 85 from M. bovis BCG, suggesting strong cross-reactivity between the two species and underlining the biological importance of such secreted antigens. PMID:1934596

  6. Dermatoglyphics in leprosy: (III) Creases of palm.

    PubMed

    Ghei, S K; Katoch, K; Girdhar, B K; Ramu, G; Sengupta, U

    1989-01-01

    Palmar configurations of triradii and creases of 100 leprosy patients [50 lepromatous (BL/LL) and 50 tuberculoid (BT/LL)] were compared with those of 100 normal persons selected from families of these patients. The patterns of position of triradii were similar in controls and leprosy patients as such. But, the patterns in the two types of leprosy patients were different. As for palmar creases patterns, there was significant difference between those of controls and patients, double radial base crease occurring more often in patients. However, the differences between the two types of patients were not statistically significant.

  7. Mathematical modelling of leprosy and its control.

    PubMed

    Blok, David J; de Vlas, Sake J; Fischer, Egil A J; Richardus, Jan Hendrik

    2015-03-01

    Leprosy or Hansen's disease is an infectious disease caused by the bacterium Mycobacterium leprae. The annual number of new leprosy cases registered worldwide has remained stable over the past years at over 200,000. Early case finding and multidrug therapy have not been able interrupt transmission completely. Elimination requires innovation in control and sustained commitment. Mathematical models can be used to predict the course of leprosy incidence and the effect of intervention strategies. Two compartmental models and one individual-based model have been described in the literature. Both compartmental models investigate the course of leprosy in populations and the long-term impact of control strategies. The individual-based model focusses on transmission within households and the impact of case finding among contacts of new leprosy patients. Major improvement of these models should result from a better understanding of individual differences in exposure to infection and developing leprosy after exposure. Most relevant are contact heterogeneity, heterogeneity in susceptibility and spatial heterogeneity. Furthermore, the existing models have only been applied to a limited number of countries. Parameterization of the models for other areas, in particular those with high incidence, is essential to support current initiatives for the global elimination of leprosy. Many challenges remain in understanding and dealing with leprosy. The support of mathematical models for understanding leprosy epidemiology and supporting policy decision making remains vital. PMID:25765193

  8. Histopathological examination of nerve samples from pure neural leprosy patients: obtaining maximum information to improve diagnostic efficiency.

    PubMed

    Antunes, Sérgio Luiz Gomes; Chimelli, Leila; Jardim, Márcia Rodrigues; Vital, Robson Teixeira; Nery, José Augusto da Costa; Corte-Real, Suzana; Hacker, Mariana Andréa Vilas Boas; Sarno, Euzenir Nunes

    2012-03-01

    Nerve biopsy examination is an important auxiliary procedure for diagnosing pure neural leprosy (PNL). When acid-fast bacilli (AFB) are not detected in the nerve sample, the value of other nonspecific histological alterations should be considered along with pertinent clinical, electroneuromyographical and laboratory data (the detection of Mycobacterium leprae DNA with polymerase chain reaction and the detection of serum anti-phenolic glycolipid 1 antibodies) to support a possible or probable PNL diagnosis. Three hundred forty nerve samples [144 from PNL patients and 196 from patients with non-leprosy peripheral neuropathies (NLN)] were examined. Both AFB-negative and AFB-positive PNL samples had more frequent histopathological alterations (epithelioid granulomas, mononuclear infiltrates, fibrosis, perineurial and subperineurial oedema and decreased numbers of myelinated fibres) than the NLN group. Multivariate analysis revealed that independently, mononuclear infiltrate and perineurial fibrosis were more common in the PNL group and were able to correctly classify AFB-negative PNL samples. These results indicate that even in the absence of AFB, these histopathological nerve alterations may justify a PNL diagnosis when observed in conjunction with pertinent clinical, epidemiological and laboratory data.

  9. History of leprosy in Rio de Janeiro*

    PubMed Central

    Avelleira, João Carlos Regazzi; Bernardes, Fred; Quaresma, Maria Victória; Vianna, Francisco Reis

    2014-01-01

    The record of the first cases of leprosy in Rio de Janeiro dates from the seventeenth century. The first local host of leprosy patients was created from 1741, and the first colonies hospitals were built in the early twentieth century, in order to avoid contagion of the population. The first structures dedicated to research also date from this time: the Leprosy International Institute, the Leprology Institute, and the Leprosy Laboratory of the Oswaldo Cruz Foundation, where the most prestigious leprologists of Rio de Janeiro worked. Currently, investigations are focused on the Oswaldo Cruz Foundation; additionally, leprosy patients are treated at municipal health centers and state hospitals, and former colony hospitals only accept patients with severe disabilities. PMID:24937834

  10. [How does one treat the osteitis and osteoarthritis of the extremities in older leprosy patients using granulated table sugar?].

    PubMed

    Grauwin, M Y; Cartel, J L; Lepers, J P

    1999-01-01

    A common problem of osteitis and septic arthritis is the recurrent bone infection after surgical debridement, a problem frequently encountered in patients with sequela leprosy. In these cases the authors propose the use of an ancient method of post surgical wound care based on the treatment with ordinary granulated sugar. The hyperosmolar climate created this way in the wounds inhibits the bacterial growth, enhances bacterial death and therefore permits the growth of granulation tissue in order to recover the debrided nude bones. At ILAD (Leprosy Institute of Dakar), 36 osteitis and septic arthritis were treated and healed during the last 2 years from March 1995 to March 1997 using this technic. All the wounds healed in the mean-time of 44 days. Only two of them needed a second debridement and healed afterwards. Up to now the method using ordinary sugar was applied in the treatment of infected wounds, eschars and postsurgical infections. Our experience shows that it also can be indicated to treat bone infections. This method is easy to apply also under often difficult field conditions and is very cheap.

  11. Histoid leprosy: case report.

    PubMed

    Bakry, Ola Ahmed; Attia, Aballa Mohamed

    2012-01-01

    Histoid leprosy is a rare but well-defined entity with specific clinical, histopathologic, and bacteriologic features. We present a case of histoid leprosy in an 84-year-old Egyptian male in view of the rarity of this condition. The patient presented with erythematous itchy discrete and coalescent papules that were distributed bilaterally and symmetrically on the front and back of the trunk. Before approaching us, he was initially misdiagnosed as a case of pityriasis rosea. There was no mucosal or facial affection and the patient's general examination was normal. Routine hematologic investigations, urine analysis, liver and renal function tests were all normal. Slit skin smear revealed acid-fast bacilli of BI - 6+ and MI - 50-60%. Histopathologic examination of hematoxylin and eosin-stained section revealed atrophic epidermis with flattened rete ridges and dermal infiltration by nodular granulomata formed of spindle shaped histiocytes with pyknotic nuclei oriented in a storiform pattern. Fite's stain for lepra bacilli showed plenty of acid fast bacilli. So, the diagnosis of histoid leprosy was made. Therefore, ROM therapy (rifampicin 600 mg, ofloxacin 400 mg, minocycline 200 mg) was started and followed by multi-drug therapy for 2 years. PMID:23317487

  12. Defaulting patterns in a provincial leprosy control programme in Northern Mozambique.

    PubMed

    Griffiths, S; Ready, N

    2001-06-01

    Cohort-based multidrug therapy (MDT) completion rates are used to assess adherence to MDT. However this measure gives no information about when during the treatment period defaulting occurs. Two districts in Cabo Delgado province in Northern Mozambique were selected for evaluation of multibacillary patient defaulter data between 1993 and 1997 to examine when patients default during the treatment penod. In all, 548 (59.2%) of 926 MB patients completed treatment and 378 (40.8%) defaulted between 1993 to 1997. The percentage of defaulters fell steadily from 59.8% in 1993 to 23.2% in 1997. Of the 378 defaulters 57.7% defaulted treatment within 6 months and 83.1% within 1 year of starting treatment. It was observed that patients tend to default early rather than late in the treatment period and that this pattern is maintained over time despite a fall in defaulter rates. Patients established early into a treatment routine were more likely to complete treatment. A comprehensive effort to improve and maintain leprosy control services will probably influence adherence more than any single, specific strategy. Shortening MDT treatment from 2 years to 1 year is unlikely to affect the defaulter rate.

  13. Association of polymorphism at COL3A and CTLA4 loci on chromosome 2q31-33 with the clinical phenotype and in-vitro CMI status in healthy and leprosy subjects: a preliminary study.

    PubMed

    Kaur, G; Sachdeva, G; Bhutani, L K; Bamezai, R

    1997-07-01

    Two genetic loci, viz. COL3A and CTLA4, located within the chromosome 2q31-33 region in the vicinity of the proposed syntenic site of the mouse "Bcg" locus were genotyped by the polymerase chain reaction in leprosy patients and healthy individuals. All the subjects studied were assessed as in-vitro responders/non-responders to mycobacterial antigens. Simple sequence length polymorphism analysis revealed five (236 to 312 bp) and eight (84 to 120 bp) allelomorphs for COL3A and CTLA4, respectively. Our preliminary analysis showed a significant association between the 250-bp COL3A allelomorph in the homozygous condition and the multibacillary form of leprosy (P < 0.05: relative risk = 5.5). Another allelic (312 bp) variant of COL3A was significantly correlated with non-responsiveness to M. leprae antigens in vitro (P < 0.01). The 104-bp allelomorph of CTLA4 was not observed in any of the 25 cases of leprosy. This absence was statistically significant (P < 0.05) when compared with normal healthy controls and depicted a high relative risk (RR = 25.83). An additional observation of the predominance of a unique 84-bp CTLA4/CTLA4-like allelomorph was observed in the Indian subjects studied. PMID:9225967

  14. The epidemiological consequences of leprosy-tuberculosis co-infection.

    PubMed

    Hohmann, N; Voss-Böhme, A

    2013-02-01

    While in antiquity both leprosy and tuberculosis were prevalent in Europe, leprosy declined thereafter and, simultaneously, tuberculosis prevalence increased. Since both diseases are caused by mycobacterial infections, it has been suggested that there might be a causal relationship between both epidemics. Chaussinand observed the inverse prevalence of leprosy and tuberculosis and suggested that individuals with a latent tuberculosis infection are protected from acquiring leprosy. His cross-immunity hypothesis has been countered more recently by a co-infection hypothesis. The latter suggestion, proposed by Donoghue, states that people being infected with multi-bacillary leprosy are more susceptible to tuberculosis, which leads to increased mortality from the disease. This study utilizes mathematical modeling to explore the epidemiological consequences of the co-infection hypothesis for realistically confined parameter values. While the co-infection hypothesis appears plausible at first glance, a second thought reveals that it comprises also substantial consequences for tuberculosis epidemics: if co-infection raises the mortality rate above that of purely tuberculosis infected persons, then tuberculosis might as well be eradicated by leprosy. It is the specific interplay of both increased susceptibility towards tuberculosis and increased death rate when co-infected that determines the epidemiological fate. As a result of this analysis, it is shown that there is a large parameter region where the eventual disappearance of leprosy could indeed be explained by co-infection. This parameter region is considerably larger than that predicted by the cross-immunity hypothesis. This shows that the co-infection hypothesis should be considered a significant alternative to the cross-immunity hypothesis. The time scales at which the effects of co-infection are observed depend critically on the spatial distribution of the individuals but reach epidemiologically realistic values for

  15. Leprosy Drug Resistance Surveillance in Colombia: The Experience of a Sentinel Country

    PubMed Central

    Beltrán-Alzate, Camilo; López Díaz, Fernando; Romero-Montoya, Marcela; Sakamuri, Rama; Li, Wei; Kimura, Miyako; Brennan, Patrick

    2016-01-01

    An active search for Mycobacterium leprae drug resistance was carried out, 243 multibacillary patients from endemic regions of Colombia were included from 2004 to 2013 in a surveillance program. This program was a World Health Organization initiative for drug resistance surveillance in leprosy, where Colombia is a sentinel country. M. leprae DNA from slit skin smear and/or skin biopsy samples was amplified and sequenced to identify mutations in the drug resistance determining region (DRDR) in rpoB, folP1, gyrA, and gyrB, the genes responsible for rifampicin, dapsone and ofloxacin drug-resistance, respectively. Three isolates exhibited mutations in the DRDR rpoB gene (Asp441Tyr, Ser456Leu, Ser458Met), two in the DRDR folP1 gene (Thr53Ala, Pro55Leu), and one isolate exhibited mutations in both DRDR rpoB (Ser456Met) and DRDR folP1 (Pro55Leu), suggesting multidrug resistance. One isolate had a double mutation in folP1 (Thr53Ala and Thr88Pro). Also, we detected mutations outside of DRDR that required in vivo evaluation of their association or not with drug resistance: rpoB Arg505Trp, folP1 Asp91His, Arg94Trp, and Thr88Pro, and gyrA Ala107Leu. Seventy percent of M. leprae mutations were related to drug resistance and were isolated from relapsed patients; the likelihood of relapse was significantly associated with the presence of confirmed resistance mutations (OR range 20.1–88.7, p < 0.05). Five of these relapsed patients received dapsone monotherapy as a primary treatment. In summary, the current study calls attention to M. leprae resistance in Colombia, especially the significant association between confirmed resistance mutations and relapse in leprosy patients. A high frequency of DRDR mutations for rifampicin was seen in a region where dapsone monotherapy was used extensively. PMID:27706165

  16. Nailfold capillaroscopy in leprosy*

    PubMed Central

    de Lima, Adma Silva; Pizzol, Vanessa Irusta dal; Fritsch, Scheila; Fonseca, Gabriela Poglia; Mulinari-Brenner, Fabiane Andrade; Muller, Carolina de Souza; Ottoboni, Vanessa Cristhine Dalombo

    2016-01-01

    Due to mounting evidences of interaction between Hansen's bacilli with endothelial cells and the paucity of studies addressing the presence of nailfold capillaroscopic alterations in patients with Hansen's disease, a study was carried out in order to verify the presence of capillaroscopic alterations in patients with leprosy in its various forms and its correlation with clinical parameters. Ten patients were evaluated at a specialized university service. Sixty percent of those had some capillaroscopic change, such as micro-hemorrhages, ectatic, bushy and corkscrew capillaries. Such changes were unspecific, which suggests there is not a specific pattern for this disease.

  17. Pure neuritic leprosy: Current status and relevance.

    PubMed

    Rao, P Narasimha; Suneetha, Sujai

    2016-01-01

    Pure neuritic leprosy has always been an enigma due to its clinical and management ambiguities. Although only the Indian Association of Leprologist's classification recognizes 'pure neuritic leprosy' as a distinct sub group of leprosy, cases nonetheless are reported from various countries of Asia, Africa, South America and Europe, indicating its global relevance. It is important to maintain pure neuritic leprosy as a subgroup as it constitutes a good percentage of leprosy cases reported from India, which contributes to more than half of global leprosy numbers. Unfortunately, a high proportion of these patients present with Grade 2 disability at the time of initial reporting itself due to the early nerve involvement. Although skin lesions are absent by definition, when skin biopsies were performed from the skin along the distribution of the affected nerve, a proportion of patients demonstrated leprosy pathology, revealing sub-clinical skin involvement. In addition on follow-up, skin lesions are noted to develop in up to 20% of pure neuritic leprosy cases, indicating its progression to manifest cutaneous disease. Over the decades, the confirmation of diagnosis of pure neuritic leprosy has been subjective, however, with the arrival and use of high-resolution ultrasonography (HRUS) for nerve imaging, we have a tool not only to objectively measure and record the nerve thickening but also to assess the morphological alterations in the nerve including echo texture, fascicular pattern and vascularity. Management of pure neuritic leprosy requires multidrug therapy along with appropriate dose of systemic corticosteroids, for both acute and silent neuritis. Measures for pain relief, self-care of limbs and physiotherapy are important to prevent as well as manage disabilities in this group of patients. PMID:27088926

  18. Florid reactive periostitis ossificans of long bones and digits associated with reaction in a patient with leprosy.

    PubMed

    Chakma, Joy Kumar; Malaviya, G N; Girdhar, Anita; Hussein, Sajid

    2012-03-01

    Florid reactive periostitis ossificans is a rare bone lesion usually occurring in the small, tubular bones of the hands and feet. This entity is a benign and aggressive periosteal reaction associated with soft tissue swelling that appears similar to a bone lesion that radiographically and clinically mimics an infectious or neoplastic process. Typically the lesions occurs in an adolescent or young adult and presents as a small area of painful swelling and erythema over the affected bone. The cause of florid reactive periostitis ossificans is not exactly known though many authors have postulated varied etiopathogenesis for the same condition. In this report, is a very rare and unusual example of this entity that has been observed in association with erythema nodosum leprosum (ENL) a type 2 lepra reaction in a Leprosy patient.

  19. Florid reactive periostitis ossificans of long bones and digits associated with reaction in a patient with leprosy.

    PubMed

    Chakma, Joy Kumar; Malaviya, G N; Girdhar, Anita; Hussein, Sajid

    2012-03-01

    Florid reactive periostitis ossificans is a rare bone lesion usually occurring in the small, tubular bones of the hands and feet. This entity is a benign and aggressive periosteal reaction associated with soft tissue swelling that appears similar to a bone lesion that radiographically and clinically mimics an infectious or neoplastic process. Typically the lesions occurs in an adolescent or young adult and presents as a small area of painful swelling and erythema over the affected bone. The cause of florid reactive periostitis ossificans is not exactly known though many authors have postulated varied etiopathogenesis for the same condition. In this report, is a very rare and unusual example of this entity that has been observed in association with erythema nodosum leprosum (ENL) a type 2 lepra reaction in a Leprosy patient. PMID:22655475

  20. Teaching of leprosy: current challenges*

    PubMed Central

    Alves, Cynthia Rossetti Portela; Ribeiro, Maria Mônica Freitas; Melo, Elza Machado; Araújo, Marcelo Grossi

    2014-01-01

    In the context of declining leprosy endemicity worldwide, keeping the interest in knowledge and expertise in leprosy alive has been a matter of concern. Approaching the problem only in primary care, without the proper integration with other levels of care in the health system fails to account for the complexity of the disease. Training professionals to work at different levels of health care is a current challenge. The objective of this review was to look for experiences related to the teaching of leprosy both in undergraduate courses in the field of health sciences and in training programs for professionals who work in patient care. We highlight the role of the dermatologist in the management of control programs, diagnosis and treatment of the disease, as well as in the continuous education of other health professionals. PMID:24937820

  1. Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic

    PubMed Central

    Leon, Kristoffer E.; Jacob, Jesse T.; Franco-Paredes, Carlos; Kozarsky, Phyllis E.; Wu, Henry M.; Fairley, Jessica K.

    2016-01-01

    Background. Hansen's disease (HD), or leprosy, is uncommon in the United States. We sought to describe the characteristics of patients with HD in a US clinic, including an assessment of delays in diagnosis and HD reactions, which have both been associated with nerve damage. Methods. A retrospective chart review was conducted on patients seen at an HD clinic in the southern United States between January 1, 2002 and January 31, 2014. Demographic and clinical characteristics were summarized, including delays in diagnosis, frequency of reactions, and other complications including peripheral neuropathy. Results. Thirty patients were seen during the study time period. The majority of patients were male (73%) and had multibacillary disease (70%). Brazil, Mexico, and the United States were the most frequent of the 14 countries of origin. Hansen's disease “reactions”, severe inflammatory complications, were identified among 75% of patients, and nerve damage was present at diagnosis in 36% of patients. The median length of time between symptom onset and diagnosis was long at 12 months (range, 1–96), but no single factor was associated with a delay in diagnosis. Conclusions. The diagnosis of HD was frequently delayed among patients referred to our US clinic. The high frequency of reactions and neuropathy at diagnosis suggests that further efforts at timely diagnosis and management of this often unrecognized disease is needed to prevent the long-term sequelae associated with irreversible nerve damage. PMID:27186586

  2. Assessment of viability by normal mouse foot-pad and bacillary ATP bioluminescence assay in multibacillary cases treated with an MDT regimen using conventional as well as newer drugs like minocycline and ofloxacin.

    PubMed

    Gupta, U D; Katoch, K; Singh, H B; Natrajan, M; Sharma, V D; Katoch, V M

    2000-01-01

    The therapeutic effect of a drug regimen of conventional drugs as well as newer drugs like ofloxacin and minocycline in smear-positive multibacillary (MB) leprosy cases was assessed by mouse foot-pad and ATP bioluminiscence methods. Biopsies were taken before starting treatment and after one year of treatment. They were processed for viability assessment by normal mouse foot-pad inoculation and bacillary ATP assay techniques. The test regimen was quite effective in its anti-bacterial effect as it was found to result in loss of bacillary viability in all the cases, as assessed by both methods.

  3. The demystification of leprosy: a multifactorial problem.

    PubMed

    Kato, L

    1990-01-01

    Abolishment of misbeliefs and misconceptions, unfounded fear and prejudice are factors as important in leprosy control as prevention, early detection and therapy. Concrete measures of demystification are proposed. Identify and divulge the absolute truth about leprosy. Calling leprosy "Hansen's disease" did not result in demystification. Patients know that the two terms are identical. Treating them as human beings attracts more patients to the healers than the Hansenologian ritual. Contrary to statements, no major advances are being made in the field of bacteriology, immunology, molecular biology, mode of transmission and epidemiology of leprosy. Not a single new drug has been discovered in 26 years. Vaccination is a dubious venture. The question arises as to whether the right priorities are promoted in leprosy research. Cultivation of the leprosy bacillus is the sine qua non of any further progress. This field of research is a lost and totally neglected priority. Consequently we have no pharmacological model for badly needed of ultrapotent antileprosy drugs. Syphilis is now cured with a single dose of penicillin. A drug as potent against leprosy should not be a mission impossible if an appropriate pharmacological model--the in vitro culture--is available. The multifactorial problem of demystification is a difficult but not an impossible task. Less sensationalism, more real progress in research, selecting the right priorities, achieving the "ultimate drug", shelter, food, shoes, soap and broom for every human on this planet constitute the road to demystification. PMID:2220303

  4. Can leprosy be eradicated with chemotherapy? An evaluation of the Malta Leprosy Eradication Project.

    PubMed

    Jacobson, Robert R; Gatt, Paul

    2008-12-01

    The Malta Leprosy Eradication Project (MLEP) was proposed in 1971 by Freerksen with the aim of eradicating leprosy in Malta. The project involved re-treatment of all known cases in Malta as of 1972 and all new cases thereafter with a regimen consisting of Isoprodian (a combination of dapsone, prothionamide and isoniazid) and rifampicin for varying intervals depending on the severity of their disease and their response to treatment. Overall the response to therapy was excellent with an extremely low relapse rate. During the 30 years of the project the incidence of leprosy steadily decreased continuing a decline that had started at least two decades earlier and Freerksen declared the disease eradicated from Malta in 2001. Although given the long incubation period of leprosy cases may still be occasionally detected in the future, the disease has been basically eradicated at this time and there are no patients currently receiving treatment. This work was done at the leprosy clinic, Boffa Hospital, Floriana, Malta.

  5. Severe Leprosy Reactions Due to Mycobacterium lepromatosis

    PubMed Central

    Han, Xiang Y.; Jessurun, Jose

    2012-01-01

    Leprosy is caused by the well known Mycobacterium leprae and the newly discovered Mycobacterium lepromatosis. We describe here 2 cases of leprosy with unusual clinical presentation caused by M. lepromatosis. The patients, a 32-year-old man and a 50-year-old woman, both of Mexican origin, manifested high fever, lymphadenopathy, and florid skin lesions in the form of erythema nodosum and Lucio’s phenomenon as the first clinical presentation. Heavy infiltration of acid-fast bacilli was identified in the tissues that led to the diagnosis of lepromatous leprosy or diffuse leprosy. The patients were treated with multi-drug regimen and responded appropriately. From the lymph node tissue, we showed the bacillus to be M. lepromatosis, not M. leprae as presumed previously, by using differential polymerase chain reactions and analysis of gene sequences. These cases add to the growing studies on this organism, expand its endemic regions in Mexico, and provide more clinical insight. PMID:23111393

  6. The demographic and clinical characteristics of leprosy in Saudi Arabia.

    PubMed

    Alotaibi, Mohammad H; Bahammam, Salman A; Ur Rahman, Saeed; Bahnassy, Ahmed A; Hassan, Imad S; Alothman, Adel F; Alkayal, Abdulkareem M

    2016-01-01

    Leprosy is a chronic disease caused by Mycobacterium leprae. Although the occurrence of leprosy has declined in Saudi Arabia, it has not yet been eradicated. To our knowledge, this descriptive retrospective study is the first to assess the clinical presentation of leprosy at the time of diagnosis in Saudi Arabia. All study subjects were leprosy patients admitted to Ibn Sina hospital, the only referral hospital for leprosy in Saudi Arabia, between January 2000 and May 2012. A total of 164 subjects, the majority of whom (65%) were between 21 and 50 years of age, were included, and the male-to-female ratio was 2.8:1. Of these 164 patients, 63% were Saudis, and 77% of all admitted patients were from the western region. Lepromatous leprosy was observed most frequently (33%), and 31% of cases had a positive history of close contact with leprosy. At the time of diagnosis, 84% of all subjects presented with skin manifestation. The prevalence of neurological deficit at the time of diagnosis was 87%. Erythema nodosum leprosum (E.N.L.) developed in only 10% of all subjects. Further studies are needed to determine the clinical characteristics pertaining to each type of leprosy in the region, and training courses in caring for and diagnosing patients with leprosy should be organized for health workers.

  7. Plastic footwear for leprosy.

    PubMed

    Antia, N H

    1990-03-01

    The anaesthetic foot in leprosy poses the most major problem in the rehabilitation of its patients. Various attempts have been made to produce protective footwear such as the microcellular rubber-car-tyre sandals. Unfortunately these attempts have had little success on a large scale because of the inability to produce them in large numbers and the stigma attached to such unusual footwear. While such footwear may be superior to the 'tennis' shoe in protecting the foot from injury by the penetration of sharp objects, it fails to distribute the weight-bearing forces which is the major cause of plantar damage and ulceration in the anaesthetic foot. This can be achieved by providing rigidity to the sole, as demonstrated by the healing of ulcers in plaster of paris casts or the rigid wooden clog. A new type of moulded plastic footwear has been evolved in conjunction with the plastic footwear industry which provides footwear that can be mass produced at a low price and which overcomes the stigma of leprosy. Controlled rigidity is provided by the incorporation of a spring steel shank between the sponge insole and the hard wearing plastic sole. Trials have demonstrated both the acceptability of the footwear and its protective effects as well as its hard wearing properties. PMID:2319903

  8. Leprosy in the Bible.

    PubMed

    Grzybowski, Andrzej; Nita, Małgorzata

    2016-01-01

    For many years, the biblical term tzaraat has referred to leprosy. In fact, the disease or diseases described under this name have no relationship to leprosy, as it was known in the Middle Ages or today; moreover, the term referred not only to skin disease, but also to the state of the ritual impurity and punishment for the sins. Although the real nature of tzaraat remains unknown, the differential diagnosis might include the following: Psoriasis, seborrheic dermatitis, favus, dermatophyte infections, nummular dermatitis, atopic dermatitis, pityriasis rosea, crusted scabies, syphilis, impetigo, sycosis barbae, alopecia areata, furuncles, scabies, neurodermatitis, scarlet fever, lupus erythematosus, lichen sclerosus et atrophicus, folliculitis decalvans, morphea, sarcoidosis, and lichen planopilaris. Leprosy became interchangeable with the biblical leprosy due to two inaccurate translations: The Hebrew tzaraat was first translated into Greek as leprosy in the sixth century, and later, the word leprosy was translated into Arabic as lepra in the ninth century.

  9. Leprosy in the Bible.

    PubMed

    Grzybowski, Andrzej; Nita, Małgorzata

    2016-01-01

    For many years, the biblical term tzaraat has referred to leprosy. In fact, the disease or diseases described under this name have no relationship to leprosy, as it was known in the Middle Ages or today; moreover, the term referred not only to skin disease, but also to the state of the ritual impurity and punishment for the sins. Although the real nature of tzaraat remains unknown, the differential diagnosis might include the following: Psoriasis, seborrheic dermatitis, favus, dermatophyte infections, nummular dermatitis, atopic dermatitis, pityriasis rosea, crusted scabies, syphilis, impetigo, sycosis barbae, alopecia areata, furuncles, scabies, neurodermatitis, scarlet fever, lupus erythematosus, lichen sclerosus et atrophicus, folliculitis decalvans, morphea, sarcoidosis, and lichen planopilaris. Leprosy became interchangeable with the biblical leprosy due to two inaccurate translations: The Hebrew tzaraat was first translated into Greek as leprosy in the sixth century, and later, the word leprosy was translated into Arabic as lepra in the ninth century. PMID:26773616

  10. A Randomized Controlled Double Blind Trial of Ciclosporin versus Prednisolone in the Management of Leprosy Patients with New Type 1 Reaction, in Ethiopia

    PubMed Central

    Lambert, Saba M.; Alembo, Digafe T.; Nigusse, Shimelis D.; Yamuah, Lawrence K.; Walker, Stephen L.; Lockwood, Diana N. J.

    2016-01-01

    Background Leprosy Type 1 (T1R) reactions are immune-mediated events leading to nerve damage and preventable disability affecting hands, feet and eyes. Type 1 Reactions are treated with oral corticosteroids. There is little evidence on alternative treatments for patients who do not respond to steroids or experience steroid adverse effects. We report the results of a randomized controlled trial testing the efficacy and adverse effect profile of ciclosporin and prednisolone (CnP) in comparison to prednisolone only (P) in patients with new T1R in Ethiopia. Ciclosporin is a potent immunosuppressant. Outcomes were measured using a clinical severity score, recurrence rate, adverse events and quality of life. Results Seventy three patients with new T1R were randomized to receive CnP or P for 20 weeks. Recovery rates in skin signs was similar in both groups (91% vs 88%). Improvements in nerve function both, new and old, sensory (66% vs 49%) and motor (75% vs 74%) loss were higher (but not significantly so) in the patients on CnP. Recurrences rates of T1R (85%) were high in both groups, and recurrences occurred significantly earlier (8 weeks) in patients CnP, who needed 10% more additional prednisolone. Serious major and minor adverse events rates were similar in patients in the two treatment arms of the study. Both groups had a significant improvement in their quality of life after the study, measured by the SF-36. Conclusions This is the first double-blind RCT assessing ciclosporin, in the management of T1R in Africa. Ciclosporin could be a safe alternative second-line drug for patients with T1R who are not improving with prednisolone or are experiencing adverse events related to prednisolone. This study illustrates the difficulty in switching off leprosy inflammation. Better treatment agents for leprosy patients with reactions and nerve damage are needed. PMID:27046330

  11. Type 2 leprosy reaction with Sweet's syndrome-like presentation*

    PubMed Central

    Chiaratti, Francielle Chiavelli; Daxbacher, Egon Luiz Rodrigues; Neumann, Antonielle Borges Faria; Jeunon, Thiago

    2016-01-01

    Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation. PMID:27438203

  12. Autochthonous borderline tuberculoid leprosy in a man from Florida.

    PubMed

    Villada, Gabriel; Zarei, Mina; Romagosa, Ricardo; Forgione, Patrizia; Fabbrocini, Gabriella; Romanelli, Paolo

    2016-03-01

    Leprosy (Hansen's disease) is a chronic contagious granulomatous disease principally affecting the skin and peripheral nervous system, caused by Mycobacterium leprae. In this report, we present a case of autochthonous leprosy in a man from Florida as the first human case reported from this region. Authors believe dermatologists need to be aware of the possibility of autochthonous transmission of leprosy in the Eastern-Southern United States, and should consider leprosy in any patient with atypical skin lesions, even when a history of contact with armadillo is missing. PMID:27255063

  13. Arthritis and diagnosis of leprosy: a case report and review of the literature*

    PubMed Central

    Fernandes, Tania Rita Moreno de Oliveira; Korinfskin, Juliana Pedrosa; Espíndola, Mariana Mercês Mesquita; Corrêa, Lis Moreno de Oliveira

    2014-01-01

    Leprosy is clinically characterized by involvement of peripheral nerves and skin. The immunological profile of the individual defines the diversity of clinical manifestations, from skin disorders to systemic manifestations, especially the articulation ones, common in multibacillary forms, which may mimic collagen diseases and often posing diagnostic difficulties in endemic areas. This is a case report of asymmetric polyarthritis of small and large articulations associated with skin lesions which had been treated by a rheumatologist for 2 years with initial clinical diagnosis of rheumatoid arthritis, and later, with the appearance of skin lesions, of systemic lupus erythematosus. PMID:24770512

  14. Epidemiological aspects of leprosy in Juazeiro-BA, from 2002 to 2012*

    PubMed Central

    Silva, Maria Eduarda Gomes da Cruz; de Souza, Carlos Dornels Freire; Silva, Susanne Pinheiro Costa e; da Costa, Flávia Monteiro; do Carmo, Rodrigo Feliciano

    2015-01-01

    BACKGROUND Leprosy is an infectious disease caused by Mycobacterium leprae, able to infect large numbers of people. This work is relevant to Juazeiro-BA, a hyper-endemic area for leprosy, since unravel the behavior of the disease in the area, may suggest the decision making for sectors of surveillance, establishing strategies, organizing and evaluating programs and services. OBJECTIVES To analyze the epidemiology of leprosy in Juazeiro-BA, from 2002 to 2012. METHODS A descriptive, cross-sectional study was conducted based in data of the Diseases Notification System, assigned by the service of Epidemiology from Juazeiro-BA, between 2002 and 2012. RESULTS 1,916 new cases of leprosy were detected between 2002 and 2012, of which 921 (48.07%) represented male sex, 995 (51.93%) female, and there was a reduction in the incidence rate of leprosy per 100,000 inhabitants. Most carriers were brown individuals, with low levels of education, living in the urban area, being more prevalent in the economically active age group. Through statistical analysis we found that there are more chances of developing sequelae among men, and multibacillary individuals older than 45 years. CONCLUSIONS The work serves to direct efforts to control this disease, and highlights the importance of active search for new cases to achieve an early diagnosis, reducing the number of sequels and allowing breaking the chain of disease transmission. PMID:26734859

  15. [Leprosy in French Guyana: a retrospective study from 1997 to 2006].

    PubMed

    Domergue, V; Clyti, E; Sainte-Marie, D; Huber, F; Marty, C; Couppié, P

    2008-02-01

    French Guyana borders Brazil with the second highest number of cases of leprosy in the world. The purpose of this retrospective study of leprosy cases diagnosed in Guyana between January 1997 and December 2006 was to calculate the incidence of the disease and to identify any special clinical and epidemiological features. A total of 90 new cases were recorded during the study period for a mean incidence of 0.53 cases/10,000 inhabitants/year. Since this incidence is below the 1/10,000 threshold defined by the World Health Organization, leprosy is no longer considered as a major public health issue in French Guyana. However it must be noted that while the number of "native leprosy" cases has declined, the number of Brazilian cases has increased (p<0.01). Brazilian leprosy has different epidemiological features, i.e., dominance of multibacillary forms and high incidence in gold panning and western regions of the country where the incidence is over 1/10,000 inhabitants/year.

  16. A patient with erythema nodosus leprosum and Chagas cardiopathy: challenges in patient management and review of the literature.

    PubMed

    Trindade, Maria Ângela B; Carvalho, Noemia B; Belfort, Elaini C; Pagliari, Carla; Gakiya, Erika; Sakai-Valente, Neusa Y; Benard, Gil; Shikanai-Yasuda, Maria A

    2011-06-01

    We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.

  17. Citrus leprosis research update

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis is one of the oldest citrus diseases, but is also one of the most important emerging citrus diseases in South and Central America, and it is apparently spreading northward towards the U.S. Research in our labs and by others has shown that citrus leprosis disease is caused by a compl...

  18. Leprosy prevention law and healthcare professionals in Japan.

    PubMed

    Aoki, Yumie

    2002-01-01

    This article considers the issues surrounding leprosy, and focuses on the social stigma and mistreatment associated with the disease. In particular, the history of leprosy patients and leprosy-prevention law in Japan is examined in both a historical and social context. Matters related to infringement of human rights are also considered along with issues for nurses caring for patients with leprosy. Eugenics and its legal approval are then discussed, as is the abolition of the leprosy laws in Japan. Finally, the author argues that problems surrounding this infectious disease are not country-specific; nurses may be ignorant of the number of patients with this debilitating disease worldwide, and of the policies and laws surrounding it.

  19. A case of leprosy in Malawi. Making the final push towards eradication: a clinical and public health perspective.

    PubMed

    Roe, Cieron; May, Lucy Sarah

    2016-01-01

    Statistically speaking, Malawi has achieved the World Health Organisation's target for the elimination of leprosy (<1 case per 10 000 people), yet the disease is still considered a leading cause of long term physical disability. In this case study the authors discuss the presentation of a 39-year-old gentleman to a district hospital in Malawi with multibacillary, lepromatous leprosy. The condition was initially managed in the community as an 'allergy' which suggests that local barriers currently hinder the detection of leprosy in this developing primary care system. Leprosy is a multi-system disease and this gentleman demonstrated evidence of lepromatous orchitis. Promoting an awareness of these systemic manifestations will increase the the detection of complications and circumvent long term morbidity. Efforts to optimise systems of detection, management and public and professional education are essential to drive eradication in these at-risk populations. At an international level, we must strive to fulfil the objectives outlined by the 'Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011-2015'. At a national level, local research should delineate community factors that impede the eradication of leprosy. Developing new diagnostic and epidemiologic tools, more efficacious chemoprophylactic regimens and vaccination for endemic regions would facilitate these efforts. PMID:27585828

  20. A case of leprosy in Malawi. Making the final push towards eradication: a clinical and public health perspective.

    PubMed

    Roe, Cieron; May, Lucy Sarah

    2016-01-01

    Statistically speaking, Malawi has achieved the World Health Organisation's target for the elimination of leprosy (<1 case per 10 000 people), yet the disease is still considered a leading cause of long term physical disability. In this case study the authors discuss the presentation of a 39-year-old gentleman to a district hospital in Malawi with multibacillary, lepromatous leprosy. The condition was initially managed in the community as an 'allergy' which suggests that local barriers currently hinder the detection of leprosy in this developing primary care system. Leprosy is a multi-system disease and this gentleman demonstrated evidence of lepromatous orchitis. Promoting an awareness of these systemic manifestations will increase the the detection of complications and circumvent long term morbidity. Efforts to optimise systems of detection, management and public and professional education are essential to drive eradication in these at-risk populations. At an international level, we must strive to fulfil the objectives outlined by the 'Enhanced Global Strategy for Further Reducing the Disease Burden due to Leprosy for 2011-2015'. At a national level, local research should delineate community factors that impede the eradication of leprosy. Developing new diagnostic and epidemiologic tools, more efficacious chemoprophylactic regimens and vaccination for endemic regions would facilitate these efforts.

  1. Association between STR -794 CATT5-8 and SNP -173 G/C polymorphisms in the MIF gene and Lepromatous Leprosy in Mestizo patients of western Mexico.

    PubMed

    Martinez-Guzman, M A; Alvarado-Navarro, A; Pereira-Suarez, A L; Muñoz-Valle, J F; Fafutis-Morris, M

    2016-10-01

    Lepromatous Leprosy (LL) is the most common presentation of leprosy in Mexico. LL patients are unable to activate an effective inflammatory response against Mycobacterium leprae probably due to the genetics of the host. Macrophage Migration Inhibitory Factor (MIF) is important to trigger inflammation processes. Two polymorphisms have been reported for human MIF: STR -794 CATT5-8 and SNP -173 G/C. 7-8 CATT repeats at -794 and the C allele at -173 increase the expression of MIF. We aim to determine the association between the polymorphisms in MIF gene and LL. We carried a case and controls study with 100 Mexican LL patients and 100 healthy subjects (HS). PCR was used for genotyping of STR -794 CATT5-8 polymorphism and PCR-RFLP for -173 G/C. We found that LL patients possess high -794 CATT repeats (47.1%) more often than HS (32.7%). In conclusion, a MIF polymorphism is associated with susceptibility to LL in Western Mexican population.

  2. Nerve abscess in primary neuritic leprosy.

    PubMed

    Rai, Dheeraj; Malhotra, Hardeep Singh; Garg, Ravindra Kumar; Goel, Madhu Mati; Malhotra, Kiran Preet; Kumar, Vijay; Singh, Arun Kumar; Jain, Amita; Kohli, Neera; Singh, Shailesh Kumar

    2013-06-01

    Nerve abscess is an infrequently reported complication of leprosy. We describe a patient with a pure neuritic type of leprosy with multiple nerve abscesses, who presented with tingling and numbness in the medial aspect of his right forearm and hand. Subsequently he developed pain, redness and swelling over the medial side of his right elbow and the flexor aspect of his right wrist. High-resolution ultrasound showed diffuse thickening of the right ulnar nerve with hypoechoic texture housing a cystic lesion with internal debris suggesting an abscess, at the cubital tunnel. Histopathological examination of the pus and tissue obtained from the abscess revealed presence of granulomas with lepra bacilli. The patient responded to surgery and multidrug therapy. In conclusion, the nerve abscess as the first manifestation of leprosy is uncommon and a high index of suspicion is required to make a correct diagnosis. PMID:24171239

  3. Clinical Pearls: Leprosy Reactions.

    PubMed

    Wu, Jane; Boggild, Andrea K

    2016-09-01

    Leprosy reactions are acute inflammatory episodes that occur in the setting of Mycobacterium leprae infection. Precipitants of reactions can be pharmacologic and nonpharmacologic. Both type 1 and type 2 reactions typically occur before and during leprosy treatment but may also occur after treatment has been completed. Reactions cause morbidity due to nerve damage, and prompt corticosteroid therapy is warranted to minimize nerve damage due to reactions.

  4. Proposing a Compartmental Model for Leprosy and Parameterizing Using Regional Incidence in Brazil

    PubMed Central

    2016-01-01

    Hansen’s disease (HD), or leprosy, is still considered a public health risk in much of Brazil. Understanding the dynamics of the infection at a regional level can aid in identification of targets to improve control. A compartmental continuous-time model for leprosy dynamics was designed based on understanding of the biology of the infection. The transmission coefficients for the model and the rate of detection were fit for each region using Approximate Bayesian Computation applied to paucibacillary and multibacillary incidence data over the period of 2000 to 2010, and model fit was validated on incidence data from 2011 to 2012. Regional variation was noted in detection rate, with cases in the Midwest estimated to be infectious for 10 years prior to detection compared to 5 years for most other regions. Posterior predictions for the model estimated that elimination of leprosy as a public health risk would require, on average, 44–45 years in the three regions with the highest prevalence. The model is easily adaptable to other settings, and can be studied to determine the efficacy of improved case finding on leprosy control. PMID:27532862

  5. Leprosy treatment dropout: a sistematic review

    PubMed Central

    2013-01-01

    Background Leprosy is a chronic infectious disease endemic in some undeveloped areas, and still represents a public health problem in Brazil. Therefore, the control of this endemic disease depends necessarily on the institution of correct treatment and containment of treatment dropout. This study aims to conduct a systematic review of published studies on treatment dropout of leprosy. Methods We conducted a systematic review of articles on treatment dropout of leprosy, published between january 2005 and april 2013, on MEDLINE and SciELO databases. The search was performed using the MeSH terms: “leprosy”; “patients dropouts” and the keywords: “leprosy, treatment” and “noncompliance, leprosy” in association, beside the equivalents in Portuguese. Results There were originally 196 references. After analyzing the titles and abstracts of articles, 20 articles were obtained and included in the final sample. Discussion Leprosy is a notifiable disease known as its disfiguring capability and the high rate of non-compliance to treatment. The low adhesion is responsible for the remaining potential sources of infection, irreversible complications, incomplete cure and, additionally, may lead to resistance to multiple drugs. Many factors are responsible for the interruption or dropout treatment: socioeconomic factors, education level, knowledge about the disease, lack of efficiency of health services, demographics, side effects of drugs, alcoholism, among others. Conclusion The recent scientific literature about the subject diverge regarding the factors that most affect the dropout problem in treating leprosy patients. However, better integration between professionals and users, and greater commitment of the patient, are common points among the authors of the studies. PMID:24000954

  6. Leprosy of the past and today.

    PubMed

    Grange, John M; Lethaby, Julie I

    2004-06-01

    Despite enhanced disease control efforts, leprosy remains an important cause of disability in several countries. Being based on case detection, the exact prevalence of the disease is not easily estimated. Currently around 600,000 new cases are treated annually. Advances in immunology and molecular biology have led to a greater understanding of the disease and to hopes for improved diagnostic tests and vaccination strategies. The major advance, though, is the development of highly effective combination drug regimens which, provided all doses are taken, rarely fails to cure. The challenge to leprosy control services is to overcome the stigma associated with the disease so that patients present with minimal lesions and before disabilities have developed. Although it is hoped that leprosy as a serious public health problem will be eliminated within a few years, continuing care for those suffering from deformity and rejection by society will be required for several decades.

  7. Application of Mycobacterium Leprae-specific cellular and serological tests for the differential diagnosis of leprosy from confounding dermatoses.

    PubMed

    Freitas, Aline Araújo; Hungria, Emerith Mayra; Costa, Maurício Barcelos; Sousa, Ana Lúcia Osório Maroccolo; Castilho, Mirian Lane Oliveira; Gonçalves, Heitor Sá; Pontes, Maria Araci Andrade; Duthie, Malcolm S; Stefani, Mariane Martins Araújo

    2016-10-01

    Mycobacterium leprae-specific serological and cell-mediated-immunity/CMI test were evaluated for the differential diagnosis of multibacillary/MB, and paucibacillary/PB leprosy from other dermatoses. Whole-blood assay/WBA/IFNγ stimulated with LID-1 antigen and ELISA tests for IgG to LID-1 and IgM to PGL-I were performed. WBA/LID-1/IFNγ production was observed in 72% PB, 11% MB leprosy, 38% dermatoses, 40% healthy endemic controls/EC. The receiver operating curve/ROC for WBA/LID-1 in PB versus other dermatoses showed 72.5% sensitivity, 61.5% specificity and an area-under-the-curve/AUC=0.75; 74% positive predictive value/PPV, 59% negative predictive value/NPV. Anti PGL-I serology was positive in 67% MB, 8% PB leprosy, 6% of other dermatoses; its sensitivity for MB=66%, specificity=93%, AUC=0.89; PPV=91%, NPV=72%. Anti-LID-1 serology was positive in 87% MB, 7% PB leprosy, all other participants were seronegative; 87.5% sensitivity for MB, 100% specificity, AUC=0.97; PPV=100%, NPV=88%. In highly endemic areas anti-LID-1/PGL-I serology and WBA/LID-1-represent useful tools for the differential diagnosis of leprosy from other confounding dermatoses.

  8. Renal amyloidosis in leprosy, an infrequent cause of nephrotic syndrome in Europe.

    PubMed

    Sanz-Martín, Noelia; Samillán-Sosa, Kelly Del Rocío; De Miguel, Julio; Martínez-Miguel, Patricia

    2016-01-01

    Leprosy is a chronic infectious disease caused by Mycobacterium leprae The main clinical manifestations involve the skin and the peripheral nervous system. Several types of nephropathy have been described in leprosy. One frequent form of renal involvement is amyloidosis, especially in patients with lepromatous leprosy. In these patients, end-stage renal disease is an important contributor to morbidity and mortality. Here, we present the case of a patient with nephrotic syndrome caused by secondary amyloidosis, chronic peripheral neuropathy and a history of leprosy. The patient was correctly treated in her youth, which is the best way to avoid renal pathology, but she developed a nephrotic syndrome years later. PMID:27489069

  9. The Leprosy Agents Mycobacterium lepromatosis and Mycobacterium leprae in Mexico

    PubMed Central

    Han, Xiang Y.; Sizer, Kurt Clement; Velarde-Félix, Jesús S.; Frias-Castro, Luis O.; Vargas-Ocampo, Francisco

    2011-01-01

    Summary Background Mycobacterium leprae was the only known cause of leprosy until 2008, when a new species, named Mycobacterium lepromatosis, was found to cause diffuse lepromatous leprosy (DLL), a unique form of leprosy endemic in Mexico. Methods We sought to differentiate the leprosy agents among 120 Mexican patients with various clinical forms of leprosy and to compare their relative prevalence and disease features. Archived skin biopsy specimens from these patients were tested for both M. leprae and M. lepromatosis using polymerase chain reaction-based species-specific assays. Results Eighty-seven (72.5%) patients were confirmed for etiologic species, including 55 with M. lepromatosis, 18 with M. leprae, and 14 with both organisms. The endemic regions of each agent differed but overlapped. Patients with M. lepromatosis were younger and from more states, and their clinical diagnoses included 13 DLL, 34 lepromatous leprosy (LL), and eight other forms of leprosy. By contrast, the diagnoses of patients with M. leprae included none DLL, 15 LL and three other forms. Thus, M. lepromatosis caused DLL specifically (p=0.023). Patients with M. lepromatosis also showed more variable skin lesions and the extremities were the commonest biopsy sites. Finally, patients with dual infections manifested all clinical forms and accounted for 16.1% of all species-confirmed cases. Conclusions M. lepromatosis is another cause of leprosy and is probably more prevalent than M. leprae in Mexico. It mainly causes LL and also specifically DLL. Dual infections caused by both species may occur in endemic area. PMID:22788812

  10. Chemotherapy of leprosy.

    PubMed

    Biswas, Surajit Kumar

    2004-12-01

    The WHO MDT regimens have proved highly successful in preventing relapse of leprosy cases. It has indirectly lad to marked reduction in prevalence of disabilities. For PB leprosy, rifampicin 600 mg monthly and 100 mg dapsone daily for a total of 6 months therapy is required. For MB leprosy clofazimine 300 mg once monthly, supervised and 50 mg daily self administered is added. For single skin lesion the current WHO recommendation is 600 mg rifampicin + 400 mg ofloxacin + 100 mg minocycline given as a single dose for adults. Dose adjustment for children and clinical information have been discussed in a nutshell. A number of trials are going on, some are yet to be completed which do offer the prospect of perhaps simplifying therapy and improving with shorter duration.

  11. Is there a relation between hemicrania continua and leprosy?

    PubMed

    Ferreira, K S; Freitas, D J; Speciali, J G

    2012-01-01

    The association of hemicrania continua and leprosy has been described in 2008. This relation can be causal or casual. Hemicrania continua is a strictly unilateral, moderate to severe, continuous, indomethacin-responsive primary headache with autonomic cranial symptoms and leprosy is an usual cause of peripheral neuropathy. Prevalence has fallen in the past years, but transmission continues and leprosy remains a public health problem. The objective of this study is to report one case of headache fulfilling the IHS criteria for HC, presented during the course of leprosy. A 61 years old woman started hypo and hiperpigmented lesions with impaired sensation to touch on right side of face (malar). She had biopsy in facial lesion and histopathology compatible with a borderline leprosy form. At the same time, she reported new headaches, daily and continuous, without pain-free periods, unilateral (which were located in the same side of the leprosy lesion in face), throbbing and severe (VAS = 8) with ipsilateral conjuntival injection and lacrimation that improved with indomethacin. We hypothesize that the local injury on the face of this patient predisposes a mechanism of central sensitization, resulting in trigeminal autonomic cephalgia. Relation between trigemino-autonomic cephalalgias and leprosy provides insights into craniofacial pain mechanisms.

  12. Quality of life in patients with erythema nodosum leprosum in Kuala Lumpur, Malaysia

    PubMed Central

    Yap, Felix B.; Kiung, Sze T.; Yap, Jeffrey B.

    2016-01-01

    Background: There is a paucity of data on quality of life issues in patients with leprosy suffering from erythema nodosum leprosum (ENL). Thus, we aim to study the effect of ENL on quality of life. Materials and Methods: This cross-sectional study was conducted in Hansen's Clinic, Hospital Kuala Lumpur between January 2010 and December 2013 among patients with multibacillary leprosy using the Dermatology Life Quality Index (DLQI). Results: A total of 153 patients participated with 31.4% suffering from ENL. The mean age at presentation was 40.5 ± 16.49 years. The mean DLQI was 7.1 ± 3.72. Patients with ENL were younger (mean age 36.5 vs. 42.4, P = 0.026), had higher mean bacteriologic index (4.3 vs. 3.8, P = 0.004), had physical deformities (47.9% vs. 31.4%, P = 0.049), and had higher mean DLQI score (9.1 vs. 6.2, P < 0.001). All the DLQI domains were higher in patients suffering from ENL except the treatment domain. Symptoms and feeling was the domain with the largest effect followed by daily activities and leisure. Personal relationship had the lowest effect. Conclusion: Quality of life impairment in patients with leprosy in Malaysia is moderate, with larger effect among patients with ENL. The impairment in ENL is comparable to itchy skin conditions such as urticarial and is worse than chronic skin disease such as psoriasis. Thus, it is essential that management of leprosy incorporate quality of life issues. PMID:27559497

  13. Leprosis in Guatemala

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Leprosis is a disease caused by a rhabdovirus and transmitted by mites of the genus Brevipalpus. It causes severe damages mostly in sweet oranges (Citrus sinensis L.). In Guatemala it was detected around 1995 for the first time but did not become a problem until about 2002. It was first detected ...

  14. Job of the Bible: leprosy or scabies?

    PubMed

    Appelboom, Thierry; Cogan, Elie; Klastersky, Jean

    2007-04-01

    Proposing a medical diagnosis a posteriori of a person who died a long time ago is not as impossible as it sounds if sufficient medical history is available.A whole book of the Bible is devoted to Job and his trials. The diagnosis of leprosy has been generally accepted by medieval commentators because the verses of the Book speak of ulcers disseminated over the skin, and also because leprosy is an exemplary sanction imposed by way of example by God to punish those who have committed a sin. In this paper, we have taken the different verses with a medical content from the Book of Job, and reconstructed the clinical picture as if the patient had turned up in the 21st century in order to see if the diagnosis of leprosy may be called into question, and to discuss the limits of the medico-historic approach. The clinical picture of the disease consists of deterioration in the general condition, with widespread pain, confusion, skin eruptions, bilious vomiting, and so on. Under these conditions, if Job did exist, and if the retrospective medical history is reliable, the most likely diagnosis is that of scabies rather than leprosy.

  15. Mechanisms of nerve injury in leprosy.

    PubMed

    Scollard, David M; Truman, Richard W; Ebenezer, Gigi J

    2015-01-01

    All patients with leprosy have some degree of nerve involvement. Perineural inflammation is the histopathologic hallmark of leprosy, and this localization may reflect a vascular route of entry of Mycobacterium leprae into nerves. Once inside nerves, M. leprae are ingested by Schwann cells, with a wide array of consequences. Axonal atrophy may occur early in this process; ultimately, affected nerves undergo segmental demyelination. Knowledge of the mechanisms of nerve injury in leprosy has been greatly limited by the minimal opportunities to study affected nerves in man. The nine-banded armadillo provides the only animal model of the pathogenesis of M. leprae infection. New tools available for this model enable the study and correlation of events occurring in epidermal nerve fibers, dermal nerves, and nerve trunks, including neurophysiologic parameters, bacterial load, and changes in gene transcription in both neural and inflammatory cells. The armadillo model is likely to enhance understanding of the mechanisms of nerve injury in leprosy and offers a means of testing proposed interventions. PMID:25432810

  16. Laryngeal involvement causing dysphonia in a 29 year old nursing mother with lepromatous leprosy

    PubMed Central

    Fwoloshi, Sombo; Machona, Sharon Musonda; Mudenda, Victor; Ngalamika, Owen

    2015-01-01

    Leprosy is a granulomatous disease that mainly affects the skin and peripheral nerves. It is caused by infection with mycobacterium leprae or mycobacterium lepromatosus. In most instances, diagnosis of leprosy can easily be made based on the clinical signs and symptoms. However, when patients present with atypical features, clinical diagnosis can be a challenge. We report a case of a nursing mother with lepromatous leprosy who presented with dysphonia and skin lesions initially thought to be a deep cutaneous mycosis. PMID:26327983

  17. Leprosy in the 21st century.

    PubMed

    White, Cassandra; Franco-Paredes, Carlos

    2015-01-01

    Despite significant improvements in leprosy (Hansen's disease) treatment and outlook for patients since the introduction of multidrug therapy (MDT) 3 decades ago, the global incidence remains high, and patients often have long-term complications associated with the disease. In this article, we discuss recent findings related to genetics, susceptibility, and disease reservoirs and the implications of these findings for Hansen's disease control and health outcomes for patients. We describe the continued difficulties associated with treatment of inflammatory episodes known as "leprosy reactions," which cause much of the disability associated with the disease and can affect people for many years after MDT is complete. We also discuss some of the contemporary challenges for physicians and patients, including international and internal migration of people affected by the disease. We suggest some important areas of focus for future Hansen's disease research. PMID:25567223

  18. Leprosy in the 21st Century

    PubMed Central

    Franco-Paredes, Carlos

    2015-01-01

    SUMMARY Despite significant improvements in leprosy (Hansen's disease) treatment and outlook for patients since the introduction of multidrug therapy (MDT) 3 decades ago, the global incidence remains high, and patients often have long-term complications associated with the disease. In this article, we discuss recent findings related to genetics, susceptibility, and disease reservoirs and the implications of these findings for Hansen's disease control and health outcomes for patients. We describe the continued difficulties associated with treatment of inflammatory episodes known as “leprosy reactions,” which cause much of the disability associated with the disease and can affect people for many years after MDT is complete. We also discuss some of the contemporary challenges for physicians and patients, including international and internal migration of people affected by the disease. We suggest some important areas of focus for future Hansen's disease research. PMID:25567223

  19. [Focal epithelial hyperplasia in lepromatous leprosy].

    PubMed

    Jacyk, W; Lechner, W

    1983-10-15

    Focal epithelial hyperplasia Heck (FEH) is most likely caused by human papilloma virus. It mainly occurs in children and young people showing no associated diseases. For the first time, we describe a case of FEH in a patient with lepromatous leprosy who due to persistent erythema nodosum leprosum has been treated with a lang-term glucocorticoid therapy. The question of the competence of lepromatous patients in resisting certain viral infections arises.

  20. Langerhans cells (CD1a and CD207), dermal dendrocytes (FXIIIa) and plasmacytoid dendritic cells (CD123) in skin lesions of leprosy patients.

    PubMed

    Hirai, Kelly Emi; Aarão, Tinara Leila de Sousa; Silva, Luciana Mota; de Sousa, Jorge Rodrigues; de Souza, Juarez; Dias, Leonidas Braga; Carneiro, Francisca Regina Oliveira; Fuzii, Hellen Thais; Quaresma, Juarez Antonio Simões

    2016-02-01

    The clinical course of infection with Mycobacterium leprae varies widely and depends on the pattern of the host immune response. Dendritic cells play an important role in the activation of the innate and adaptive immune system and seem to be essential for the development of the disease. To analyze the presence of epidermal dendritic cells (CD1a and CD207), plasmacytoid dendritic cells (CD123) and dermal dendrocytes (factor XIIIa) in lesion fragments of leprosy patients, skin samples from 30 patients were studied. These samples were submitted to immunohistochemistry against CD1a, CD207, FXIIIa, and CD123. The results showed a larger number of Langerhans cells, detected with the CD1a or CD207 marker, dermal dendrocytes and plasmacytoid dendritic cells in patients with the tuberculoid form. A positive correlation was observed between the Langerhans cell markers CD1a and CD207 in both the tuberculoid and lepromatous forms, and between Langerhans cells and dermal dendrocytes in samples with the tuberculoid form. The present results indicate the existence of a larger number of dendritic cells in patients at the resistant pole of the disease (tuberculoid) and suggest that the different dendritic cells studied play a role, favoring an efficient immune response against infection with M. leprae.

  1. Newer Management Options in Leprosy

    PubMed Central

    Rao, P Narasimha; Jain, Suman

    2013-01-01

    Newer management options are needed for leprosy control even at present, as it is predicted that new cases of leprosy will continue to appear for many more years in future. This article detail newer methods of clinical grading of peripheral nerve involvement (thickening, tenderness and nerve pain which are subjective in nature) and the advances made in the use of Ultrasonography and Colour Doppler as an objective imaging tool for nerves in leprosy. It also briefly discusses the newer drugs and alternative regimens as therapeutic management options which hold promise for leprosy in future. PMID:23372204

  2. On the Age of Leprosy

    PubMed Central

    Han, Xiang Y.; Silva, Francisco J.

    2014-01-01

    Leprosy is a chronic infection of the skin and nerves caused by Mycobacterium leprae and the newly discovered Mycobacterium lepromatosis. Human leprosy has been documented for millennia in ancient cultures. Recent genomic studies of worldwide M. leprae strains have further traced it along global human dispersals during the past ∼100,000 years. Because leprosy bacilli are strictly intracellular, we wonder how long humans have been affected by this disease-causing parasite. Based on recently published data on M. leprae genomes, M. lepromatosis discovery, leprosy bacilli evolution, and human evolution, it is most likely that the leprosy bacilli started parasitic evolution in humans or early hominids millions of years ago. This makes leprosy the oldest human-specific infection. The unique adaptive evolution has likely molded the indolent growth and evasion from human immune defense that may explain leprosy pathogenesis. Accordingly, leprosy can be viewed as a natural consequence of a long parasitism. The burden of leprosy may have affected minor selection on human genetic polymorphisms. PMID:24551248

  3. Induction and treatment of anergy in murine leprosy

    PubMed Central

    Juarez-Ortega, Mario; Hernandez, Víctor G; Arce-Paredes, Patricia; Villanueva, Enrique B; Aguilar-Santelises, Miguel; Rojas-Espinosa, Oscar

    2015-01-01

    Leprosy is a disease consisting of a spectrum of clinical, bacteriological, histopathological and immunological manifestations. Tuberculoid leprosy is frequently recognized as the benign polar form of the disease, while lepromatous leprosy is regarded as the malignant form. The different forms of leprosy depend on the genetic and immunological characteristics of the patient and on the characteristics of the leprosy bacillus. The malignant manifestations of lepromatous leprosy result from the mycobacterial-specific anergy that develops in this form of the disease. Using murine leprosy as a model of anergy in this study, we first induced the development of anergy to Mycobacterium lepraemurium (MLM) in mice and then attempted to reverse it by the administration of dialysable leucocyte extracts (DLE) prepared from healthy (HLT), BCG-inoculated and MLM-inoculated mice. Mice inoculated with either MLM or BCG developed a robust cell-mediated immune response (CMI) that was temporary in the MLM-inoculated group and long-lasting in the BCG-inoculated group. DLE were prepared from the spleens of MLM- and BCG-inoculated mice at the peak of CMI. Independent MLM intradermally-inoculated groups were treated every other day with HLT-DLE, BCG-DLE or MLM-DLE, and the effect was documented for 98 days. DLE administered at a dose of 1.0 U (1 × 106 splenocytes) did not affect the evolution of leprosy, while DLE given at a dose of 0.1 U showed beneficial effects regardless of the DLE source. The dose but not the specificity of DLE was the determining factor for reversing anergy. PMID:25529580

  4. Leprosy control: the rationale of integration.

    PubMed

    Loretti, A

    1989-12-01

    After considering the situation and the perspectives of integration and the drawbacks that a vertical approach can represent for leprosy control, the author proposes the framework of control programmes as a systemic model for comprehensive health care. The structure that health services in developing countries are adopting in order to implement PHC allows for an horizontal integration of specific activities; conversely, activities which have already proved their value for leprosy control can easily enlarge their scope and include other prevalent conditions. Integration leads to an improvement in patients' and health workers' attitudes; provided that the necessary supervision is guaranteed, integration is feasible and warrants more effective patients' care and a better exploitation of resources in order to reduce the specific risk in the community.

  5. The leprosy problem in the world*

    PubMed Central

    Bechelli, L. M.; Domínguez, V. Martínez

    1966-01-01

    There is at present a lack of accurate data on the prevalence of leprosy in the different countries of the world, primarily because case-finding has not reached the desired level in many of them. The authors have attempted to provide more realistic figures, using information obtained from several sources and various criteria for calculating estimated prevalence rates. In all there are 2 831 775 registered patients and 10 786 000 estimated cases; the latter figure may well be an underestimate. The number of treated patients is about 1 928 000, some 68% of the registered cases and 18% of the estimated. About 2097 million people live in areas with prevalence rates of 0.5 per 1000 or higher; in these areas nearly one million new cases of leprosy can be expected within the next five years. The estimated number of disabled patients is 3 872 000, of whom 1 961 000 are in disability grades 2-5 (excluding anaesthesia to pain). The data represent an attempt, made with many reservations, to give an indication of the magnitude of the leprosy problem throughout the world. PMID:5296533

  6. Inoculation site leprosy in a tattoo as a paradoxical reaction following tuberculosis treatment.

    PubMed

    Branagan, P; Moran, B; Fitzgibbon, M; Reid, V; McMenamin, M; Kane, M; Kelly, F; Barnes, L; McLaughlin, A; Keane, J

    2016-05-01

    We present a patient who developed inoculation site leprosy in a tattoo, which was confirmed by Mycobacterium leprae DNA sequencing of a polymerase chain reaction product from a skin biopsy. His leprosy became manifest as a paradoxical reaction only after 8 weeks of treatment for pulmonary tuberculosis. PMID:27084829

  7. Zoonotic Leprosy in the Southeastern United States.

    PubMed

    Sharma, Rahul; Singh, Pushpendra; Loughry, W J; Lockhart, J Mitchell; Inman, W Barry; Duthie, Malcolm S; Pena, Maria T; Marcos, Luis A; Scollard, David M; Cole, Stewart T; Truman, Richard W

    2015-12-01

    Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and have been implicated in zoonotic transmission of leprosy. Early studies found this disease mainly in Texas and Louisiana, but armadillos in the southeastern United States appeared to be free of infection. We screened 645 armadillos from 8 locations in the southeastern United States not known to harbor enzootic leprosy for M. leprae DNA and antibodies. We found M. leprae-infected armadillos at each location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using single-nucleotide polymorphism variable number tandem repeat genotyping/genome sequencing, we detected M. leprae genotype 3I-2-v1 among 35 armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In comparison, 52 human patients from the same region were infected with 31 M. leprae types. However, 42.3% (22/52) of patients were infected with 1 of the 2 M. leprae genotype strains associated with armadillos. The geographic range and complexity of zoonotic leprosy is expanding. PMID:26583204

  8. Zoonotic Leprosy in the Southeastern United States

    PubMed Central

    Sharma, Rahul; Singh, Pushpendra; Loughry, W.J.; Lockhart, J. Mitchell; Inman, W. Barry; Duthie, Malcolm S.; Pena, Maria T.; Marcos, Luis A.; Scollard, David M.; Cole, Stewart T.

    2015-01-01

    Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and have been implicated in zoonotic transmission of leprosy. Early studies found this disease mainly in Texas and Louisiana, but armadillos in the southeastern United States appeared to be free of infection. We screened 645 armadillos from 8 locations in the southeastern United States not known to harbor enzootic leprosy for M. leprae DNA and antibodies. We found M. leprae–infected armadillos at each location, and 106 (16.4%) animals had serologic/PCR evidence of infection. Using single-nucleotide polymorphism variable number tandem repeat genotyping/genome sequencing, we detected M. leprae genotype 3I-2-v1 among 35 armadillos. Seven armadillos harbored a newly identified genotype (3I-2-v15). In comparison, 52 human patients from the same region were infected with 31 M. leprae types. However, 42.3% (22/52) of patients were infected with 1 of the 2 M. leprae genotype strains associated with armadillos. The geographic range and complexity of zoonotic leprosy is expanding. PMID:26583204

  9. [Leprosy and medicine I--proposal of an isolation policy and its background].

    PubMed

    Mori, Shuichi; Ishii, Norihisa

    2006-02-01

    The leprosy policy of Japan began from when the government enacted "law No. 11 (The leprosy prevention act)" in 1907 (Meiji 40) and several leprosy sanatoriums were built and the patient who wanders about was received. Then, in rise of totalitarianism, the isolation policy of Japan gained national support under a slogan "Patient Relief", and it would become the big factor to which enactment of "Leprosy Prevention Law" in 1931 (Showa 6) and leprosy policy changed to segregation which aimed at internment of all leprosy patients. From today's research on the leprosy policy of Japan, it is internment of all leprosy patients, whole life isolation, social defense and neglect of patients' human-rights and led to many tragedy of patient. However, there is little research which can reply clearly to the question of whether the leprosy policy of Japan was really original and what the factors of led to the formation of the segregation policy. This paper focuses on the relation between leprosy policy and medicine, and from this, I make clear the similarity, or peculiarity of the isolation policy between Japan and the vest of the world, and clarify the factors of progress of the absolute isolation policy. The processes are historical and medical historical the verification of the relation between the formation of the national medicine and the progress of the isolation policy of Meiji Era, the proposal of the isolation policy by Dr. Keizo Dohi, Dr. Shibasaburo Kitasato, and Dr. Masatsugu Yamane, and the application by Dr. Kensuke Mitsuda, the decision to enact this policy and its support by the Health and Medical Bureau and the Department of the Interior, as well as many factors.

  10. Indigenous Cases of Leprosy (Hansen's Disease) in Southern Mississippi.

    PubMed

    Marcos, Luis A; Dobbs, Thomas; Walker, Sue; Waller, William; Stryjewska, Barbara M

    2015-07-01

    Hansen's disease or leprosy is a chronic infection of the skin and peripheral nerves caused by Mycobacterium leprae. In the U.S., leprosy is mainly reported in immigrants, but indigenous leprosy cases have been also reported in this country, especially in semitropical southern states (i.e., Texas, Louisiana). The objective of this series of cases is to describe indigenous leprosy cases reported in southern Mississippi (MS) during the period 2012-2014. Information was collected from medical records at Hattiesburg Clinic and the MS Department of Health. Four cases were reported during the period of study (3 Caucasian males, 1 African-American woman). Non of visited endemic leprosy country. The age ranged from 60 to 83 years (median: 75.5 years). Of the four cases, three presented with a slowly progressive erythematous rash disseminated mainly on the thorax and abdomen, with a lesser degree on the extremities. The time between onset of rash until the diagnosis ranged from 5 to 16 months (median: 7 months). Only one case had direct contact with armadillos (blood exposure). Non of these patients had a history of immunosuppression. The most common symptoms were neuropathic pain (n=2), generalized pruritus (n=2) and loss of sensation in extremities (n=2). One case had severe peripheral neuropathy with muscle weakness, atrophy in left arm, and wasting on left hand. Skin biopsies showed diffuse granulomatous infiltrate with foamy histiocytes along with acid fast bacilli by Fite stain. By Ridley-Jopling classification system, three cases were diagnosis as lepromatous leprosy, and one, borderline lepromatous. Treatment included clofazimine, dapsone and rifampin that was offered free of charge by the National Hansen's Diseases Program, Baton Rouge, L.A. One patient did not tolerate therapy. In conclusion, a slowly progressive disseminated erythematous skin rash on the trunk should raise suspicion for leprosy in the elderly population in south MS. PMID:26434167

  11. Erythema nodosum leprosum and reversal reaction in 2 cases of imported leprosy.

    PubMed

    Pulido-Pérez, A; Mendoza-Cembranos, M D; Avilés-Izquierdo, J A; Suárez-Fernández, R

    2013-12-01

    Leprosy reactions, which are abrupt changes in the clinical condition of patients with immunologically unstable forms of the disease, can mask the cardinal signs of leprosy, delaying both diagnosis and treatment. The main complications that arise from delayed diagnosis reflect the characteristic features of the disease, involving impaired nerve function and both local (ulcers, pyogenic infection, osteomyelitis) and systemic compromise. Through clinical examination, sensory testing, and, where necessary, histopathology and microbiology, are essential when leprosy is suspected. Rapid initiation of anti-inflammatory treatment reduces the risk of functional impairment, the main concern in leprosy. We describe type 1 and type 2 leprosy reactions in 2 patients who had not yet been diagnosed with the disease. PMID:23177396

  12. [Leprosy and medicine II--progress and establishment of an absolute isolation policy].

    PubMed

    Mori, Shuichi; Ishii, Norihisa

    2007-02-01

    The leprosy policy of Japan began from when the government enacted "law No. 11 (The leprosy prevention act)" in 1907 (Meiji 40) and several leprosy sanatoriums were built to receive previously homeless patients. Then, with the rise of totalitarianism, the isolation policy of Japan gained national support under the slogan "Patient Relief", which would become a major factor behind the enactment of "Leprosy Prevention Law" in 1931 (Showa 6) by which the leprosy policy was changed to one of absolute isolation aimed at the internment of all leprosy patients. From recent research on the leprosy policy of Japan, the internment of all leprosy patients, isolation for life, social defense, and neglect of patients' human-rights had tragic results in many cases. However, there is little research which can reply clearly to the question of whether the leprosy policy of Japan was really original and what factors led to the formation of the absolute isolation policy. This paper focuses on the relation between leprosy policy and treatment, and from this, I make clear the similarities, or peculiarities, of the isolation policy between Japan and the rest of the world, while clarifying the factors associated with the progress of the absolute isolation policy. The processes involved were historical and medical historical in that the relation between the formation of a national health system and the progress of the isolation policy of Meiji Era, the proposal of the isolation policy by Dr. Keizo Dohi, Dr. Shibasaburo Kitasato, and Dr. Masatsugu Yamane; the practical application of this policy by Dr. Kensuke Mitsuda, and the decision to enact this policy and its support by the Health and Medical Bureau and the Department of the Interior, as well as many other factors, all contributed to the final implementation of the absolute isolation policy.

  13. Histological diagnosis of early and suspicious leprosy by in situ PCR.

    PubMed

    Natrajan, M; Katoch, K; Katoch, V M; Das, Ram; Sharma, V D

    2012-01-01

    Leprosy is a chronic mycobacterial disease whose diagnosis is primarily based on clinico-pathological examination and supported by slit skin smears for the presence of acid fast bacilli (AFB). However, definitive diagnosis of early leprosy and those suspected to have the disease but not histologically confirmed pose major public health problems. The present study reports the utility of the in situ Polymerase Chain Reaction amplification (PCR) directed at a 530bp fragment of DNA encoding the 36kd antigen of the causative Mycobacterium leprae for the diagnosis of such patients using skin biopsies of lesions. Twenty five adult patients (aged 15-50yrs) each from the clinical categories of Early and clinically Suspect leprosy were selected for the study after obtaining permission. They had solitary lesions, which were negative for AFB on slit skin smear examination. Routine histopathology confirmed the diagnosis of leprosy in 8/25 (32%) cases in the category of Early leprosy with AFB being seen in 2 biopsies, and in 5/25(20%) cases of Suspect leprosy with AFB being seen in a solitary case. The Direct in situ PCR procedure which was performed in the histologically unconfirmed cases improved the diagnosis with positive results observed in 12/17 (70.6%) cases of Early (p=0.001) and in 12/20 (60%) cases of Suspect Leprosy (p=0.005 indicating the usefulness of the Direct in situ PCR to establish the diagnosis of leprosy in histologically doubtful cases.

  14. On the origin of leprosy.

    PubMed

    Monot, Marc; Honoré, Nadine; Garnier, Thierry; Araoz, Romulo; Coppée, Jean-Yves; Lacroix, Céline; Sow, Samba; Spencer, John S; Truman, Richard W; Williams, Diana L; Gelber, Robert; Virmond, Marcos; Flageul, Béatrice; Cho, Sang-Nae; Ji, Baohong; Paniz-Mondolfi, Alberto; Convit, Jacinto; Young, Saroj; Fine, Paul E; Rasolofo, Voahangy; Brennan, Patrick J; Cole, Stewart T

    2005-05-13

    Leprosy, a chronic human disease with potentially debilitating neurological consequences, results from infection with Mycobacterium leprae. This unculturable pathogen has undergone extensive reductive evolution, with half of its genome now occupied by pseudogenes. Using comparative genomics, we demonstrated that all extant cases of leprosy are attributable to a single clone whose dissemination worldwide can be retraced from analysis of very rare single-nucleotide polymorphisms. The disease seems to have originated in Eastern Africa or the Near East and spread with successive human migrations. Europeans or North Africans introduced leprosy into West Africa and the Americas within the past 500 years.

  15. Global strategy for further reducing the leprosy burden and sustaining leprosy control activities 2006-2010. Operational guidelines.

    PubMed

    2006-09-01

    The Global Strategy for further reducing the leprosy burden and sustaining leprosy control activities (2006 - 2010) has been widely welcomed and endorsed. The overall goal is to provide access to quality leprosy services for all affected communities following the principles of equity and social justice. The purpose of these Operational Guidelines is to help managers of national health services to implement the new Global Strategy in their own countries. This will be done as they develop detailed policies applicable to their own situation, and revise their National Manual for Leprosy Control. Leprosy services are being integrated into the general health services throughout the world; a new emphasis is given here to the need for an effective referral system, as part of an integrated programme. Good communication between all involved in the management of a person with leprosy or leprosy- related complications is essential. These Guidelines should help managers to choose which activities can be carried out at the primary health care level and for which aspects of care patients will have to be referred. This will depend on the nature of the complication and the capacity of the health workers to provide appropriate care at different levels of the health system. The promotion of self-reporting is now crucial to case detection, as case- finding campaigns become less and less cost-effective. It is important to identify and remove barriers that may prevent new cases from coming forward. The procedures for establishing the diagnosis of leprosy remain firmly linked to the cardinal signs of the disease, but the accuracy of diagnosis must be monitored. The Guidelines suggest a greater emphasis on the assessment of disability at diagnosis, so that those at particular risk can be recognized and managed appropriately. The treatment of leprosy with MDT has been a continuing success; neither relapse nor drug-resistance are significant problems and the regimens are well- tolerated

  16. Ulcerating type 1 lepra reaction mimicking lazarine leprosy: an unusual presentation of immune reconstitution inflammatory syndrome in an HIV-infected patient.

    PubMed

    Bhat, Ramesh; Pinto, Malcolm; Dandakeri, Sukumar; Kambil, Srinath

    2013-12-01

    Leprosy maybe "unmasked" in the context of immune reconstitution inflammatory syndrome and treating dermatologists, particularly in highly endemic areas for Hansen's disease, need to be cognizant to this possibility. It may also reflect emergence of a previously clinically silent infection in the course of immunologic restoration. PMID:24216029

  17. [Leprosy--a stigma in the 21st century].

    PubMed

    Falus, Orsolya

    2011-02-13

    For the initiation of the French journalist Raoul Follereau in 1954 the UNO inaugurated the Leprosy Day (Martyr's Day) that is celebrated on the last Sunday of January every year. Although the bacterium that causes leprosy was isolated by the Norwegian scientist Gerhard Henrik Armauer Hansen in 1873 and from 1982 this disease can be cured with a special pharmaceutical complex, still 219.826 new leprous are detected on Earth every year, according to the data published in August, 2010 by WHO-experts. Ancient Chinese and Hindu source-strings from 600 B. C. are referring to leprosy, however, the disease was imported by the army of Alexander the Great from India around 327-326 B. C. Even the Old and the New Testament from the Holy Bible are mentioning leprosy in several details. During the Middle Ages the Military and Hospitaller Order of St. Lazarus of Jerusalem, established in the Holy Land in 72 A. D., did pioneer work in nursing leprous. In the process of time the medical attendance concerning leprous was organized in special hospitals called "leprosoriums" built on river-banks. Special office and even services were organized for the treatment and isolation of the people infected. Although medical science has prevailed against leprosy, and almost simultaneously even jurisprudence defended the patients' rights via legislation, still mankind can regrettably not get rid of this disease that stigmatizes seriously.

  18. Serological findings in leprosy

    PubMed Central

    Ruge, H. G. S.; Fromm, G.; Fühner, F.; Guinto, R. S.

    1960-01-01

    In serological tests for syphilis, leprosy sera often give biologically false positive reactions. These may be due to the presence of non-specific elements—for example, the ubiquitous lipid antibodies—in the leprosy sera; or they may be the result of errors in technique or unfavourable working conditions in the laboratory. This paper presents the results of an investigation in which several hundred sera from lepers were submitted to four of the so-called ”standard” serological tests for syphilis (STS), using either cardiolipin or crude lipid antigens; to a complement-fixation test using as antigen a suspension of Reiter treponemes (PR test); and to the Treponema pallidum immobilization (TPI) test. The investigation was carried out in a moderate climate and in technically well-equipped laboratories. It was found that the number of biologically false positive reactions was not as high as had been expected in the light of previous investigations. It was discovered, moreover, that it was the lipid antigens that were mainly responsible for the non-specific reactions, since both the PR and the TPI test showed a far greater specificity than any of the STS. But the TPI test, though highly specific, is also technically very complicated and therefore not suitable for use in regions where technical facilities are lacking. The authors consider that, in such regions, the simpler PR test will give sufficiently accurate results in the serodiagnosis of treponematoses. It must, however, be recognized that even the treponemal tests are not capable of differentiating between syphilis and yaws infections. PMID:13744600

  19. Biological agents: investigation into leprosy and other infectious diseases before indication*

    PubMed Central

    Antônio, João Roberto; Soubhia, Rosa Maria Cordeiro; Paschoal, Vania Del Arco; Amarante, Carolina Forte; Travolo, Ana Regina Franchi

    2013-01-01

    Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil. PMID:24346871

  20. Biological agents: investigation into leprosy and other infectious diseases before indication.

    PubMed

    Antônio, João Roberto; Soubhia, Rosa Maria Cordeiro; Paschoal, Vania Del Arco; Amarante, Carolina Forte; Travolo, Ana Regina Franchi

    2013-01-01

    Biological agents are widely used for various immune-mediated diseases, with remarkable effectiveness in the treatment of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis, ankylosing spondylitis and Crohn's disease. However, attention needs to be drawn to the adverse effects of these therapies and the risk of reactivating underlying granulomatous infectious diseases such as tuberculosis, leprosy, syphilis, leishmaniasis, among others. The objective of this paper is to describe a case of leprosy in a patient with RA using anti-TNF alfa, demonstrating the need for systematic investigation of skin lesions suggestive of leprosy in patients who require rheumatoid arthritis therapeutic treatment, especially in endemic regions like Brazil. PMID:24346871

  1. Comparative assessment of the leprosy antibody absorption test, Mycobacterium leprae extract enzyme-linked immunosorbent assay, and gelatin particle agglutination test for serodiagnosis of lepromatous leprosy.

    PubMed Central

    Escobar-Gutiérrez, A; Amezcua, M E; Pastén, S; Pallares, F; Cázares, J V; Pulido, R M; Flores, O; Castro, E; Rodríguez, O

    1993-01-01

    A comparative assessment of three serological methods for leprosy diagnosis (the fluorescent leprosy antibody absorption [FLA-ABS] test, the Mycobacterium leprae soluble-extract enzyme-linked immunosorbent assay [ELISA], and the M. leprae particle agglutination [MLPA] test) was carried out. The objective was to identify their performance in clinical and epidemiological diagnosis of leprosy. The study group included 45 lepromatous leprosy patients under treatment. Specificity was > 95% for all three assays, and sensitivity was 95, 58, and 74% for the FLA-ABS test, the MLPA test, and the ELISA, respectively. The only cross-reactivity for M. tuberculosis-infected patients was with the soluble-extract ELISA. Although the FLA-ABS test displayed the highest specificity and sensitivity values, it can only be used in well-developed laboratories, and the patient's clinical and epidemiological background must be considered when results are interpreted because the test remains positive after therapeutic success and could be positive for some household contacts. The MLPA test is easier to perform and interpret, and it is adequate for small laboratories and epidemiological studies intended to detect active untreated or irregularly treated leprosy cases. Therefore, the FLA-ABS and MLPA tests are complementary, and both should be used for serodiagnosis of leprosy. PMID:8501238

  2. The Continuing Challenges of Leprosy

    PubMed Central

    Scollard, D. M.; Adams, L. B.; Gillis, T. P.; Krahenbuhl, J. L.; Truman, R. W.; Williams, D. L.

    2006-01-01

    Leprosy is best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses in humans. The second is a peripheral neuropathy that is initiated by the infection and the accompanying immunological events. The infection is curable but not preventable, and leprosy remains a major global health problem, especially in the developing world, publicity to the contrary notwithstanding. Mycobacterium leprae remains noncultivable, and for over a century leprosy has presented major challenges in the fields of microbiology, pathology, immunology, and genetics; it continues to do so today. This review focuses on recent advances in our understanding of M. leprae and the host response to it, especially concerning molecular identification of M. leprae, knowledge of its genome, transcriptome, and proteome, its mechanisms of microbial resistance, and recognition of strains by variable-number tandem repeat analysis. Advances in experimental models include studies in gene knockout mice and the development of molecular techniques to explore the armadillo model. In clinical studies, notable progress has been made concerning the immunology and immunopathology of leprosy, the genetics of human resistance, mechanisms of nerve injury, and chemotherapy. In nearly all of these areas, however, leprosy remains poorly understood compared to other major bacterial diseases. PMID:16614253

  3. Viral Co-infection and Leprosy Outcomes: A Cohort Study

    PubMed Central

    Machado, Paulo R. L.; Machado, Lídia M.; Shibuya, Mayume; Rego, Jamile; Johnson, Warren D.; Glesby, Marshall J.

    2015-01-01

    Background The role of the host immunity in determining leprosy clinical forms and complications is well recognized, implying that changes in the immune status may interfere with several aspects of the disease. Therefore, we hypothesized that the presence of viral co-infections and associated immunological changes will have a clinical impact on leprosy outcomes. The aim of our study was to determine the clinical impact of human immunodeficiency virus (HIV), human T cell lymphotrophic virus type 1 (HTLV-1), hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on the development of reactions, neuritis, neuropathy and relapses. Methodology/Principal Findings Cohort study in 245 leprosy subjects from Bahia, Brazil. Patients were followed from the time of diagnosis until at least the end of multidrug therapy. Viral co-infection was detected in 36 out of the 245 patients (14.7%). Specific co-infection rates were 10.6% for HBV, 2.9% for HIV, 2.5% for HTLV-1 and 0.8% for HCV. All four groups of co-infected patients had higher rates of neuritis and nerve function impairment compared to non co-infected leprosy subjects. The relapse rate was also higher in the co-infected group (8.3%) versus patients without co-infection (1.9%); relative risk 4.37, 95% confidence interval 1.02–18.74. Conclusions/Significance Leprosy patients should be screened for HBV, HCV, HIV and HTLV-1 co-infections. Besides contributing to better health care, this measure will facilitate the early detection of severe complications through targeting of higher risk patients. PMID:26267882

  4. An unusual case of isolated sixth cranial nerve palsy in leprosy.

    PubMed

    Vaishampayan, Sanjeev; Borde, Priyanka

    2012-08-01

    Cranial nerve involvement is not common in leprosy. The fifth and seventh cranial nerves are the most commonly affected in leprosy. Herein we present a patient with Hansen disease (BL) with type I reaction who developed isolated involvement of the sixth cranial nerve leading to lateral rectus muscle palsy. He responded to timely anti-reactional therapy and it produced a good response. Careful observation of patients with lepra reaction is needed to avoid damage to important organs. PMID:22948066

  5. Translating leprosy: the expert and the public in Stanley Stein's anti-stigmatization campaigns, 1931-60.

    PubMed

    John, Heather Varughese

    2013-10-01

    This article examines three campaigns through which patient activist Stanley Stein sought to combat the stigmatized connotations of the word "leprosy." In 1931, soon after starting the first patient newspaper at the U.S. national leprosy hospital at Carville, Stein became convinced of the necessity of finding an alternative to "leprosy." His ensuing campaign to promote the use of the words "Hansen's Disease" to describe the condition from which he and fellow Carville patients suffered became his most passionate and life-long project. In the 1950s, Stein became involved in efforts to change the translation of "leprosy" in the Bible. Finally, in 1960, he waged a campaign to de-stigmatize encyclopedia entries on leprosy. These campaigns illustrate how even elevation of the medical expert and a seeming disdain for the public can function as a protest of medical authority and reveal a presumption that a significant degree of authority actually resides with the public. PMID:24106217

  6. Recent Food Shortage Is Associated with Leprosy Disease in Bangladesh: A Case-Control Study

    PubMed Central

    Feenstra, Sabiena G.; Nahar, Quamrun; Pahan, David; Oskam, Linda; Richardus, Jan Hendrik

    2011-01-01

    Background Leprosy is remaining prevalent in the poorest areas of the world. Intensive control programmes with multidrug therapy (MDT) reduced the number of registered cases in these areas, but transmission of Mycobacterium leprae continues in most endemic countries. Socio-economic circumstances are considered to be a major determinant, but uncertainty exists regarding the association between leprosy and poverty. We assessed the association between different socio-economic factors and the risk of acquiring clinical signs of leprosy. Methods and Findings We performed a case-control study in two leprosy endemic districts in northwest Bangladesh. Using interviews with structured questionnaires we compared the socio-economic circumstances of recently diagnosed leprosy patients with a control population from a random cluster sample in the same area. Logistic regression was used to compare cases and controls for their wealth score as calculated with an asset index and other socio-economic factors. The study included 90 patients and 199 controls. A recent period of food shortage and not poverty per se was identified as the only socio-economic factor significantly associated with clinical manifestation of leprosy disease (OR 1.79 (1.06–3.02); p = 0.030). A decreasing trend in leprosy prevalence with an increasing socio-economic status as measured with an asset index is apparent, but not statistically significant (test for a trend: OR 0.85 (0.71–1.02); p = 0.083). Conclusions Recent food shortage is an important poverty related predictor for the clinical manifestation of leprosy disease. Food shortage is seasonal and poverty related in northwest Bangladesh. Targeted nutritional support for high risk groups should be included in leprosy control programmes in endemic areas to reduce risk of disease. PMID:21572979

  7. Negligible risk of inducing resistance in Mycobacterium tuberculosis with single-dose rifampicin as post-exposure prophylaxis for leprosy.

    PubMed

    Mieras, Liesbeth; Anthony, Richard; van Brakel, Wim; Bratschi, Martin W; van den Broek, Jacques; Cambau, Emmanuelle; Cavaliero, Arielle; Kasang, Christa; Perera, Geethal; Reichman, Lee; Richardus, Jan Hendrik; Saunderson, Paul; Steinmann, Peter; Yew, Wing Wai

    2016-01-01

    Post-exposure prophylaxis (PEP) for leprosy is administered as one single dose of rifampicin (SDR) to the contacts of newly diagnosed leprosy patients. SDR reduces the risk of developing leprosy among contacts by around 60 % in the first 2-3 years after receiving SDR. In countries where SDR is currently being implemented under routine programme conditions in defined areas, questions were raised by health authorities and professional bodies about the possible risk of inducing rifampicin resistance among the M. tuberculosis strains circulating in these areas. This issue has not been addressed in scientific literature to date. To produce an authoritative consensus statement about the risk that SDR would induce rifampicin-resistant tuberculosis, a meeting was convened with tuberculosis (TB) and leprosy experts. The experts carefully reviewed and discussed the available evidence regarding the mechanisms and risk factors for the development of (multi) drug-resistance in M. tuberculosis with a view to the special situation of the use of SDR as PEP for leprosy. They concluded that SDR given to contacts of leprosy patients, in the absence of symptoms of active TB, poses a negligible risk of generating resistance in M. tuberculosis in individuals and at the population level. Thus, the benefits of SDR prophylaxis in reducing the risk of developing leprosy in contacts of new leprosy patients far outweigh the risks of generating drug resistance in M. tuberculosis. PMID:27268059

  8. Community care of the physically disabled due to leprosy

    PubMed Central

    Ganapati, R.

    2011-01-01

    This preliminary presentation based on extensive field studies carried out by Bombay Leprosy Project, a research-oriented NGO, portrays the alarming dimensions of the disease burden felt by rural communities and recommends a cost effective field model. This study in an adopted rural population in Shahapur “taluka” of Thane District assumes tremendous significance and is worthy of replication in comparable situations. This is particularly so in the background of the absence in the literature of any similar field studies based entirely on community care of the physically disabled due to leprosy. The magnitude of the problem posed by leprosy patients with disabilities and their rehabilitation is highly challenging and is expected to pose a heavy burden on the community as well as unprecedented strain on the PHCs managed by the government. The health planners should rethink on future strategies in such a manner that human rights of the downtrodden patients suffering from the “neglected disease” of leprosy are not sidelined PMID:23130228

  9. Leprosy Mimicking Common Rheumatologic Entities: A Trial for the Clinician in the Era of Biologics

    PubMed Central

    Bhargava, Shrinath; Kundu, Bijit Kumar

    2014-01-01

    Rheumatoid arthritis and seronegative spondyloarthritis, which make up the lion's share of cases attending a rheumatology clinic, are relatively easy to diagnose. However, when an entity of infective aetiology like leprosy known to be a great mimic of different autoimmune conditions presents with features similar to these, the possibility of it being diagnosed at the outset is very slim indeed. The ease with which the diagnosis of leprosy can be missed assumes sinister proportions as the use of disease modifying agents can have deleterious effects in these patients. In the era of increasing availability and use of biologic disease modifying agents, it is imperative not only to actively rule out the presence of leprosy but also to make it a part of the prebiologic screening of patients in whom biologics are being planned to be administered, especially in leprosy endemic areas. PMID:25431725

  10. [Leprosy and human rights: trends in Japan and in the world].

    PubMed

    Yokota, Yozo

    2014-12-01

    Leprosy, or Hansen's disease, has long been regarded as an incurable and dreadful contagious disease. The patients have been forcefully hospitalized and deprived of many basic human rights. Their family members have often been discriminated against due to stigma associated with this disease. Soon after the Second World War, a specific remedy called "multi-drug therapy" (MDT) was discovered and leprosy became a relatively easily curable disease. Despite this medical development, it took time to change the policy and legislation of forceful hospitalization of leprosy patients. The stigma surrounding leprosy and consequent discrimination have continued. In Japan, it was only in 1996 that the legislation requiring forceful hospitalization of leprosy patients was repealed. The Government decided to provide remedies to the former patients who had suffered from this policy. At the United Nations, the General Assembly adopted a resolution to eradicate discrimination against persons affected by leprosy and their family members. It is hoped that discrimination associated with Hansen's disease will soon be overcome by the efforts of all concerned, particularly doctors and nurses who are specialists of this disease.

  11. Role of S-100 Immunostaining in Demonstration of Nerve Changes and Quantification of Dendritic Cells in Leprosy

    PubMed Central

    Mohanraj, Anand; Srinivasan, Sowmya

    2014-01-01

    Background: A definitive diagnosis of leprosy is based on a demonstration of either acid-fast bacilli or nerve elements within the granulomas. On routine hematoxylin and eosin stains, the nerve fibers are not easily identifiable. In this study, S-100 immunostain is used to highlight the nerve elements and to demonstrate and compare the nerve changes in spectrum of leprosy including reactions. Aim: To demonstrate the nerve changes in spectrum of leprosy using S-100 immunostaining so as to categorize them for the purpose of early diagnosis and treatment. We also want to demonstrate and quantify the dendritic cells in lepromatous spectrum of leprosy using S-100 immunostain. Materials and Methods: Twenty consecutive skin biopsy specimens from patients with histopathological diagnosis of leprosy in the year 2012 were studied. Of these 20 cases, 13 were Borderline Tuberculoid, 1 was of indeterminate leprosy, 1 Borderline Lepromatous, 2 cases of Lepromatous Lep-rosy , 1 case of Type 1 reac-tion and 2 cases of Type 2 reaction. Stains used were Hematoxylin and Eosin stain for the histopathological diagnosis, Fites stain for Bacillary index and S-100 immunoperoxidase staining for nerve changes. 5 cases of granulomatous dermatosis of skin other than leprosy (5 cases of lupus vulgaris) were included as controls. Results: On Hematoxylin and Eosin staining, the nerve fibers showed vertical orientation in relation to epidermis in Borderline Tuberculoid leprosy. In addition , the nerve fibers showed rounded contour in Tuberculoid leprosy. The entire spectrum of leprosy showed evidence of nerve damage in S-100 immunostaining which was categorized in 4 patterns 1. Absent, 2. Fragmented, 3. Discontinuous and 4. Intact. The majority of Borderline Tuberculoid leprosy cases showed absent pattern of nerve damage. Dendritic cells were also positive for S-100 immunostaining with granular positivity in Borderline Tuberculoid Leprosy cases and membranous positivity in Lepromatous spectrum

  12. Histoid leprosy: review of the literature.

    PubMed

    Gupta, Sunil Kumar

    2015-11-01

    Leprosy is a chronic granulomatous inflammation primarily of the peripheral nervous system, skin, and reticuloendothelial system caused by Mycobacterium leprae. It presents clinically as an erythematous or hypopigmented anesthetic patch and a thickened and/or tender cutaneous nerve trunk. Leprosy is also called Hansen disease. Leprosy is a great imitator of other skin diseases, and it can present with different morphological lesions, which is why an expert eye is needed to diagnose it. One of the important clinical presentations of leprosy is histoid leprosy, which is very difficult to diagnose due to different clinical and histopathological findings that mimic, e.g., a fibromatous disorder. Histoid leprosy is a very rare clinicopathological variant of leprosy. It is clinically characterized by skin-colored, soft, succulent nodules, and plaques on apparently normal skin and histologically by a dense bundle of histiocytes arranged in storiform. Though histoid leprosy is a very rare type of leprosy, the higher load of lepra bacilli in these cases makes it a concern as a reservoir for leprosy. PMID:26094829

  13. Identification of Urban Leprosy Clusters

    PubMed Central

    Paschoal, José Antonio Armani; Paschoal, Vania Del'Arco; Nardi, Susilene Maria Tonelli; Rosa, Patrícia Sammarco; Ismael, Manuela Gallo y Sanches; Sichieri, Eduvaldo Paulo

    2013-01-01

    Overpopulation of urban areas results from constant migrations that cause disordered urban growth, constituting clusters defined as sets of people or activities concentrated in relatively small physical spaces that often involve precarious conditions. Aim. Using residential grouping, the aim was to identify possible clusters of individuals in São José do Rio Preto, Sao Paulo, Brazil, who have or have had leprosy. Methods. A population-based, descriptive, ecological study using the MapInfo and CrimeStat techniques, geoprocessing, and space-time analysis evaluated the location of 425 people treated for leprosy between 1998 and 2010. Clusters were defined as concentrations of at least 8 people with leprosy; a distance of up to 300 meters between residences was adopted. Additionally, the year of starting treatment and the clinical forms of the disease were analyzed. Results. Ninety-eight (23.1%) of 425 geocoded cases were located within one of ten clusters identified in this study, and 129 cases (30.3%) were in the region of a second-order cluster, an area considered of high risk for the disease. Conclusion. This study identified ten clusters of leprosy cases in the city and identified an area of high risk for the appearance of new cases of the disease. PMID:24288467

  14. Identification of urban leprosy clusters.

    PubMed

    Paschoal, José Antonio Armani; Paschoal, Vania Del'Arco; Nardi, Susilene Maria Tonelli; Rosa, Patrícia Sammarco; Ismael, Manuela Gallo y Sanches; Sichieri, Eduvaldo Paulo

    2013-01-01

    Overpopulation of urban areas results from constant migrations that cause disordered urban growth, constituting clusters defined as sets of people or activities concentrated in relatively small physical spaces that often involve precarious conditions. Aim. Using residential grouping, the aim was to identify possible clusters of individuals in São José do Rio Preto, Sao Paulo, Brazil, who have or have had leprosy. Methods. A population-based, descriptive, ecological study using the MapInfo and CrimeStat techniques, geoprocessing, and space-time analysis evaluated the location of 425 people treated for leprosy between 1998 and 2010. Clusters were defined as concentrations of at least 8 people with leprosy; a distance of up to 300 meters between residences was adopted. Additionally, the year of starting treatment and the clinical forms of the disease were analyzed. Results. Ninety-eight (23.1%) of 425 geocoded cases were located within one of ten clusters identified in this study, and 129 cases (30.3%) were in the region of a second-order cluster, an area considered of high risk for the disease. Conclusion. This study identified ten clusters of leprosy cases in the city and identified an area of high risk for the appearance of new cases of the disease.

  15. Classification of leprosy from the clinical point of view.

    PubMed

    Ganapati, R

    1976-04-01

    While, according to some, classification of leprosy is primarily clinical, there should be no objection to the application of the advances made in the last decade in understanding the immunological and histopathological aspects of the disease, provided thereby the clinical classification can be made with more accuracy. Unlike most other diseases, the bulk of the process of attempts at diagnosis and classification of this disease is still in the hands of para-medical personnel in the field, and hence it is important that at the same time, an easily understood, uniformly accepted clinical classification should be recommended for field workers. While tuberculoid and lepromatous leprosy of the polar types can be diagnosed with accuracy even under field conditions, confusion generally arises with reference to the diagnosis or indeterminate maculoanaesthetic and borderline forms, and to identify some reacting lesions. Certain terminologies in vogue add further to the confusion. Reacting lesions are confused with active lesions. The importance of recognition of varieties of reacting lesions is stressed since the therapeutic management in such cases is entirely different. It is suggested that the early forms of leprosy characterised by paucity of cardinal features of the disease should be separated from the more established types and grouped under the term indeterminate leprosy. The diagnostic points to be taken into consideration in these lesions are discussed. The importance of investigating thoroughly before classifying patients who report rarely with neuritic symptoms without any evidence of skin lesion is stressed.

  16. Leprosy in six isolated residents of northern Louisiana. Time-clustered cases in an essentially nonendemic area.

    PubMed

    West, B C; Todd, J R; Lary, C H; Blake, L A; Fowler, M E; King, J W

    1988-09-01

    Northern Louisiana has been essentially free of indigenous leprosy, and now it is not. Six new cases of leprosy have been diagnosed: three in 1986, the other three in 1985, 1983, and 1982, respectively. The patients had been lifelong residents of six scattered rural parishes. Leprosy had never been reported from five of them. No patient had had contact with human leprosy. The patients were white; four were women; the mean +/- SD age at onset was 60.3 +/- 16.4 years (age range, 31 to 80 years); and the mean +/- SD interval to diagnosis was 1.2 +/- 1.4 years. One patient had Hodgkin's disease at the age of 25 years and leprosy at the age of 31 years; another patient had cervical carcinoma. All rural northern Louisiana residents coexist with armadillos (Dasypus novemcinctus), some of which are infected with Mycobacterium leprae, the significance of which is unknown. Hypothetically, exposure to an unknown human case, reactivation of "asymptomatic" leprosy through immunosenescence or immunosuppression, or infection from an environmental source might have occurred. Because the patients lacked contact, travel, residence, and exposure risk factors, the origin of leprosy in the new indigenous cases is noteworthy and is not understood.

  17. Atraumatic Main-En-Griffe due to Ulnar Nerve Leprosy

    PubMed Central

    Aswani, Yashant; Saifi, Shenaz

    2016-01-01

    Summary Background Leprosy is the most common form of treatable peripheral neuropathy. However, in spite of effective chemotherapeutic agents, neuropathy and associated deformities are seldom ameliorated to a significant extent. This necessitates early diagnosis and treatment. Clinical examination of peripheral nerves is highly subjective and inaccurate. Electrophysiological studies are painful and expensive. Ultrasonography circumvents these demerits and has emerged as the preferred modality for probing peripheral nerves. Case Report We describe a 23-year-old male who presented with weakness and clawing of the medial digits of the right hand (main-en-griffe) and a few skin lesions since eighteen months. The right ulnar nerve was thickened and exquisitely tender on palpation. Ultrasonography revealed an extensive enlargement of the nerve with presence of intraneural color Doppler signals suggestive of acute neuritis. Skin biopsy was consistent with borderline tuberculoid leprosy with type 1 lepra reaction. The patient was started on WHO multidrug therapy for paucibacillary leprosy along with antiinflammatory drugs. Persistence of vascular signals at two months’ follow-up has led to continuation of the steroid therapy. The patient is compliant with the treatment and is on monthly follow-up. Conclusions In this manuscript, we review multitudinous roles of ultrasonography in examination of peripheral nerves in leprosy. Ultrasonography besides diagnosing enlargement of nerves in leprosy and acute neuritis due to lepra reactions, guides the duration of anti-inflammatory therapy in lepra reactions. Further, it is relatively inexpensive, non-invasive and easily available. All these features make ultrasonography a preferred modality for examination of peripheral nerves. PMID:26788223

  18. Oropharyngeal leprosy in art, history, and medicine.

    PubMed

    Scollard, D M; Skinsnes, O K

    1999-04-01

    Advanced lesions of the face, nasopharynx, and oropharynx have played an important role in the medical and social history of Hansen's disease. Renaissance artists included detailed portrayals of these lesions in some of their paintings, a testimony not only to their artistic skill and powers of observation but also to the common presence of these patients in European cities and towns of the period. The disease is now understood as a broad immunologic spectrum of host responses to Mycobacterium leprae, with a variety of clinical and pathologic manifestations in nerve, soft tissues, and bone. This review incorporates the findings of 2 extraordinary studies (one from Europe and the other from Japan) of pharyngeal and facial lesions. In the 1950s, studies of skeletal remains from the churchyard of a Danish leprosarium revealed a triad of maxillofacial lesions unique to leprosy and designated facies leprosa. In pre-World War II Japan, before effective treatment had been discovered, a prominent otorhinolaryngologist studying oropharyngeal and nasopharyngeal lesions prepared watercolor illustrations of the natural progression of untreated Hansen's disease. As a result of effective antimicrobial therapy, such advanced lesions are now rarely seen, but the presenting signs and symptoms of leprosy still occasionally arise in the nasal and oral mucosa. The nasopharynx and oropharynx may be important early sites of inoculation and infection by M leprae, and they require additional emphasis in worldwide efforts toward early diagnosis and treatment of Hansen's disease.

  19. Oropharyngeal leprosy in art, history, and medicine.

    PubMed

    Scollard, D M; Skinsnes, O K

    1999-04-01

    Advanced lesions of the face, nasopharynx, and oropharynx have played an important role in the medical and social history of Hansen's disease. Renaissance artists included detailed portrayals of these lesions in some of their paintings, a testimony not only to their artistic skill and powers of observation but also to the common presence of these patients in European cities and towns of the period. The disease is now understood as a broad immunologic spectrum of host responses to Mycobacterium leprae, with a variety of clinical and pathologic manifestations in nerve, soft tissues, and bone. This review incorporates the findings of 2 extraordinary studies (one from Europe and the other from Japan) of pharyngeal and facial lesions. In the 1950s, studies of skeletal remains from the churchyard of a Danish leprosarium revealed a triad of maxillofacial lesions unique to leprosy and designated facies leprosa. In pre-World War II Japan, before effective treatment had been discovered, a prominent otorhinolaryngologist studying oropharyngeal and nasopharyngeal lesions prepared watercolor illustrations of the natural progression of untreated Hansen's disease. As a result of effective antimicrobial therapy, such advanced lesions are now rarely seen, but the presenting signs and symptoms of leprosy still occasionally arise in the nasal and oral mucosa. The nasopharynx and oropharynx may be important early sites of inoculation and infection by M leprae, and they require additional emphasis in worldwide efforts toward early diagnosis and treatment of Hansen's disease. PMID:10225629

  20. The inclusivity of exclusion: isolation and community among leprosy-affected people in the South Pacific.

    PubMed

    Buckingham, Jane

    2011-01-01

    From 1911 to 1969 those people diagnosed with leprosy in the South Pacific were gradually isolated and received medical treatment at the Central Lepers' Hospital, Makogai Island, Fiji. Until the discovery of sulfones in the 1940s leprosy was largely incurable and it was expected that those who went to the island would never return. This paper assumes that the stigma attendant on leprosy which provoked the isolation order is itself a form of disability. The paper draws on patients'stories to explore their individual and collective experience of isolation and suggests that for many, collective isolation on Makogai was an enabling experience. On Makogai, leprosy was the 'norm', the social disability of stigma was removed and people were able to be self-sufficient, to build community and social relationships and to live a fairly ordinary island life.

  1. Clofazimine-induced Hair Pigmentation.

    PubMed

    Philip, Mariam; Samson, Joan Felicita; Simi, Puthenveedu Salahudeen

    2012-07-01

    A 45-year-old man was treated with WHO multibacillary multidrug therapy for borderline leprosy and high dose daily Clofazimine for lepra reaction. Along with the expected side effect of skin pigmentation, the patient also noticed darkening of previously grey hair. This colour persisted eight months after completing multibacillary multidrug therapy. PMID:23180930

  2. [Leprosy in Germany 100 years and the early development of anti-leprosy drugs].

    PubMed

    Hundeiker, M; Brömmelhaus, H

    2007-10-01

    Leprosy was nearly eliminated in central Europe by the beginning of 18th century. In the 2nd half of the 19th century, leprosy was imported by Lithuanian rural workers immigrating from the Russian empire into East Prussia. At that time, the ways of infection, the bacteria, and essential diagnostic methods were already known, but there was no effective treatment. A leprosarium was founded in 1899 in Memel. Legislation in 1900 and 1904 regulated the fight against the disease. The patients had to be isolated and not allowed to work with others, in contrast to the situation with cutaneous tuberculosis. Patients with lupus vulgaris, which was not infectious, even had suitable jobs in hospitals. In 1907, Antileprol (Bayer) became available, the first industrial preparation developed from chaulmoogra oils, which had been long used in Indian medicine. The situation of patients, however, remained nearly unchanged, up to the middle of the 20th century, when the first effective mycobacteriostatic agents were introduced. PMID:17673959

  3. CXCL10, MCP-1, and other immunologic markers involved in neural leprosy.

    PubMed

    Medeiros, Mildred F; Rodrigues, Márcia M J; Vital, Robson T; da Costa Nery, José A; Sales, Anna M; de Andrea Hacker, Mariana; Ferreira, Helen; Chimelli, Leila; Sarno, Euzenir N; Antunes, Sérgio L G

    2015-03-01

    Nerve damage in leprosy can be directly induced by Mycobacterium leprae in the early stages of infection, however, immunomediated mechanisms add gravity to the impairment of neural function in symptomatic periods of the disease. This study investigated the immunohistochemical expression of immunomarkers involved in the pathogenic mechanisms of leprosy nerve damage. These markers selected were CXCL10, CCL2 chemokines and immunomarkers as CD3, CD4, CD8, CD45RA, CD45RO, CD68, HLA-DR, and metalloproteinases 2 and 9 (MMP2 and MMP9) occurring in nerve biopsy specimens collected from leprosy (23) and nonleprosy patients (5) suffering peripheral neuropathy. CXCL10, CCL2, MMP2, and MMP9 immunoreactivities were found in the leprosy nerves but not in nonleprosy samples. Immunolabeling was predominantly found in recruited macrophages and Schwann cells composing the inflammatory cellular population in the leprosy-affected nerves. The immunohistochemical expression of all the markers, but CXCL10, was associated with fibrosis, however, only CCL2 was, independently from the others, associated with this excessive deposit of extracellular matrix. No difference in the frequency of the immunolabeling was detected between the AFB⁺ and AFB⁻ leprosy subgroups of nerve, exception made to some statistical trend to difference in regard to CD68⁻ and HLA-DR⁺ cells in the AFB⁻ nerves exhibiting epithelioid granuloma. MMP9 expression associated with fibrosis is consistent with previous results of research group. The findings conveys the idea that CCL2 and CXCL10 chemokines at least in advanced stages of leprosy nerve lesions are not determinant for the establishment of AFB⁺ or AFB⁻ leprosy lesions, however, CCL2 is associated with macrophage recruitment and fibrosis.

  4. Rabies, tetanus, leprosy, and malaria.

    PubMed

    Murthy, J M K; Dastur, Faram D; Khadilkar, Satish V; Kochar, Dhanpat K

    2014-01-01

    The developing world is still endemic to rabies, tetanus, leprosy, and malaria. Globally more than 55000 people die of rabies each year, about 95% in Asia and Africa. Annually, more than 10 million people, mostly in Asia, receive postexposure vaccination against the disease. World Health Organization estimated tetanus-related deaths at 163000 in 2004 worldwide. Globally, the annual detection of new cases of leprosy continues to decline and the global case detection declined by 3.54% during 2008 compared to 2007. Malaria is endemic in most countries, except the US, Canada, Europe, and Russia. Malaria accounts for 1.5-2.7 million deaths annually. Much of the disease burden related to these four infections is preventable.

  5. Generalized eruptive histiocytosis mimicking leprosy.

    PubMed

    Sharath Kumar, B C; Nandini, A S; Niveditha, S R; Gopal, M G

    2011-01-01

    Generalized eruptive histiocytosis (GEH) is a rare cutaneous histiocytosis that mainly affects adults and presents with multiple symmetric papules on face, trunk, and proximal extremities. GEH is included in type IIa (histiocytes involving cells of dermal dendrocyte lineage) of histiocytic disorders. Clinical and pathological correlations are required for differentiating GEH from other histiocytic disorders and from lepromatous leprosy which clinically mimic GEH and is prevalent in India. We report a case of a middle-aged woman who presented with generalized asymptomatic papules and nodules and was treated for leprosy but was finally diagnosed to have GEH after clinical, histopathological, and immunohistochemical correlation. Furthermore, the newer lesions also showed features of progressive nodular histiocytosis.

  6. A epidemiologist's view of leprosy

    PubMed Central

    Newell, Kenneth W.

    1966-01-01

    While leprosy has been studied exhaustively by leprologists, it is only recently that persons in other disciplines have given this disease the attention it deserves. Various methods for its prevention and control are now being advocated and tested in the field, and it appears reasonable for an epidemiologist to review the bases of current theories and to examine the evidence for existing hypotheses. This has been done by a review of some of the more recent literature. The conclusion is reached that the anergic, or factor N, hypothesis that has been evolved to relate the lepromin test to the findings in clinical leprosy appears to be the most promising, and that, if this hypothesis can be substantiated, it is unlikely that BCG vaccination can be a very useful tool for prevention. Many possibilities exist for epidemiological and laboratory research into this disease, which in many ways appears to be unique. PMID:5330347

  7. Leprosy as a model of immunity.

    PubMed

    Degang, Yang; Nakamura, Kazuaki; Akama, Takeshi; Ishido, Yuko; Luo, Yuqian; Ishii, Norihisa; Suzuki, Koichi

    2014-01-01

     Leprosy displays a spectrum of clinical manifestations, such as lepromatous and tuberculoid leprosy, and type I and II lepra reactions, which are thought to be a reflection of the host's immunological response against Mycobacterium leprae. Therefore, differential recognition of M. leprae, as well as its degraded components, and subsequent activation of cellular immunity will be an important factor for the clinical manifestation of leprosy. Although M. leprae mainly parasitizes tissue macrophages in the dermis and the Schwann cells of peripheral nerves, the presence of M. leprae in other organs, such as the liver, may also play important roles in the further modification of seesaw-like bipolar phenotypes of leprosy. Thus, leprosy is an exciting model for investigating the role of the human immune system in host defense and susceptibility to infection. PMID:24328380

  8. Epidemiology of Leprosy in Spain: The Role of the International Migration

    PubMed Central

    Ramos, José M.; Romero, David; Belinchón, Isabel

    2016-01-01

    Background Although incidence of leprosy in Spain has declined steadily over the years, the fivefold increase in immigration since the turn of the century—much of it from countries where leprosy is still prevalent—has been linked to an uptick in registered cases. Objective To describe the epidemiologic trends of incident leprosy cases detected in Spain among Spanish- and foreign-born population groups. Methods Observational, retrospective study of suspected leprosy cases in Spain, as reported through the System of Compulsory Notification of Diseases from 2003 to 2013, with results disaggregated by country of birth. We collected statistical data on leprosy burden for other countries from WHO to estimate the expected number of imported cases. Results Of the 168 leprosy cases registered during the study period, 40 (24.6%) were in Spanish patients, while 128 (76.2%) were detected in legally resident immigrants. We identified a significantly higher number of imported leprosy cases during the 2008–2010 and 2011–2013 trienniums compared to the reference biennium 2003–2004 (OR 5.38, 95% CI 1.83–14.88 and OR 4.80, 95% CI 1.41–16.33, respectively). Most imported cases were diagnosed in Latin American immigrants (71.9%), especially Brazilians, but also Paraguayans, Bolivians and other nationalities from South and Central America. However, registered incidence was lower than expected for each year. For example, in 2003, the expected new cases in immigrants was 47.12, compared to only four cases that were actually detected (a 91% difference). Likewise, we expected to find 49.6 incident cases among immigrants in 2009, but only 15 new cases were reported (60% fewer than expected). Conclusion Imported cases of leprosy are responsible for most leprosy incidence in Spain, and we cannot rule out some under-diagnosis. Clinicians should be made more aware of the potential for leprosy incidence among patients from countries where the disease is endemic. PMID:26939132

  9. Syphilis, leprosy, and human immunodeficiency virus coinfection: a challenging diagnosis.

    PubMed

    Souza, Claudia Fd; Bornhausen-Demarch, Eduardo; Prata, Aline G; de Andrade, Felipe C; Fernandes, Mariana P; Lopes, Marcia Ra; Nery, José Ac

    2013-08-01

    The association between syphilis, leprosy, and human immunodeficiency virus (HIV) is not well documented, and the emergence of isolated cases raises the interest and indicates that this triple coinfection can occur. We report the case of a 42-year-old man from Rio de Janeiro, Brazil, who presented with erythematous papules on the trunk, back, and upper and lower extremities; an erythematous plaque on the upper abdomen; and an erythematous violaceous plaque on the right thigh with altered sensitivity. Laboratory investigation showed a reagent VDRL test (1:512) and positive test results for Treponema pallidum hemagglutination. Treatment with benzathine penicillin (2,400,000 U intramuscularly) was started (2 doses 1 week apart). On follow-up 40 days later, the lesions showed partial improvement with persistence of the plaques on the right thigh and upper abdomen as well as a new similar plaque on the back. Further laboratory examinations showed negative bacilloscopy, positive HIV test, and histologic findings consistent with tuberculoid leprosy. The patient was started on multidrug therapy for paucibacillary leprosy with clinical improvement; the patient also was monitored by the HIV/AIDS department. We emphasize the importance of clinical suspicion for a coinfection case despite the polymorphism of these diseases as well as the precise interpretation of laboratory and histopathology examinations to correctly manage atypical cases. PMID:24087779

  10. Leprosy (Hansen's Disease)

    MedlinePlus

    ... Patients Procedure for Accessing Lab Services Data Package Requirements AIDS Therapies Resource Guide In Vitro Efficacy Evaluations ... Assurances to Users Application and Approval Process User Requirements Malaria Vaccine Production Services Data Sharing and Release ...

  11. IL-27 suppresses antimicrobial activity in human leprosy

    PubMed Central

    Teles, Rosane M. B.; Kelly-Scumpia, Kindra M.; Sarno, Euzenir N.; Rea, Thomas H.; Ochoa, Maria T.; Cheng, Genhong; Modlin, Robert L.

    2015-01-01

    The mechanisms by which intracellular pathogens trigger immunosuppressive pathways are critical for understanding the pathogenesis of microbial infection. One pathway that inhibits host defense responses involves the induction of type I interferons and subsequently IL-10, yet the mechanism by which type I IFN induces IL-10 remains unclear. Our studies of gene expression profiles derived from leprosy skin lesions suggested a link between IL-27 and the IFN-β induced IL-10 pathway. Here, we demonstrate that the IL-27p28 subunit is upregulated following treatment of monocytes with IFN-β and Mycobacterium leprae, the intracellular bacterium that causes leprosy. The ability of IFN-β and M. leprae to induce IL-10 was diminished by IL-27 knockdown. Additionally, treatment of monocytes with recombinant IL-27 was sufficient to induce the production of IL-10. Functionally, IL-27 inhibited the ability of IFN-γ to trigger antimicrobial activity against M. leprae in infected monocytes. At the site of disease, IL-27 was more strongly expressed in skin lesions of patients with progressive lepromatous leprosy, correlating and colocalizing with IFN-β and IL-10 in macrophages. Together, these data provide evidence that in the human cutaneous immune responses to microbial infection, IL-27 contributes to the suppression of host antimicrobial responses. PMID:26030183

  12. Molecular, ethno-spatial epidemiology of leprosy in China: novel insights for tracing leprosy in endemic and non endemic provinces.

    PubMed

    Weng, Xiaoman; Xing, Yan; Liu, Jian; Wang, Yonghong; Ning, Yong; Li, Ming; Wu, Wenbin; Zhang, Lianhua; Li, Wei; Vander Heiden, Jason; Vissa, Varalakshmi

    2013-03-01

    Leprosy continues to be detected at near stable rates in China even with established control programs, necessitating new knowledge and alternative methods to interrupt transmission. A molecular epidemiology investigation of 190 patients was undertaken to define Mycobacterium leprae strain types and discern genetic relationships and clusters in endemic and non-endemic regions spanning seventeen provinces and two autonomous regions. The findings support multiple locus variable number of tandem repeat (VNTR) analysis as a useful tool in uncovering characteristic patterns across the multiethnic and divergent geographic landscape of China. Several scenarios of clustering of leprosy from township to provincial to regional levels were recognized, while recent occupational or remote migration showed geographical separation of certain strains. First, prior studies indicated that of the four major M. leprae subtypes defined by single nucleotide polymorphisms (SNPs), only type 3 was present in China, purportedly entering from Europe/West/Central Asia via the Silk Road. However, this study revealed VNTR linked strains that are of type 1 in Guangdong, Fujian and Guangxi in southern China. Second, a subset of VNTR distinguishable strains of type 3, co-exist in these provinces. Third, type 3 strains with rpoT VNTR allele of 4, detected in Japan and Korea were discovered in Jiangsu and Anhui in the east and in western Sichuan bordering Tibet. Fourth, considering the overall genetic diversity, strains of endemic counties of Qiubei, Yunnan; Xing Yi, Guizhou; and across Sichuan in southwest were related. However, closer inspection showed distinct local strains and clusters. Altogether, these insights, primarily derived from VNTR typing, reveal multiple and overlooked paths for spread of leprosy into, within and out of China and invoke attention to historic maritime routes in the South and East China Sea. More importantly, new concepts and approaches for prospective case finding and

  13. Leprosy type-I reaction episode mimicking facial cellulitis-the importance of early diagnosis*

    PubMed Central

    Fernandes, Tania Rita Moreno de Oliveira; Brandão, Graziele Áquila de Souza; Souza, Bruno de Castro e

    2015-01-01

    Leprosy is aneasily recognizable disease due to its dermato-neurological manifestations. It must be present in the physician’s diagnostic repertoire, especially for those working in endemic areas. However, leprosy reaction is not always easily recognized by non-dermatologists, becoming one of the major problems in the management of patients with leprosy, as it presents clinical complications characterized by inflammatory process, accompanied by pain, malaise and sometimes the establishment or worsening of the patient’s disabilities. We report the case of a patient with type-1 periorbital reaction admitted to the hospital, diagnosed and treated as facial cellulitis, whose late diagnosis may have contributed to the appearance or worsening of facial neuritis. PMID:26312679

  14. Perceived Stigma towards Leprosy among Community Members Living Close to Nonsomboon Leprosy Colony in Thailand

    PubMed Central

    Kaehler, Nils; Adhikar, Bipin; Raut, Shristi; Marahatta, Sujan Babu; Chapman, Robert Sedgwick

    2015-01-01

    Background Interpretation of Leprosy as a sickness differs among society. The set of beliefs, knowledge and perceptions towards a disease play a vital role in the construction of stigma towards a disease. The main purpose of this study was to explore the extent and correlates of the perceived stigma towards leprosy in the community living close to the leprosy colony in Non Somboon region of Khon Kaen Province of Thailand. Methods A cross-sectional study was conducted among 257 leprosy unaffected community participants, above the age of 18 who were living close to the Leprosy colony in Non Somboon region of Thailand. Each participant was asked a questionnaire containing characteristics of the participants in terms of socio-demographic background and knowledge regarding the disease. In addition perceived stigma towards leprosy was measured using EMIC (Explanatory Model Interview Catalogue) questionnaire. Results Among EMIC items, shame or embarrassment in the community due to leprosy was felt by 54.5%, dislike to buy food from leprosy affected persons were 49.8% and difficulty to find work for leprosy affected persons were perceived by 47.1%. Higher total EMIC score was found in participants age 61 years or older (p = 0.021), staying longer in the community (p = 0.005), attending fewer years of education (p = 0.024) and who were unemployed (p = 0.08). Similarly, perceptions about leprosy such as difficult to treat (p = 0.015), severe disease (p = 0.004) and punishment by God (p = 0.011) were significantly associated with higher perceived stigma. Conclusions Perceived stigma towards leprosy was found highest among participants with age 61 years or older, longer duration of stay in community close to the leprosy colony, lower duration of education and participants who were unemployed had higher perceived stigma. Similarly, participants with perceptions of leprosy such as difficult to treat, severe disease and punishment by God had higher perceived stigma towards

  15. Diagnosis and medical treatment of neuropathic pain in leprosy 1

    PubMed Central

    Arco, Rogerio Del; Nardi, Susilene Maria Tonelli; Bassi, Thiago Gasperini; Paschoal, Vania Del Arco

    2016-01-01

    ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5%) had neuropathic pain (or a mixture of this pain and their existing pain) and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5%) of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12) for neuropathic pain, 5 (41.6%) responded that they became better. For the other 7 (58.4%) there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12) and those that were not, showed significant differences (value p=0.020). Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture. PMID:27508904

  16. Beyond quarantine: a history of leprosy in Puerto Rico, 1898-1930s.

    PubMed

    Levison, Julie H

    2003-01-01

    From biblical times to the modern period, leprosy has been a disease associated with stigma. This mark of disgrace, physically present in the sufferers' sores and disfigured limbs, and embodied in the identity of a "leper", has cast leprosy into the shadows of society. This paper draws on primary sources, written in Spanish, to reconstruct the social history of leprosy in Puerto Rico when the United States annexed this island in 1898. The public health policies that developed over the period of 1898 to the 1930s were unique to Puerto Rico because of the interplay between political events, scientific developments and popular concerns. Puerto Rico was influenced by the United States' priorities for public health, and the leprosy control policies that developed were superimposed on vestiges of the colonial Spanish public health system. During the United States' initial occupation, extreme segregation sacrificed the individual rights and liberties of these patients for the benefit of society. The lives of these leprosy sufferers were irrevocably changed as a result.

  17. Impact of a Reference Center on Leprosy Control under a Decentralized Public Health Care Policy in Brazil

    PubMed Central

    Barbieri, Raquel Rodrigues; Sales, Anna Maria; Hacker, Mariana Andrea; Nery, José Augusto da Costa; Duppre, Nádia Cristina; Machado, Alice de Miranda; Moraes, Milton Ozório; Sarno, Euzenir Nunes

    2016-01-01

    Reorientation of the public health policies in Brazil over the last 20 years in association with a stable rate of new-case detection prompted the establishment of a decentralized leprosy control strategy. The aim was to move from a vertical model associated with general dermatological services to one in which the diagnosis and treatment of the disease would be integrated into the primary care level of the national health care facilities. Once patients demand for leprosy reference centers began to be affected by the process of integrating leprosy diagnosis into the basic health care services, it was necessary to determine the profile of all our referrals in light of the new decentralization policy. Objective We evaluated the profile of patients referred to the Fiocruz Outpatient Clinic, a reference center for the diagnosis and treatment of leprosy in Rio de Janeiro, RJ, and analyzed the origins and outcomes of these referrals. Methods This is an observational retrospective study based on information collected from the Leprosy Laboratory database at Fiocruz, Rio de Janeiro, RJ, Brazil. A total of 1,845 suspected leprosy cases examined at the reference center between 2010 and 2014 were included. The originating health service referrals and diagnostic outcomes were analyzed as well as the clinical and epidemiological data of patients diagnosed with leprosy. Result Our data show that the profile of the patients treated at the Clinic has changed in recent years. There was an increase in both the proportion of patients with other skin diseases and those who had visited only one health service prior to our Clinic. Among the total 1,845 cases analyzed, the outcomes of 1,380 were linked to other diseases and, in 74% of these cases, a biopsy was not necessary to reach a diagnostic conclusion. A decrease in new leprosy case detection among our patients was also observed. Yet, among the leprosy patients, 40% had some degree of disability at diagnosis. Conclusion The results of

  18. Metabonomics Reveals Drastic Changes in Anti-Inflammatory/Pro-Resolving Polyunsaturated Fatty Acids-Derived Lipid Mediators in Leprosy Disease

    PubMed Central

    Amaral, Julio J.; Antunes, Luis Caetano M.; de Macedo, Cristiana S.; Mattos, Katherine A.; Han, Jun; Pan, Jingxi; Candéa, André L. P.; Henriques, Maria das Graças M. O.; Ribeiro-Alves, Marcelo; Borchers, Christoph H.; Sarno, Euzenir N.; Bozza, Patrícia T.; Finlay, B. Brett; Pessolani, Maria Cristina V.

    2013-01-01

    Despite considerable efforts over the last decades, our understanding of leprosy pathogenesis remains limited. The complex interplay between pathogens and hosts has profound effects on host metabolism. To explore the metabolic perturbations associated with leprosy, we analyzed the serum metabolome of leprosy patients. Samples collected from lepromatous and tuberculoid patients before and immediately after the conclusion of multidrug therapy (MDT) were subjected to high-throughput metabolic profiling. Our results show marked metabolic alterations during leprosy that subside at the conclusion of MDT. Pathways showing the highest modulation were related to polyunsaturated fatty acid (PUFA) metabolism, with emphasis on anti-inflammatory, pro-resolving omega-3 fatty acids. These results were confirmed by eicosanoid measurements through enzyme-linked immunoassays. Corroborating the repertoire of metabolites altered in sera, metabonomic analysis of skin specimens revealed alterations in the levels of lipids derived from lipase activity, including PUFAs, suggesting a high lipid turnover in highly-infected lesions. Our data suggest that omega-6 and omega-3, PUFA-derived, pro-resolving lipid mediators contribute to reduced tissue damage irrespectively of pathogen burden during leprosy disease. Our results demonstrate the utility of a comprehensive metabonomic approach for identifying potential contributors to disease pathology that may facilitate the development of more targeted treatments for leprosy and other inflammatory diseases. PMID:23967366

  19. Leprosy among children under 15 years of age: literature review*

    PubMed Central

    de Oliveira, Marcela Bahia Barretto; Diniz, Lucia Martins

    2016-01-01

    Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age. PMID:27192519

  20. Leprosy among children under 15 years of age: literature review.

    PubMed

    Oliveira, Marcela Bahia Barretto de; Diniz, Lucia Martins

    2016-04-01

    Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age. PMID:27192519

  1. Disability adjusted working life years (DAWLYs) of leprosy affected persons in India

    PubMed Central

    Rao, P.S.S.; Darlong, F.; Timothy, M.; Kumar, Sandeep; Abraham, S.; Kurian, Royce

    2013-01-01

    Background & objectives: Disability-adjusted life years (DALYs) have been accepted as a useful method to estimate the burden of disease, and can be adapted to determine the number of productive years lost due to the disability. DALY has been reported for many studies but not for leprosy. Hence this study was carried out in three States of India. In view of the fact that in this study, productive working years are used, the term is modified as DAWLY. Methods: A representative random sample of 150 leprosy affected persons, 50 from each States of Uttar Pradesh, West Bengal and Chhattisgarh, was chosen, and data were collected on detailed work-life history, occupation, time when leprosy was discovered, reported and treatment started, break of job/loss of income due to leprosy. The loss of wages and durations were used to compute the life-years lost due to leprosy, and summarized over the average total duration of 42 years of productive work-life from 18 to 60 years. The percentage losses were determined and differences tested for statistical significance. Results: The overall mean (± SE) disability adjusted working life years was 28.6 (±0.67), a reduction of 13.4 yr from the ideal productive working life period of 42 yr. The youngest patients with disability had a reduction of 41.4 per cent, as compared to the oldest patients. There was a significant increase in loss based on year for those whose disability started earlier (P=0.0024). Interpretation & conclusions: On an average, 30 per cent of the leprosy affected person's work life is lost due to disability. PMID:23760375

  2. Integration of the leprosy programme into primary health care: a case study of perceptions of primary health care workers.

    PubMed

    Raju, M S; Dongre, V V

    2003-01-01

    Integration of the vertical leprosy programme into the existing horizontal health programme poses various administrative and operational challenges to programmers. In order to understand the preparedness of the PHC workers for integration of leprosy into primary health care services, 71 PHC workers were interviewed using a structured interview schedule. The results showed that about 42% of the staff have heard of the concept of integration earlier and 90% of the PHC staff are willing to treat leprosy patients in the primary health care centre, but only 72% were in favour of integration. The reasons for favouring integration were (1) wider coverage with MDT, (2) frequent field visits by the worker, (3) better rapport with the community, (4) timely treatment and (5) cost-effectiveness. About 28% of the staff members did not favour integration for the reasons that the leprosy programme would suffer, targets cannot be met, supervision would be difficult, knowledge of the staff was inadequate and importance cannot be given to leprosy as family planning is always a priority in PHC centres. About 43% of the staff felt that the performance of the leprosy programme would be better after integration. With regard to workload, 60% of the sample felt that there would be increase in the workload in the field, record maintenance and supervision. The difficulties foreseen by the workers were grouped into 6 categories, viz., administrative, managerial, technical, personnel, social and miscellaneous. It is worth noting that 91% of the staff that included all categories said they were not afraid of leprosy, but needed training in leprosy work. About 50% of the staff expected increase in salaries and promotions if integration took place.

  3. Safety and Efficacy Assessment of Two New Leprosy Skin Test Antigens: Randomized Double Blind Clinical Study

    PubMed Central

    Rivoire, Becky L.; Groathouse, Nathan A.; TerLouw, Stephen; Neupane, Kapil Dev; Ranjit, Chaman; Sapkota, Bishwa Raj; Khadge, Saraswoti; Kunwar, Chatra B.; Macdonald, Murdo; Hawksworth, Rachel; Thapa, Min B.; Hagge, Deanna A.; Tibbals, Melinda; Smith, Carol; Dube, Tina; She, Dewei; Wolff, Mark; Zhou, Eric; Makhene, Mamodikoe; Mason, Robin; Sizemore, Christine; Brennan, Patrick J.

    2014-01-01

    Background New tools are required for the diagnosis of pre-symptomatic leprosy towards further reduction of disease burden and its associated reactions. To address this need, two new skin test antigens were developed to assess safety and efficacy in human trials. Methods A Phase I safety trial was first conducted in a non-endemic region for leprosy (U.S.A.). Healthy non-exposed subjects (n = 10) received three titrated doses (2.5 µg, 1.0 µg and 0.1 µg) of MLSA-LAM (n = 5) or MLCwA (n = 5) and control antigens [Rees MLSA (1.0 µg) and saline]. A randomized double blind Phase II safety and efficacy trial followed in an endemic region for leprosy (Nepal), but involved only the 1.0 µg (high dose) and 0.1 µg (low dose) of each antigen; Tuberculin PPD served as a control antigen. This Phase II safety and efficacy trial consisted of three Stages: Stage A and B studies were an expansion of Phase I involving 10 and 90 subjects respectively, and Stage C was then conducted in two parts (high dose and low dose), each enrolling 80 participants: 20 borderline lepromatous/lepromatous (BL/LL) leprosy patients, 20 borderline tuberculoid/tuberculoid (BT/TT) leprosy patients, 20 household contacts of leprosy patients (HC), and 20 tuberculosis (TB) patients. The primary outcome measure for the skin test was delayed type hypersensitivity induration. Findings In the small Phase I safety trial, reactions were primarily against the 2.5 µg dose of both antigens and Rees control antigen, which were then excluded from subsequent studies. In the Phase II, Stage A/B ramped-up safety study, 26% of subjects (13 of 50) showed induration against the high dose of each antigen, and 4% (2 of 50) reacted to the low dose of MLSA-LAM. Phase II, Stage C safety and initial efficacy trial showed that both antigens at the low dose exhibited low sensitivity at 20% and 25% in BT/TT leprosy patients, but high specificity at 100% and 95% compared to TB patients. The high dose of both antigens

  4. Leprosy on Reunion Island, 2005-2013: Situation and Perspectives

    PubMed Central

    Camuset, Guillaume; Lafarge, Sophie; Borgherini, Gianandrea; Gerber, Anne; Pouderoux, Nicolas; Foucher, Aurélie; Poubeau, Patrice; Manaquin, Rodolphe; Larrieu, Sophie; Vilain, Pascal; Huiart, Laetitita

    2016-01-01

    Background Reunion Island is a French overseas territory located in the south-western of Indian Ocean, 700 km east of Madagascar. Leprosy first arrived on Reunion Island in the early 1700s with the African slaves and immigration from Madagascar. The disease was endemic until 1980 but improvement of health care and life conditions of inhabitants in the island have allowed a strong decrease in new cases of leprosy. However, the reintroduction of the disease by migrants from endemic neighbouring countries like Comoros and Madagascar is a real and continuing risk. This observational study was then conducted to measure the number of new cases detected annually on Reunion Island between 2005 and 2013, and to describe the clinical features of these patients. Methodology/Principal Findings Data were collected over two distinct periods. Incident cases between 2005 and 2010 come from a retrospective study conducted in 2010 by the regional Office of French Institute for Public Health Surveillance (CIRE of Indian Ocean), when no surveillance system exist. Cases between 2011 and 2013 come from a prospective collection of all new cases, following the implementation of systematic notification of all new cases. All patient data were anonymized. Among the 25 new cases, 12 are Reunion Island residents who never lived outside Reunion Island, and hence are considered to be confirmed autochthonous patients. Registered prevalence in 2014 was 0.05 /10 000 habitants, less than the WHO’s eradication goal (1/10 000). Conclusions/Significance Leprosy is no longer a major public health problem on Reunion Island, as its low prevalence rate indicates. However, the risk of recrudescence of the disease and of renewed autochthonous transmission remains real. In this context, active case detection must be pursued through the active declaration and rapid treatment of all new cases. PMID:27082879

  5. [Leprosy--current aspects of a disease from biblical times].

    PubMed

    Sticht-Groh, V; Bretzel, G

    1995-12-01

    95% of individuals who come in contact with M. leprae do not develop an overt disease. It begins as an indeterminate form that may undergo spontaneous cure or may progress to different forms of leprosy (TT, BT, unstable form of BB, BL, or LL). The clinical form of the disease correlates with the T cell mediated immune response rather than to the direct damage caused by the bacilli. The lack of cellular immunity in lepromatous patients relates specifically to M. leprae. Current aspects of etiology, transmission, epidemiology, classification, clinical features, immunopathology, chemotherapy, treatment of reactions, immunotherapy and vaccination are elucidated and discussed.

  6. High-Resolution Sonography: A New Technique to Detect Nerve Damage in Leprosy

    PubMed Central

    Jain, Suman; Visser, Leo H.; Praveen, T. L. N.; Rao, P. Narasimha; Surekha, Thummalakunta; Ellanti, Ramesh; Abhishek, Thummalakunta L. N.; Nath, Indira

    2009-01-01

    Background Leprosy is the most common treatable peripheral nerve disorder worldwide with periods of acute neuritis leading to functional impairment of limbs, ulcer formation and stigmatizing deformities. Since the hallmarks of leprosy are nerve enlargement and inflammation, we used high-resolution sonography (US) and color Doppler (CD) imaging to demonstrate nerve enlargement and inflammation. Methology/Principal Findings We performed bilateral US of the ulnar (UN), median (MN), lateral popliteal (LP) and posterior tibial (PT) nerves in 20 leprosy patients and compared this with the clinical findings in these patients and with the sonographic findings in 30 healthy Indian controls. The nerves were significantly thicker in the leprosy patients as compared to healthy controls (p<0.0001 for each nerve). The two patients without nerve enlargements did not have a type 1 or type 2 reaction or signs of neuritis. The kappa for clinical palpation and nerve enlargement by sonography was 0.30 for all examined nerves (0.32 for UN, 0.41 for PN and 0.13 for LP). Increased neural vascularity by CD imaging was present in 39 of 152 examined nerves (26%). Increased vascularity was observed in multiple nerves in 6 of 12 patients with type 1 reaction and in 3 of 4 patients with type 2 reaction. Significant correlation was observed between clinical parameters of grade of thickening, sensory loss and muscle weakness and US abnormalities of nerve echotexture, endoneural flow and cross-sectional area (p<0.001). Conclusions/Significance We conclude that clinical examination of enlarged nerves in leprosy patients is subjective and inaccurate, whereas sonography provides an objective measure of nerve damage by showing increased vascularity, distorted echotexture and enlargement. This damage is sonographically more extensive and includes more nerves than clinically expected. PMID:19668356

  7. Activation and cytokine profile of monocyte derived dendritic cells in leprosy: in vitro stimulation by sonicated Mycobacterium leprae induces decreased level of IL-12p70 in lepromatous leprosy

    PubMed Central

    Braga, André Flores; Moretto, Daniela Ferraz; Gigliotti, Patrícia; Peruchi, Mariela; Vilani-Moreno, Fátima Regina; Campanelli, Ana Paula; Latini, Ana Carla Pereira; Iyer, Anand; Das, Pranab Kumar; de Souza, Vânia Nieto Brito

    2015-01-01

    Dendritic cells (DCs) play a pivotal role in the connection of innate and adaptive immunity of hosts to mycobacterial infection. Studies on the interaction of monocyte-derived DCs (MO-DCs) using Mycobacterium leprae in leprosy patients are rare. The present study demonstrated that the differentiation of MOs to DCs was similar in all forms of leprosy compared to normal healthy individuals. In vitro stimulation of immature MO-DCs with sonicated M. leprae induced variable degrees of DC maturation as determined by the increased expression of HLA-DR, CD40, CD80 and CD86, but not CD83, in all studied groups. The production of different cytokines by the MO-DCs appeared similar in all of the studied groups under similar conditions. However, the production of interleukin (IL)-12p70 by MO-DCs from lepromatous (LL) leprosy patients after in vitro stimulation with M. leprae was lower than tuberculoid leprosy patients and healthy individuals, even after CD40 ligation with CD40 ligand-transfected cells. The present cumulative findings suggest that the MO-DCs of LL patients are generally a weak producer of IL-12p70 despite the moderate activating properties ofM. leprae. These results may explain the poor M. leprae-specific cell-mediated immunity in the LL type of leprosy. PMID:26222022

  8. Schleswig: medieval leprosy on the boundary between Germany and Denmark.

    PubMed

    Boldsen, Jesper L; Rasmussen, Kaare Lund; Riis, Thomas; Dittmar, Manuela; Weise, Svenja

    2013-01-01

    Leprosy was a well-recognized and dreaded disease in medieval Europe. The disease is reported to have reached Germany with the Roman invasion and it was present in Scandinavia in the first centuries AD. This paper estimates and analyzes the frequency of leprosy among adult people buried in one of five medieval cemeteries in the city of Schleswig. Seven different dichotomous osteological lesions indicative of leprosy were analyzed, and it was possible to score at least one of these conditions on 350 adult skeletons (aged 15 or older). The scores were transformed to a statistic indicating the likelihood that the person to whom the skeleton belonged suffered from leprosy. It was found that the frequency of leprosy in the five cemeteries varied between 9 and 44%. Four of the five cemeteries showed frequencies ranging from 35 and 44% and with no statistically significant differences among them. The fifth cemetery showed a significantly lower frequency of leprosy (9%). The distribution of female age at death does not appear to be affected by leprosy status. This means that females experienced a considerably elevated risk of dying once they had contracted leprosy as the disease usually has a mid-adulthood age of onset. In four of the five cemeteries males with leprosy died in higher ages than men without leprosy--in two of the cemeteries the difference was statistically significant. This indicates that leprosy usually added less to the risk of dying among men than among women in medieval Schleswig.

  9. Leprosy - evolution of the path to eradication

    PubMed Central

    Dogra, Sunil; Narang, Tarun; Kumar, Bhushan

    2013-01-01

    Leprosy is among the world's oldest and most dreaded diseases and it has been synonymous with stigma and discrimination due to the hideous deformities it produced, mystery around its aetiology and transmission and lack of any effective remedy till recently. Leprosy control started with the use of chaulmoogra oil and for the last three decades, multi drug therapy (MDT) has been our main tool against leprosy. In the last two decades, the reported global prevalence of active leprosy infection has dropped by almost 90 per cent by the combined efforts of the World Health Organization (WHO), local governments, health professionals, and non-governmental organizations (NGOs), however, a parallel drop in the incidence or new case detection rate (NCDR) has not occurred. From 1994 through 2011, more than 100,000 new cases are being detected annually, of whom maximum case load is from India. There is need for research on tools for early diagnosis, short and effective treatment, and prevention of deformities and disabilities. Evaluating the role of immunotherapy and immunoprophylaxis will also lead us to better understanding of their mode of action. Further molecular analysis of Mycobacterium leprae genome may provide the requisite basis for all this. The current reality is that there is a need to sustain and provide quality leprosy services to all persons through general health services, including good referral system. All these provisions in the integrated health care approach will go a long way in further reducing the stigma. Efforts need to be made to reduce deformity through early detection, self care, physiotherapy and reconstructive surgery and developing sound surveillance systems. With all the remarkable achievements in the fight against leprosy, the stage is now set for the final assault. It is hoped that with the efforts of all the stake holders and strong political will, the disease will be eradicated in the near future. PMID:23481049

  10. Leprosy: too complex a disease for a simple elimination paradigm.

    PubMed Central

    Lockwood, Diana N. J.; Suneetha, Sujai

    2005-01-01

    Can leprosy be eliminated? This paper considers the question against the background of the WHO programme to eliminate leprosy. In 1991 the World Health Assembly set a target of eliminating leprosy as a public health problem by 2000. Elimination was defined as reaching a prevalence of < 1 case per 10 000 people. The elimination programme has been successful in delivering highly effective antibiotic therapy worldwide. However, despite this advance, new-case detection rates remain stable in countries with the highest rates of endemic leprosy, such as Brazil and India. This suggests that infection has not been adequately controlled by antibiotics alone. Leprosy is perhaps more appropriately classed as a chronic stable disease than as an acute infectious disease responsive to elimination strategies. In many countries activities to control and treat leprosy are being integrated into the general health-care system. This reduces the stigma associated with leprosy. However, leprosy causes long-term immunological complications, disability and deformity. The health-care activities of treating and preventing disabilities need to be provided in an integrated setting. Detecting new cases and monitoring disability caused by leprosy will be a challenge. One solution is to implement long-term surveillance in selected countries with the highest rates of endemic disease so that an accurate estimate of the burden of leprosy can be determined. It is also critical that broad-based research into this challenging disease continues until the problems are truly solved. PMID:15798849

  11. Leprosy incidence, characterization of cases and correlation with household and cases variables of the Brazilian states in 2010*

    PubMed Central

    de Castro, Shamyr Sulyvan; Santos, Juliana Pereira Pontes; Abreu, Graziela Basílio; Oliveira, Vanessa Rossato; Fernandes, Luciane Fernanda Rodrigues Martinho

    2016-01-01

    BACKGROUND: Leprosy is millenary disease and still persists in several countries. OBJECTIVES: To estimate the incidence of leprosy in the Brazilian states and for the country in the year 2010; to describe the cases reported according to the studied variables; to verify the correlation between the overall incidence and the studied variables. METHODS: Ecological descriptive study, with population data from the 27 states, 2010. Information about reported cases were collected: gender, race, percentage of patients younger than 15 years old and living conditions. The analysis was performed using percentages, means, incidence rates and the Spearman correlation test. RESULTS: The states of Mato Grosso and Tocantins recorded the highest incidence rates; Rio Grande do Sul and Santa Catarina, the lowest; there was a higher incidence of leprosy among men; the incidence of leprosy increases proportionally with the nonwhites among the inhabitants; patients younger than 15 years; the average number of residents per household; and a decrease in coverage of water supply and presence of bathrooms. CONCLUSION: The incidence of leprosy is related to factors as gender, race and house conditions (p<0,05 for all). PMID:26982775

  12. Jagged1 Instructs Macrophage Differentiation in Leprosy.

    PubMed

    Kibbie, Jon; Teles, Rosane M B; Wang, Zhiming; Hong, Patrick; Montoya, Dennis; Krutzik, Stephan; Lee, Seung; Kwon, Ohyun; Modlin, Robert L; Cruz, Daniel

    2016-08-01

    As circulating monocytes enter the site of disease, the local microenvironment instructs their differentiation into tissue macrophages (MΦ). To identify mechanisms that regulate MΦ differentiation, we studied human leprosy as a model, since M1-type antimicrobial MΦ predominate in lesions in the self-limited form, whereas M2-type phagocytic MΦ are characteristic of the lesions in the progressive form. Using a heterotypic co-culture model, we found that unstimulated endothelial cells (EC) trigger monocytes to become M2 MΦ. However, biochemical screens identified that IFN-γ and two families of small molecules activated EC to induce monocytes to differentiate into M1 MΦ. The gene expression profiles induced in these activated EC, when overlapped with the transcriptomes of human leprosy lesions, identified Jagged1 (JAG1) as a potential regulator of MΦ differentiation. JAG1 protein was preferentially expressed in the lesions from the self-limited form of leprosy, and localized to the vascular endothelium. The ability of activated EC to induce M1 MΦ was JAG1-dependent and the addition of JAG1 to quiescent EC facilitated monocyte differentiation into M1 MΦ with antimicrobial activity against M. leprae. Our findings indicate a potential role for the IFN-γ-JAG1 axis in instructing MΦ differentiation as part of the host defense response at the site of disease in human leprosy. PMID:27532668

  13. Jagged1 Instructs Macrophage Differentiation in Leprosy

    PubMed Central

    Teles, Rosane M. B.; Wang, Zhiming; Hong, Patrick; Montoya, Dennis; Krutzik, Stephan; Lee, Seung; Kwon, Ohyun; Modlin, Robert L.; Cruz, Daniel

    2016-01-01

    As circulating monocytes enter the site of disease, the local microenvironment instructs their differentiation into tissue macrophages (MΦ). To identify mechanisms that regulate MΦ differentiation, we studied human leprosy as a model, since M1-type antimicrobial MΦ predominate in lesions in the self-limited form, whereas M2-type phagocytic MΦ are characteristic of the lesions in the progressive form. Using a heterotypic co-culture model, we found that unstimulated endothelial cells (EC) trigger monocytes to become M2 MΦ. However, biochemical screens identified that IFN-γ and two families of small molecules activated EC to induce monocytes to differentiate into M1 MΦ. The gene expression profiles induced in these activated EC, when overlapped with the transcriptomes of human leprosy lesions, identified Jagged1 (JAG1) as a potential regulator of MΦ differentiation. JAG1 protein was preferentially expressed in the lesions from the self-limited form of leprosy, and localized to the vascular endothelium. The ability of activated EC to induce M1 MΦ was JAG1-dependent and the addition of JAG1 to quiescent EC facilitated monocyte differentiation into M1 MΦ with antimicrobial activity against M. leprae. Our findings indicate a potential role for the IFN-γ-JAG1 axis in instructing MΦ differentiation as part of the host defense response at the site of disease in human leprosy. PMID:27532668

  14. Human Genetic Ancestral Composition Correlates with the Origin of Mycobacterium leprae Strains in a Leprosy Endemic Population

    PubMed Central

    Cardona-Castro, Nora; Cortés, Edwin; Beltrán, Camilo; Romero, Marcela; Badel-Mogollón, Jaime E.; Bedoya, Gabriel

    2015-01-01

    Recent reports have suggested that leprosy originated in Africa, extended to Asia and Europe, and arrived in the Americas during European colonization and the African slave trade. Due to colonization, the contemporary Colombian population is an admixture of Native-American, European and African ancestries. Because microorganisms are known to accompany humans during migrations, patterns of human migration can be traced by examining genomic changes in associated microbes. The current study analyzed 118 leprosy cases and 116 unrelated controls from two Colombian regions endemic for leprosy (Atlantic and Andean) in order to determine possible associations of leprosy with patient ancestral background (determined using 36 ancestry informative markers), Mycobacterium leprae genotype and/or patient geographical origin. We found significant differences between ancestral genetic composition. European components were predominant in Andean populations. In contrast, African components were higher in the Atlantic region. M. leprae genotypes were then analyzed for cluster associations and compared with the ancestral composition of leprosy patients. Two M. leprae principal clusters were found: haplotypes C54 and T45. Haplotype C54 associated with African origin and was more frequent in patients from the Atlantic region with a high African component. In contrast, haplotype T45 associated with European origin and was more frequent in Andean patients with a higher European component. These results suggest that the human and M. leprae genomes have co-existed since the African and European origins of the disease, with leprosy ultimately arriving in Colombia during colonization. Distinct M. leprae strains followed European and African settlement in the country and can be detected in contemporary Colombian populations. PMID:26360617

  15. Autophagy gene polymorphism is associated with susceptibility to leprosy by affecting inflammatory cytokines.

    PubMed

    Yang, Degang; Chen, Jia; Shi, Chao; Jing, Zhichun; Song, Ningjing

    2014-04-01

    Autophagy and inflammation closely interact with each other, and together, they play critical roles in bacterial infection. Leprosy is caused by the infection of Mycobacterium leprae (M. leprae). The objective of the study was to investigate the association between polymorphisms in IRGM, an autophagy gene, and susceptibility to leprosy, and identify possible functions of the polymorphism in the infection of M. leprae. Two polymorphisms in IRGM, rs4958842 and rs13361189, were tested in 412 leprosy cases and 432 healthy controls. Levels of inflammatory cytokines including interleukin 1 beta, IL-4, IL-6, and interferon gamma (INF-γ) were measured after the infection of M. leprae in the peripheral blood mononuclear cell (PBMC) of subjects with different genotypes of rs13361189. Data showed that prevalence of rs13361189TC and CC genotypes were significantly higher in leprosy patients than in healthy controls (odds ratio (OR) = 1.49, 95 % confidence interval (CI) 1.09-2.04, P = 0.012; OR = 2.58, 95 % CI 1.65-4.05, P < 0.001; respectively). Furthermore, the frequency of rs13361189CC genotype was increased in patients with complications than those without complications (P = 0.011). When analyzing the effect of rs13361189 polymorphism on M. leprae infection, we identified that M. leprae-infected PBMC with rs13361189CC genotype expressed significantly elevated levels of INF-γ and IL-4 than those with TT genotype. Our results suggested autophagy gene polymorphism was associated with the increased risk of leprosy by affecting inflammatory cytokines.

  16. [Leprosy situation in Myanmar before and after multidrug therapy].

    PubMed

    Ishii, Norihisa; Mori, Shuichi

    2005-09-01

    We introduced history of leprosy in Myanmar based on the book of Myanmar Academy of Medical Science published entitled "CONQUEST OF SCOURGES IN MYANMAR (Complied and Edited by Ko Ko, Kyaw and U Thaung) at 2002. "Leprosy Elimination Programme in Myanmar (Kyaw Lwin and Kyaw Nyunt Stein)" was appeared at chapter III in it. After dapsone treatment appeared, leprosy control program has started. Health system and service were developed and leprosy control program was also included in them. The integration of the elimination activities into basic health workers, such as midwives and health volunteers, has enabled the participation of a wide range of people in the community. After 1990s, multidrug therapy (MDT) was covered whole area of Myanmar, and task force for leprosy elimination was formed at Sate/Division, District and Township level. Finally Myanmar achieved the elimination of leprosy in January in 2003.

  17. Increased Expression of Regulatory T Cells and Down-Regulatory Molecules in Lepromatous Leprosy

    PubMed Central

    Palermo, Maria L.; Pagliari, Carla; Trindade, Maria Angela B.; Yamashitafuji, Tania M.; Duarte, Alberto José S.; Cacere, Camila R.; Benard, Gil

    2012-01-01

    T regulatory cells (Tregs) play an important role in the mechanism of host's failure to control pathogen dissemination in severe forms of different chronic granulomatous diseases, but their role in leprosy has not yet been elucidated; 28 newly diagnosed patients (16 patients with lepromatous leprosy and 12 patients with tuberculoid leprosy) and 6 healthy Mycobacterium leprae-exposed individuals (contacts) were studied. Tregs were quantified by flow cytometry (CD4+ CD25+ Foxp3+) in peripheral blood mononuclear cells stimulated in vitro with a M. leprae antigenic preparation and phytohemagglutinin as well as in skin lesions by immunohistochemistry. The lymphoproliferative (LPR), interleukin-10 (IL-10), and interferon-γ (IFN-γ) responses of the in vitro-stimulated peripheral blood mononuclear cells and the in situ expression of IL-10, transforming growth factor-β (TGF-β), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) were also determined. We show that M. leprae antigens induced significantly lower LPR but significantly higher Treg numbers in lepromatous than tuberculoid patients and contacts. Mitogen-induced LPR and Treg frequencies were not significantly different among the three groups. Tregs were also more frequent in situ in lepromatous patients, and this finding was paralleled by increased expression of the antiinflammatory molecules IL-10 and CTLA-4 but not TGF-β. In lepromatous patients, Tregs were intermingled with vacuolized hystiocyte infiltrates all over the lesion, whereas in tuberculoid patients, Tregs were rare. Our results suggest that Tregs are present in increased numbers, and they may have a pathogenic role in leprosy patients harboring uncontrolled bacillary multiplication but not in those individuals capable of limiting M. leprae growth. PMID:22556091

  18. Increased expression of regulatory T cells and down-regulatory molecules in lepromatous leprosy.

    PubMed

    Palermo, Maria L; Pagliari, Carla; Trindade, Maria Angela B; Yamashitafuji, Tania M; Duarte, Alberto José S; Cacere, Camila R; Benard, Gil

    2012-05-01

    T regulatory cells (Tregs) play an important role in the mechanism of host's failure to control pathogen dissemination in severe forms of different chronic granulomatous diseases, but their role in leprosy has not yet been elucidated; 28 newly diagnosed patients (16 patients with lepromatous leprosy and 12 patients with tuberculoid leprosy) and 6 healthy Mycobacterium leprae-exposed individuals (contacts) were studied. Tregs were quantified by flow cytometry (CD4+ CD25+ Foxp3+) in peripheral blood mononuclear cells stimulated in vitro with a M. leprae antigenic preparation and phytohemagglutinin as well as in skin lesions by immunohistochemistry. The lymphoproliferative (LPR), interleukin-10 (IL-10), and interferon-γ (IFN-γ) responses of the in vitro-stimulated peripheral blood mononuclear cells and the in situ expression of IL-10, transforming growth factor-β (TGF-β), and cytotoxic T-lymphocyte antigen 4 (CTLA-4) were also determined. We show that M. leprae antigens induced significantly lower LPR but significantly higher Treg numbers in lepromatous than tuberculoid patients and contacts. Mitogen-induced LPR and Treg frequencies were not significantly different among the three groups. Tregs were also more frequent in situ in lepromatous patients, and this finding was paralleled by increased expression of the antiinflammatory molecules IL-10 and CTLA-4 but not TGF-β. In lepromatous patients, Tregs were intermingled with vacuolized hystiocyte infiltrates all over the lesion, whereas in tuberculoid patients, Tregs were rare. Our results suggest that Tregs are present in increased numbers, and they may have a pathogenic role in leprosy patients harboring uncontrolled bacillary multiplication but not in those individuals capable of limiting M. leprae growth. PMID:22556091

  19. A migration-driven model for the historical spread of leprosy in medieval Eastern and Central Europe.

    PubMed

    Donoghue, Helen D; Michael Taylor, G; Marcsik, Antónia; Molnár, Erika; Pálfi, Gyorgy; Pap, Ildikó; Teschler-Nicola, Maria; Pinhasi, Ron; Erdal, Yilmaz S; Velemínsky, Petr; Likovsky, Jakub; Belcastro, Maria Giovanna; Mariotti, Valentina; Riga, Alessandro; Rubini, Mauro; Zaio, Paola; Besra, Gurdyal S; Lee, Oona Y-C; Wu, Houdini H T; Minnikin, David E; Bull, Ian D; O'Grady, Justin; Spigelman, Mark

    2015-04-01

    Leprosy was rare in Europe during the Roman period, yet its prevalence increased dramatically in medieval times. We examined human remains, with paleopathological lesions indicative of leprosy, dated to the 6th-11th century AD, from Central and Eastern Europe and Byzantine Anatolia. Analysis of ancient DNA and bacterial cell wall lipid biomarkers revealed Mycobacterium leprae in skeletal remains from 6th-8th century Northern Italy, 7th-11th century Hungary, 8th-9th century Austria, the Slavic Greater Moravian Empire of the 9th-10th century and 8th-10th century Byzantine samples from Northern Anatolia. These data were analyzed alongside findings published by others. M. leprae is an obligate human pathogen that has undergone an evolutionary bottleneck followed by clonal expansion. Therefore M. leprae genotypes and sub-genotypes give information about the human populations they have infected and their migration. Although data are limited, genotyping demonstrates that historical M. leprae from Byzantine Anatolia, Eastern and Central Europe resembles modern strains in Asia Minor rather than the recently characterized historical strains from North West Europe. The westward migration of peoples from Central Asia in the first millennium may have introduced different M. leprae strains into medieval Europe and certainly would have facilitated the spread of any existing leprosy. The subsequent decline of M. leprae in Europe may be due to increased host resistance. However, molecular evidence of historical leprosy and tuberculosis co-infections suggests that death from tuberculosis in leprosy patients was also a factor.

  20. Experimental Infection of Rhodnius prolixus (Hemiptera, Triatominae) with Mycobacterium leprae Indicates Potential for Leprosy Transmission

    PubMed Central

    Neumann, Arthur da Silva; Dias, Felipe de Almeida; Ferreira, Jéssica da Silva; Fontes, Amanda Nogueira Brum; Rosa, Patricia Sammarco; Macedo, Rafael Enrique; Oliveira, José Henrique; Teixeira, Raquel Lima de Figueiredo; Pessolani, Maria Cristina Vidal; Moraes, Milton Ozório; Suffys, Philip Noel; Oliveira, Pedro L.; Sorgine, Marcos Henrique Ferreira; Lara, Flavio Alves

    2016-01-01

    Leprosy is a chronic dermato-neurological disease caused by infection with Mycobacterium leprae. In 2013 almost 200,000 new cases of leprosy were detected around the world. Since the first symptoms take from years to decades to appear, the total number of asymptomatic patients is impossible to predict. Although leprosy is one of the oldest records of human disease, the mechanisms involved with its transmission and epidemiology are still not completely understood. In the present work, we experimentally investigated the hypothesis that the mosquitoes Aedes aegypti and Culex quinquefasciatus and the hemiptera Rhodnius prolixus act as leprosy vectors. By means of real-time PCR quantification of M. leprae 16SrRNA, we found that M. leprae remained viable inside the digestive tract of Rhodnius prolixus for 20 days after oral infection. In contrast, in the gut of both mosquito species tested, we were not able to detect M. leprae RNA after a similar period of time. Inside the kissing bug Rhodnius prolixus digestive tract, M. leprae was initially restricted to the anterior midgut, but gradually moved towards the hindgut, in a time course reminiscent of the life cycle of Trypanosoma cruzi, a well-known pathogen transmitted by this insect. The maintenance of M. leprae infectivity inside the digestive tract of this kissing bug is further supported by successful mice footpad inoculation with feces collected 20 days after infection. We conclude that Rhodnius prolixus defecate infective M. leprae, justifying the evaluation of the presence of M. leprae among sylvatic and domestic kissing bugs in countries endemic for leprosy. PMID:27203082

  1. Experimental Infection of Rhodnius prolixus (Hemiptera, Triatominae) with Mycobacterium leprae Indicates Potential for Leprosy Transmission.

    PubMed

    Neumann, Arthur da Silva; Dias, Felipe de Almeida; Ferreira, Jéssica da Silva; Fontes, Amanda Nogueira Brum; Rosa, Patricia Sammarco; Macedo, Rafael Enrique; Oliveira, José Henrique; Teixeira, Raquel Lima de Figueiredo; Pessolani, Maria Cristina Vidal; Moraes, Milton Ozório; Suffys, Philip Noel; Oliveira, Pedro L; Sorgine, Marcos Henrique Ferreira; Lara, Flavio Alves

    2016-01-01

    Leprosy is a chronic dermato-neurological disease caused by infection with Mycobacterium leprae. In 2013 almost 200,000 new cases of leprosy were detected around the world. Since the first symptoms take from years to decades to appear, the total number of asymptomatic patients is impossible to predict. Although leprosy is one of the oldest records of human disease, the mechanisms involved with its transmission and epidemiology are still not completely understood. In the present work, we experimentally investigated the hypothesis that the mosquitoes Aedes aegypti and Culex quinquefasciatus and the hemiptera Rhodnius prolixus act as leprosy vectors. By means of real-time PCR quantification of M. leprae 16SrRNA, we found that M. leprae remained viable inside the digestive tract of Rhodnius prolixus for 20 days after oral infection. In contrast, in the gut of both mosquito species tested, we were not able to detect M. leprae RNA after a similar period of time. Inside the kissing bug Rhodnius prolixus digestive tract, M. leprae was initially restricted to the anterior midgut, but gradually moved towards the hindgut, in a time course reminiscent of the life cycle of Trypanosoma cruzi, a well-known pathogen transmitted by this insect. The maintenance of M. leprae infectivity inside the digestive tract of this kissing bug is further supported by successful mice footpad inoculation with feces collected 20 days after infection. We conclude that Rhodnius prolixus defecate infective M. leprae, justifying the evaluation of the presence of M. leprae among sylvatic and domestic kissing bugs in countries endemic for leprosy.

  2. Further studies on seroreactivity in leprosy by means of a lecithin-free cardiolipin antigen (cardchol) and other antigens ordinarily used in the serodiagnosis of treponematoses*

    PubMed Central

    Schmidt, Henning

    1961-01-01

    In a previous study the reactivities of some lipoidal antigens in sera from patients with different types of leprosy were investigated. The present paper is a continuation of this earlier study and relates to an investigation of some 300 sera from leprosy patients in India. In particular, the reactivity of cardchol (a complement-fixing, lecithin-free, cardiolipin antigen) is compared with that of CWRM (an ”ordinary” cardiolipin antigen used in routine complement-fixation tests for the serodiagnosis of treponematoses). Cardchol, which is inferior to CWRM in reactivity with treponemal sera, has proved to be more reactive than CWRM in leprosy sera. The use of a lecithin-free cardiolipin antigen in serological investigations has revealed that the antilipoidal antibodies occurring in leprosy are most probably different from those demonstrated in treponematoses. Among the sera of non-syphilitic lepers, the percentage reactivity was significantly higher with cardchol than with CWRM. Thus, by changing the relative proportions of the three components of cardiolipin antigen, it has been possible to produce antigens with reactivities quite different from those of the antigens ordinarily used for the serological demonstration of syphilis. Cardchol is by no means a specific antigen for the demonstration of leprosy, but it has the ability to fix antibodies in certain leprosy sera that are not fixed by the ordinary CWRM antigen. PMID:14498723

  3. [Review of WHO Expert Committee on Leprosy 8th report, --comparison to 7th report].

    PubMed

    Kitajima, Shinichi; En, Junichiro; Kitajima, Shiori; Barua, Sumana; Goto, Masamichi

    2014-03-01

    In 2012 the WHO Expert Committee on Leprosy published its 8th report, 14 years after the publication of its 7th report in 1998. This report, the first since the leprosy reduction goal was met in 2000, highlights key points such as improvements in the quality of various services available to patients and the efforts of individuals and societies, in addition to medical progress in diagnosis and treatment. This review will mainly describe the changes made since the 7th report. Some of the main modifications are the deletion of single lesion paucibacillary type, elongated treatment of patients with high bacterial indices, the introduction of promising new drugs, and a shift from reducing the statistical number of patients to a new target for disability prevention.

  4. Type I reaction in leprosy--a histopathological analysis.

    PubMed

    Thomas, M; Ponnaiya, J; Emmanuel, M; Richard, J

    2013-01-01

    Even though type 1 lepra reaction (TIR) is a commonly encountered clinical problem, its histology has not yet been clearly delineated. This study attempts to enumerate the most sensitive parameters for the histological diagnosis of TIR. Case records between March 2007 and September 2007 of patients with TIR were reviewed and the biopsies were evaluated by a pathologist blinded to the previous diagnoses. Twenty three patients were included in the study. The most sensitive parameters in our study were dermal edema, intra-granuloma edema and giant cell size. Though clinical findings should remain the mainstay of diagnosis of TIR, the above mentioned parameters should be evaluated in biopsies of leprosy to look for signs of reaction which might otherwise be missed. PMID:24046908

  5. Role of TEFFECTOR/MEMORY Cells, TBX21 Gene Expression and T-Cell Homing Receptor on Type 1 Reaction in Borderline Lepromatous Leprosy Patients

    PubMed Central

    Alvim, Iris Maria Peixoto; Nery, José Augusto da Costa; Lara, Flávio Alves; Sarno, Euzenir Nunes; Esquenazi, Danuza

    2016-01-01

    In spite of hyporesponsivity to Mycobacterium leprae, borderline lepromatous (BL) patients show clinical and immunological instability, and undergo frequent acute inflammatory episodes such as type 1 reaction (T1R), which may cause nerve damages. This work focused on the participation of T cell subsets from blood and skin at T1R onset. We observed a significantly increased ex vivo frequency of both effector and memory CD4+ and CD8+ T cells in T1R group. Besides, ex vivo frequency of T cell homing receptor, the Cutaneous Leukocyte-associated Antigen (CLA) was significantly increased in T cells from T1R patients. M. leprae induced a higher frequency of CD4+ TEM and CD8+ TEF cells, as well as of CD8+/TEMRA (terminally differentiated effector T cells) subset, which expressed high CD69+. The presence of IFN-γ‒producing-CD4+ TEF and naïve and effector CD8+ T lymphocytes was significant in T1R. TBX21 expression was significantly higher in T1R, while BL showed increased GATA3 and FOXP3 expression. In T1R, TBX21 expression was strongly correlated with CD8+/IFN-γ‒ T cells frequency. The number of double positive CD8+/CLA+ and CD45RA+/CLA+ cells was significantly higher in skin lesions from T1R, in comparison with non-reactional BL group. The observed increase of ex vivo T cells at T1R onset suggests intravascular activation at the beginning of reactional episodes. The antigen-specific response in T1R group confirmed the higher number of CD8+/CLA+ and CD45RA+/CLA+ cells in T1R lesions suggests possible migration of these cells activated by M. leprae components inside the vascular compartment to skin and participation in T1R physiopathology. PMID:27764137

  6. BCG vaccination of children against leprosy

    PubMed Central

    Bechelli, L. M.; Garbajosa, Gallego; Uemura, K.; Engler, V.; Domínguez, V. Martínez; Paredes, L.; Sundaresan, T.; Koch, G.; Matejka, M.

    1970-01-01

    The use of BCG vaccine in the prevention of leprosy has been one of the most important subjects of investigation in the field of leprology in the last 25 years. The action of the vaccine was for many years investigated by determining its effect on the lepromin reaction. Field studies were later considered essential to determine whether BCG vaccination would be useful to leprosy contacts, to the child population probably exposed to infection, or to persons persistently lepromin-negative. The interest of the World Health Organization in this matter began in 1952 and, following the recommendations of certain advisory committees, it was decided to institute a field trial in Singu township in Burma. The main purpose of the investigation was to observe, in a highly endemic area, the protective effect, if any, of BCG vaccine against leprosy in the child population not exposed to Mycobacterium leprae at home but possibly exposed to the infection elsewhere. Field operations began at the end of August 1964 and the preliminary findings obtained up to the end of June 1968 relate to 3 annual re-examinations. So far, from the material studied, it appears that, under the conditions prevailing in Singu township, no significant effect of BCG vaccine can be seen within a period of 3 years. When children in both trial groups are followed-up for much longer periods, mainly children aged 0-4 years at intake, it is possible that a significant difference may emerge. However, to be operationally desirable, a merely significant difference is not enough; the protective effect of BCG should be substantial to warrant its large-scale use as an immunization procedure against leprosy. PMID:4246110

  7. Further information on the leprosy problem in the world

    PubMed Central

    Bechelli, L. M.; Domínguez, V. Martínez

    1972-01-01

    Information was obtained for the period 1966-70 concerning the number of registered cases, the number of cases that were inactive and released from control, the number of inpatients and of institutions for inpatient care, the proportion of lepromatous, tuberculoid, and indeterminate patients, and the frequency of disabilities. Comparison of the data from different countries was made difficult by non-uniform use of epidemiological terminology. In the circumstances, it would be hazardous to make an appraisal of the leprosy programmes in many of the countries, and it is difficult to determine correctly the trend of the endemics in these countries. The data collected suggest that the total number of estimated cases has not changed substantially in the last 5 years. PMID:4538196

  8. Reconstructive Surgery Camp for Leprosy Deformities in a Tertiary Hospital: An Example of Service Delivery at Low Costs

    PubMed Central

    Bhatt, Nikita R.; Vyas, Kinnari; Merchant, Rajiv

    2016-01-01

    Introduction Seventy percent of all cases of leprosy in the world occur in India. 8,462 new cases of disability were reported in India between 2010-11. Reconstructive Surgery Camps (RSC) provide free of cost plastic surgical expertise to patients of leprosy with deformity. Aim The aim of this article was to report the outcomes of a RSC in a tertiary level university hospital in India. We also described the types of deformities in the patient group and the cost of conducting such a camp. Materials and Methods The RSC involved 130 patients with leprosy related deformities operated by a team of plastic surgeons in a tertiary university hospital over 5 days. Health workers of the National Leprosy Elimination Program identified patients at community level. The camp was funded by the central government of India and the patients were provided incentives for undergoing treatment. Results Plantar ulcer was the commonest deformity (51.5%) while lagopthalmos (9.2%) was the least common deformity in the patient group. The overall complication rate in our study was around 10.6% (n=11). The total cost of this camp was 730,000 rupees (£7029.9). Conclusion Reconstructive surgery in a camp setup is a low cost alternative of correcting leprosy related deformity. It also provides valuable practical experience in reconstructive surgery to surgical trainees. Tertiary hospital based camps for conducting large-scale surgeries may be a cost effective alternative to reduce waiting lists in public health sectors. Long-term studies monitoring patients operated in a camp setting would be worthwhile. PMID:27630868

  9. Reconstructive Surgery Camp for Leprosy Deformities in a Tertiary Hospital: An Example of Service Delivery at Low Costs

    PubMed Central

    Bhatt, Nikita R.; Vyas, Kinnari; Merchant, Rajiv

    2016-01-01

    Introduction Seventy percent of all cases of leprosy in the world occur in India. 8,462 new cases of disability were reported in India between 2010-11. Reconstructive Surgery Camps (RSC) provide free of cost plastic surgical expertise to patients of leprosy with deformity. Aim The aim of this article was to report the outcomes of a RSC in a tertiary level university hospital in India. We also described the types of deformities in the patient group and the cost of conducting such a camp. Materials and Methods The RSC involved 130 patients with leprosy related deformities operated by a team of plastic surgeons in a tertiary university hospital over 5 days. Health workers of the National Leprosy Elimination Program identified patients at community level. The camp was funded by the central government of India and the patients were provided incentives for undergoing treatment. Results Plantar ulcer was the commonest deformity (51.5%) while lagopthalmos (9.2%) was the least common deformity in the patient group. The overall complication rate in our study was around 10.6% (n=11). The total cost of this camp was 730,000 rupees (£7029.9). Conclusion Reconstructive surgery in a camp setup is a low cost alternative of correcting leprosy related deformity. It also provides valuable practical experience in reconstructive surgery to surgical trainees. Tertiary hospital based camps for conducting large-scale surgeries may be a cost effective alternative to reduce waiting lists in public health sectors. Long-term studies monitoring patients operated in a camp setting would be worthwhile.

  10. Lessons in integration--operations research in an Indian leprosy NGO.

    PubMed

    Porter, J D H; Ogden, J A; Rao, P V Ranganadha; Rao, V Prabhakar; Rajesh, D; Buskade, R A; Soutar, D

    2002-06-01

    Since the Alma Ata Declaration in 1978, health systems supporting the treatment and control of infectious diseases like leprosy and tuberculosis have been encouraged to 'integrate' into the primary health care structure within countries. Now, more than 20 years later, countries are still grappling with the concept of integration and looking for ways to achieve it. This study reports findings from a leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a leprosy non-governmental organization (NGO), between 1996 and 2000 in Koraput district, Orissa. The project addressed the issue of integration on two levels. On the one hand LEPRA used the context of the project to explore ways in which to integrate TB services into their existing leprosy control structure. On the other hand, lessons from the pilot study were intended to help the organization find ways of linking with the government health care structure. Following a 'qualitative approach', this operations research project assessed the perceptions of communities and providers about leprosy and tuberculosis services. Providers across the spectrum of this plural healthcare system were asked to provide comment on developing stronger networks with each other, with NGOs and with government, while patients and communities were asked to describe the resources available to them and the constraints they face in accessing health care in general, and for leprosy and TB in particular. LEPRA staff from top management to the outreach workers were also approached for their views. Patients and communities noted that physical access to treatment was a major constraint, while the existence of local providers and family support structures facilitated health and health care. Providers expressed a willingness to collaborate (with LEPRA and the government), but lacked training, adequate staff support and the appropriate equipment/technical resources. Also lacking were adequate information campaigns to inform the

  11. The History, Biology and Medical Aspects of Leprosy.

    ERIC Educational Resources Information Center

    Eichman, Phillip

    1999-01-01

    Presents information about the history, biology, and medical aspects of leprosy, including its description in historical documents, its cause and effects, statistics on its prevalence, and various attempts at treatment. Notes that leprosy is one of the few infectious diseases that, although treatable with medication, remains incurable. Contains 30…

  12. First report of citrus leprosis virus nuclear type in Colombia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis is a difficult viral disease causing significant damage to citrus fruit in South America and Central America. The disease is marked by dramatic lesions on fruit, leaves and stems resulting in unmarketable product. Citrus leprosis virus cytoplasmic types (CiLV-C and CiLV-C2) wer edete...

  13. Borderline-lepromatous leprosy manifesting as granulomatous mastitis.

    PubMed

    Pandhi, Deepika; Verma, Prashant; Sharma, Sonal; Dhawan, Amit Kumar

    2012-06-01

    Leprosy is characterised by a chronic granulomatous inflammation of the skin and peripheral nerves. Dissemination of the lepra bacilli may cause involvement of other tissues as well. We describe an unusual case of the granulomatous involvement of the nipple-areola complex in a 35-year-old male consequent to borderline-lepromatous leprosy. PMID:22997696

  14. The challenge of producing skin test antigens with minimal resources suitable for human application against a neglected tropical disease; leprosy.

    PubMed

    Rivoire, Becky L; TerLouw, Stephen; Groathouse, Nathan A; Brennan, Patrick J

    2014-01-01

    True incidence of leprosy and its impact on transmission will not be understood until a tool is available to measure pre-symptomatic infection. Diagnosis of leprosy disease is currently based on clinical symptoms, which on average take 3-10 years to manifest. The fact that incidence, as defined by new case detection, equates with prevalence, i.e., registered cases, suggests that the cycle of transmission has not been fully intercepted by implementation of multiple drug therapy. This is supported by a high incidence of childhood leprosy. Epidemiological screening for pre-symptomatic leprosy in large endemic populations is required to facilitate targeted chemoprophylactic interventions. Such a test must be sensitive, specific, simple to administer, cost-effective, and easy to interpret. The intradermal skin test method that measures cell-mediated immunity was explored as the best option. Prior knowledge on skin testing of healthy subjects and leprosy patients with whole or partially fractionated Mycobacterium leprae bacilli, such as Lepromin or the Rees' or Convit' antigens, has established an acceptable safety and potency profile of these antigens. These data, along with immunoreactivity data, laid the foundation for two new leprosy skin test antigens, MLSA-LAM (M. leprae soluble antigen devoid of mycobacterial lipoglycans, primarily lipoarabinomannan) and MLCwA (M. leprae cell wall antigens). In the absence of commercial interest, the challenge was to develop these antigens under current good manufacturing practices in an acceptable local pilot facility and submit an Investigational New Drug to the Food and Drug Administration to allow a first-in-human phase I clinical trial. PMID:24874086

  15. The Challenge of Producing Skin Test Antigens with Minimal Resources Suitable for Human Application against a Neglected Tropical Disease; Leprosy

    PubMed Central

    Rivoire, Becky L.; TerLouw, Stephen; Groathouse, Nathan A.; Brennan, Patrick J.

    2014-01-01

    True incidence of leprosy and its impact on transmission will not be understood until a tool is available to measure pre-symptomatic infection. Diagnosis of leprosy disease is currently based on clinical symptoms, which on average take 3–10 years to manifest. The fact that incidence, as defined by new case detection, equates with prevalence, i.e., registered cases, suggests that the cycle of transmission has not been fully intercepted by implementation of multiple drug therapy. This is supported by a high incidence of childhood leprosy. Epidemiological screening for pre-symptomatic leprosy in large endemic populations is required to facilitate targeted chemoprophylactic interventions. Such a test must be sensitive, specific, simple to administer, cost-effective, and easy to interpret. The intradermal skin test method that measures cell-mediated immunity was explored as the best option. Prior knowledge on skin testing of healthy subjects and leprosy patients with whole or partially fractionated Mycobacterium leprae bacilli, such as Lepromin or the Rees' or Convit' antigens, has established an acceptable safety and potency profile of these antigens. These data, along with immunoreactivity data, laid the foundation for two new leprosy skin test antigens, MLSA-LAM (M. leprae soluble antigen devoid of mycobacterial lipoglycans, primarily lipoarabinomannan) and MLCwA (M. leprae cell wall antigens). In the absence of commercial interest, the challenge was to develop these antigens under current good manufacturing practices in an acceptable local pilot facility and submit an Investigational New Drug to the Food and Drug Administration to allow a first-in-human phase I clinical trial. PMID:24874086

  16. Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria

    PubMed Central

    Ezenduka, Charles; Post, Erik; John, Steven; Suraj, Abdulkarim; Namadi, Abdulahi; Onwujekwe, Obinna

    2012-01-01

    Background Despite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy. Methods A cross-sectional study was carried out to evaluate the additional benefits of using several case detection methods in addition to routine practice in two north-eastern states of Nigeria. Primary and secondary data were collected from routine practice records and the Nigerian Tuberculosis and Leprosy Control Programme of 2009. The methods evaluated were Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healers incentive method (TH). Effectiveness was measured as number of new leprosy cases detected and cost-effectiveness was expressed as cost per case detected. Costs were measured from both providers' and patients' perspectives. Additional costs and effects of each method were estimated by comparing each method against routine practise and expressed as incremental cost-effectiveness ratio (ICER). All costs were converted to the U.S. dollar at the 2010 exchange rate. Univariate sensitivity analysis was used to evaluate uncertainties around the ICER. Results The ICER for HCE was $142 per additional case detected at all contact levels and it was the most cost-effective method. At ICER of $194 per additional case detected, THs method detected more cases at a lower cost than the RVS, which was not cost-effective at $313 per additional case detected. Sensitivity analysis showed that varying the proportion of shared costs and subsistent wage for valuing unpaid time did not significantly change the

  17. A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis.

    PubMed

    Raharolahy, Onivola; Ramarozatovo, Lala S; Ranaivo, Irina M; Sendrasoa, Fandresena A; Andrianarison, Malalaniaina; Andrianarivelo, Mala Rakoto; Cambau, Emmanuelle; Rabenja, Fahafahantsoa Rapelanoro

    2016-01-01

    We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed. PMID:27579195

  18. A Case of Fluoroquinolone-Resistant Leprosy Discovered after 9 Years of Misdiagnosis

    PubMed Central

    Ramarozatovo, Lala S.; Ranaivo, Irina M.; Andrianarison, Malalaniaina; Cambau, Emmanuelle

    2016-01-01

    We report a case of misdiagnosed leprosy in a 21-year-old Malagasy male, who, improperly treated, developed secondary mycobacterial resistance to fluoroquinolone. The patient contracted the infection 9 years prior to the current consultation, displaying on the right thigh a single papulonodular lesion, which progressively spread to the lower leg, back, and face. Initial administration of ciprofloxacin and prednisolone led to temporary and fluctuating improvement. Subsequent long-term self-medication with ciprofloxacin and corticosteroid did not heal the foul and nonhealing ulcers on the legs and under the right sole. Histopathological findings were compatible with lepromatous leprosy. Skin biopsy was positive for acid-fast bacilli and PCR assay confirmed the presence of a fluoroquinolone-resistant strain of Mycobacterium leprae (gyrA A91V). After 6 months of standard regimen with rifampicin, clofazimine, and dapsone, clinical outcome significantly improved. Clinical characteristics and possible epidemiological implications are discussed. PMID:27579195

  19. Evaluation of the agreement between clinical and laboratorial exams in the diagnosis of leprosy.

    PubMed

    Teixeira, André Costa; Cruvinel, Danilo Lemos; Roma, Fábio Rodrigues de; Luppino, Leandro Ferreira; Resende, Luís Henrique Pereira; Sousa, Theo de; Bührer-Sékula, Samira; Goulart, Isabela Maria Bernardes

    2008-01-01

    This study examined the correlation between the clinical and laboratory diagnosis of leprosy, using biopsy results from laboratories 'A' and 'B' and the ML Flow test. Clinical and histopathological diagnoses presented 67.6% agreement. The laboratories showed 73.7% agreement in the bacterial index and laboratory 'B' detected 25.4% more positives. The highest agreement was in the LL form and lowest, in the I form. The highest diagnostic discrepancy was for the BB form. Clinical diagnosis agreement was 41.3% for laboratory 'A' and 54% for 'B'. The ML Flow test reclassified 10.7% of the patients. The spectrum of leprosy classification is important for a clearer understanding of the disease and its proper treatment, but is not used in health services, which use the simplified WHO criteria. This could be complemented by ML Flow testing. Such simplification is unacceptable for Leprosy Reference Centers regarding patient attendance, teaching and research, for which the standardization of the Ridley-Jopling classification is recommended. PMID:19618076

  20. Experiences of identification and differentiation as functions of leprosy, personality and age.

    PubMed

    Chauhan, N S; Dhar, U; Singh, Y

    1984-01-01

    It is a study of sociogenic need satisfactions that determines the homeostasis of 'being' by remaining contingent conditions of perpetuation or debasement of the social 'self'. The paper has a focus on identification satisfaction and differentiation experience of patients of the highly stigmatized leprosy. The study proceeds with an 'Experimental Group--Control-Group' randomized design. Experimental Groups are two, viz., those of Lepromatous and Non-lepromatous patients. 'Control Group' consists of 'disease-free' normal people. The three independent variables are disease types, age, personality factors. The dependent variables are two, viz., score of identification satisfaction and differentiation experience, measured by standardized tools. Each dependent variable has four '3 X 3 X 2' factorial experiments to test 56 'Null Hypotheses'. The sample consists of 360 elements for each one of the eight experiments. Leprosy elements are drawn from the Central JALMA Institute for Leprosy and the 'Kushta Seva Sadan' (Agra). The 'F' test is run for statistical verification of 'Null hypotheses'. Results show presence of 'role-reversion' and 'role negation' of age and personality factors. The disease possesses 'anti-roles'. It does not allow age and personality factors to promote identification satisfaction and to demote differentiation and experience. The disease actively promotes differentiation and demotes identification through its own 'alien system'. The senescents are the greatest sufferers. 'Social Stigma' works a 'social thanatos' and exposes senescents to substantial 'self-erosion'. PMID:6548499

  1. Diffusion Tensor Imaging Tractography in Pure Neuritic Leprosy: First Experience Report and Review of the Literature

    PubMed Central

    Tallarida, Giuseppe; d'Alcontres, Francesco Stagno; Noto, Salvatore; Parodi, Aurora; Tagliafico, Alberto

    2016-01-01

    Five years after both right ulnar and median nerve decompression for paraesthesias and palsy, a patient, coming from Nigeria but living in Italy, came to our unit claiming to have persistent pain and combined median and ulnar palsy. Under suspicion of leprosy, skin and left sural nerve biopsy were performed. Skin tests were negative, but Schwann cells resulted as positive for acid-fast bacilli (AFB), leading to the diagnosis of Pure Neuritic Leprosy (PNL). The patient was given PB multidrug therapy and recovered from pain in two months. After nine months both High Resolution Ultrasonography (HRUS) and Magnetic Resonance Imaging (MRI) were performed, revealing thickening of the nerves. Since demyelination is common in PNL, the Authors started to use Diffusion Tensor Imaging Tractography (DTIT) to get better morphological and functional data about myelination than does the traditional imaging. DTIT proved successful in showing myelin discontinuity, reorganization, and myelination, and the Authors suggest that it can give more information about the evolution of the disease, as well as further indications for surgery (nerve decompression, nerve transfers, and babysitting for distal effector protection), and should be added to traditional imaging tools in leprosy. PMID:27738537

  2. Cell-type deconvolution with immune pathways identifies gene networks of host defense and immunopathology in leprosy

    PubMed Central

    Inkeles, Megan S.; Teles, Rosane M.B.; Pouldar, Delila; Andrade, Priscila R.; Madigan, Cressida A.; Ambrose, Mike; Sarno, Euzenir N.; Rea, Thomas H.; Ochoa, Maria T.; Iruela-Arispe, M. Luisa; Swindell, William R.; Ottenhoff, Tom H.M.; Geluk, Annemieke; Bloom, Barry R.

    2016-01-01

    Transcriptome profiles derived from the site of human disease have led to the identification of genes that contribute to pathogenesis, yet the complex mixture of cell types in these lesions has been an obstacle for defining specific mechanisms. Leprosy provides an outstanding model to study host defense and pathogenesis in a human infectious disease, given its clinical spectrum, which interrelates with the host immunologic and pathologic responses. Here, we investigated gene expression profiles derived from skin lesions for each clinical subtype of leprosy, analyzing gene coexpression modules by cell-type deconvolution. In lesions from tuberculoid leprosy patients, those with the self-limited form of the disease, dendritic cells were linked with MMP12 as part of a tissue remodeling network that contributes to granuloma formation. In lesions from lepromatous leprosy patients, those with disseminated disease, macrophages were linked with a gene network that programs phagocytosis. In erythema nodosum leprosum, neutrophil and endothelial cell gene networks were identified as part of the vasculitis that results in tissue injury. The present integrated computational approach provides a systems approach toward identifying cell-defined functional networks that contribute to host defense and immunopathology at the site of human infectious disease. PMID:27699251

  3. Cell-type deconvolution with immune pathways identifies gene networks of host defense and immunopathology in leprosy

    PubMed Central

    Inkeles, Megan S.; Teles, Rosane M.B.; Pouldar, Delila; Andrade, Priscila R.; Madigan, Cressida A.; Ambrose, Mike; Sarno, Euzenir N.; Rea, Thomas H.; Ochoa, Maria T.; Iruela-Arispe, M. Luisa; Swindell, William R.; Ottenhoff, Tom H.M.; Geluk, Annemieke; Bloom, Barry R.

    2016-01-01

    Transcriptome profiles derived from the site of human disease have led to the identification of genes that contribute to pathogenesis, yet the complex mixture of cell types in these lesions has been an obstacle for defining specific mechanisms. Leprosy provides an outstanding model to study host defense and pathogenesis in a human infectious disease, given its clinical spectrum, which interrelates with the host immunologic and pathologic responses. Here, we investigated gene expression profiles derived from skin lesions for each clinical subtype of leprosy, analyzing gene coexpression modules by cell-type deconvolution. In lesions from tuberculoid leprosy patients, those with the self-limited form of the disease, dendritic cells were linked with MMP12 as part of a tissue remodeling network that contributes to granuloma formation. In lesions from lepromatous leprosy patients, those with disseminated disease, macrophages were linked with a gene network that programs phagocytosis. In erythema nodosum leprosum, neutrophil and endothelial cell gene networks were identified as part of the vasculitis that results in tissue injury. The present integrated computational approach provides a systems approach toward identifying cell-defined functional networks that contribute to host defense and immunopathology at the site of human infectious disease.

  4. Association of TNF-α-(308(GG)), IL-10(-819(TT)), IL-10(-1082(GG)) and IL-1R1(+1970(CC)) genotypes with the susceptibility and progression of leprosy in North Indian population.

    PubMed

    Tarique, Mohd; Naqvi, Raza Ali; Santosh, K V; Kamal, Vineet Kumar; Khanna, Neena; Rao, D N

    2015-05-01

    Leprosy is an infectious disease caused by M. leprae. We analyzed 48 cytokine polymorphisms in 13 (pro as well as anti-inflammatory) cytokine genes using PCR-SSP assay in 102 leprosy patients and 120 healthy controls with intent to find out a link between cytokine polymorphisms and disease susceptibility. TNF-α (-308) GG, IL-10 (-819) TT, IL-10 (-1082) GG and IL1R (+1970) CC genotypes are found to be predominant (p=0.01, p=0.02, p=0.0001 and p=0.001, respectively) in both tuberculoid as well as lepromatous leprosy patients. This observation suggests these genotypes as play the central role(s) in the progression of disease. CBA assay demonstrates the varied serum concentration of these cytokines with respect to their genotypes. The above genotypes appeared as high producer genotypes in our study. Even in presence of high produce genotypes, TNF-α level are found to be affected/masked by the presence of IL-10 in leprosy patients. Expressional masking of TNF-α is associated with the expression of IL-10 in these patients. This is one the negative impact of SNP-SNP interaction in leprosy patients. Therefore, we can conclude that cytokine gene polymorphisms determine the predisposition to the leprosy progression.

  5. The leprosy asylum in India: 1886-1947.

    PubMed

    Robertson, Jo

    2009-10-01

    Writing against a historical practice that situates the leprosy asylum exclusively within prison-like institutions, this article seeks to show the variation in leprosy asylums, the contingencies of their evolution, and the complexity of their designs, by devoting attention to the characteristics of the leprosy asylum in India from 1886 to 1947, in particular to the model agricultural colony. Drawing upon the travel narratives of Wellesley Bailey, the founder of the Mission to Lepers in India, for three separate periods in 1886, 1890-91, and 1895-96, it argues that leprosy asylums were formed in response to a complex conjunction of impulses: missionary, medical, and political. At the center of these endeavors was the provision of shelter for persons with leprosy that accorded with principles of good stewardship and took the form of judicious use of donations provided by benefactors. As the Mission to Lepers began to bring about improvements and restructuring to asylums, pleasant surroundings, shady trees, sound accommodation, and good ventilation became desirable conditions that would confer physical and psychological benefits on those living there. At the same time, the architecture of the asylum responded to economic imperatives, in addition to religious and medical aspirations, and asylums moved towards the regeneration of a labor force. Leprosy-affected people were increasingly employed in occupations that contributed to their sustenance and self-sufficiency, symbolically reincorporating the body damaged by leprosy into the economic world of productive relations. PMID:19531547

  6. Pride and prejudice--identity and stigma in leprosy work.

    PubMed

    Harris, Kristine

    2011-06-01

    This article sets out to expand the way stigma, and those affected by it, are understood within leprosy discourse and to apply these insights to the analysis of the experiences of leprosy workers. The term stigma is often used simply as shorthand for 'negative social experience'. However, to reduce the negative aspects of complex everyday life experiences to a single word is often overly simplistic and can serve to objectify, rather than illuminate, the experiences of those affected. This article argues that in order to understand the lived experience of stigma we must come to understand stigma as an ongoing, dialectical social process and develop an approach to stigma that analytically separates stigma from its negative social consequences. The article applies these insights to data collected during 14 months of fieldwork with front-line leprosy workers in India, which suggests that falling leprosy prevalence rates and a rapidly changing policy landscape have led to leprosy workers feeling marginalised and stigmatised within their own organisation. The article argues that, rather than seeing stigma merely as a negative process in which leprosy workers are passive victims, we must recognise that stigma also plays a key role in the creation and maintenance of leprosy workers' identity and is utilised as a strategic tool in the struggle for influence between different groups within the organisation. Finally, the article argues for the benefit of expanding our understanding of stigma across public health and of applying these insights to designing future interventions. PMID:21888138

  7. [Treatment of leprosy by human metabolites].

    PubMed

    Mester de Parajd, L; Mester de Parajd, M

    1986-01-01

    We are interested for other human metabolites than desoxyfructo-serotonin (DFS), showing antileprosy activity. This is the case of desoxyfructo-5-hydroxytryptophan and of some liposoluble derivatives of DFS. The time of resorption and penetration into M. leprae infected tissue, is very different for these metabolites. For this reason the simultaneous application of these compounds may represent some advantage in the treatment of multibacillar form of leprosy. The use of DFS together with the antileprosy diet "NAL" have the supplementary advantage to stabilize the DFS level in the serum during the treatment. PMID:3105224

  8. Insight into the evolution and origin of leprosy bacilli from the genome sequence of Mycobacterium lepromatosis

    PubMed Central

    Singh, Pushpendra; Benjak, Andrej; Schuenemann, Verena J.; Herbig, Alexander; Avanzi, Charlotte; Busso, Philippe; Nieselt, Kay; Krause, Johannes; Vera-Cabrera, Lucio; Cole, Stewart T.

    2015-01-01

    Mycobacterium lepromatosis is an uncultured human pathogen associated with diffuse lepromatous leprosy and a reactional state known as Lucio's phenomenon. By using deep sequencing with and without DNA enrichment, we obtained the near-complete genome sequence of M. lepromatosis present in a skin biopsy from a Mexican patient, and compared it with that of Mycobacterium leprae, which has undergone extensive reductive evolution. The genomes display extensive synteny and are similar in size (∼3.27 Mb). Protein-coding genes share 93% nucleotide sequence identity, whereas pseudogenes are only 82% identical. The events that led to pseudogenization of 50% of the genome likely occurred before divergence from their most recent common ancestor (MRCA), and both M. lepromatosis and M. leprae have since accumulated new pseudogenes or acquired specific deletions. Functional comparisons suggest that M. lepromatosis has lost several enzymes required for amino acid synthesis whereas M. leprae has a defective heme pathway. M. lepromatosis has retained all functions required to infect the Schwann cells of the peripheral nervous system and therefore may also be neuropathogenic. A phylogeographic survey of 227 leprosy biopsies by differential PCR revealed that 221 contained M. leprae whereas only six, all from Mexico, harbored M. lepromatosis. Phylogenetic comparisons indicate that M. lepromatosis is closer than M. leprae to the MRCA, and a Bayesian dating analysis suggests that they diverged from their MRCA approximately 13.9 Mya. Thus, despite their ancient separation, the two leprosy bacilli are remarkably conserved and still cause similar pathologic conditions. PMID:25831531

  9. Influence of Intron II microsatellite polymorphism in human toll-like receptor 2 gene in leprosy.

    PubMed

    Suryadevara, Naveen Chandra; Neela, Venkata Sanjeev Kumar; Devalraju, Kamakshi Prudhula; Jain, Suman; SivaSai, Krovvidi S R; Valluri, Vijaya Lakshmi; Jonnalagada, Subbanna; Anandaraj, M P J S

    2013-08-01

    Leprosy is a chronic granulomatous infection caused by the obligate intracellular organism Mycobacterium leprae. TLR2 plays a key role when activated by M. leprae lipoproteins initiating protective responses which induce bacterial killing and therefore control of disease spread. Microsatellite polymorphisms in intron2 of TLR2 gene have been reported to be associated with development of clinical features of several infectious diseases. The study aims to evaluate the influence of GT microsatellite on the expression of TLR2 which could make humans prone to M. leprae infections. A total of 279 individuals were enrolled in the study, 88 were leprosy patients, 95 were house hold contacts (HHC) and 96 were healthy controls (HC). Genotyping was done using PCR-Sequencing method. TLR2 mRNA expression was analyzed by RT-PCR. IL-10 and IFN-γ levels were measured using ELISA in MLSA stimulated cell culture supernatants. Statistical analysis was performed using Chi-Square (χ(2)) test and t-tests. Allele/genotype of TLR2 microsatellite which includes longer GT repeats was associated with low TLR2 mRNA expression and high IL-10 production while that including shorter GT repeats was associated with high TLR2 mRNA expression and low IL-10 production. High IL10 producing allele of TLR2 microsatellite might predispose house hold contacts to leprosy. PMID:23619473

  10. [Leprosy in the French Polynesian archipelagoes from 1967 to 1987].

    PubMed

    Cartel, J L; Boutin, J P; Plichart, R; Roux, J; Grosset, J H

    1988-01-01

    Between 1967 and 1987, 255 new cases of leprosy were detected in French Polynesia (FP) that means on average a 8.6% detection rate. Average detection rate calculated in 7 three-year periods did not vary significantly during the 21 years studied period of time. In two remote archipelagoes of FP average detection rate of leprosy is specially high: Gambier archipelago and Southern Marquesas archipelago with respectively a 54.7 and a 48.9% detection rate. To control leprosy, the network of treatment and active case-finding should be strengthened in archipelagoes and chemoprophylaxis programmes could be planned in places where the problem is especially important. PMID:3240567

  11. Tuberculosis and leprosy in Italy: new skeletal evidence.

    PubMed

    Rubini, Mauro; Zaio, Paola; Roberts, Charlotte

    2014-02-01

    Tuberculosis (TB) and leprosy are infections caused by Mycobacteria. This paper documents new skeletal evidence in Italy from the Iron Age site of Corvaro (Central Italy; 5th century BCE) and the Roman site of Palombara (Central Italy; 4th-5th century CE), and briefly reviews the extant evidence for these infections in Italy. The skeletal evidence for TB in Italy is more ancient than for leprosy, and is more common. The oldest evidence for both mycobacterial diseases is in the North of Italy, but this could be by chance, even if biomolecular models suggest a land route from the East to central Europe, especially for leprosy.

  12. [Leprosy in the French Polynesian archipelagoes from 1967 to 1987].

    PubMed

    Cartel, J L; Boutin, J P; Plichart, R; Roux, J; Grosset, J H

    1988-01-01

    Between 1967 and 1987, 255 new cases of leprosy were detected in French Polynesia (FP) that means on average a 8.6% detection rate. Average detection rate calculated in 7 three-year periods did not vary significantly during the 21 years studied period of time. In two remote archipelagoes of FP average detection rate of leprosy is specially high: Gambier archipelago and Southern Marquesas archipelago with respectively a 54.7 and a 48.9% detection rate. To control leprosy, the network of treatment and active case-finding should be strengthened in archipelagoes and chemoprophylaxis programmes could be planned in places where the problem is especially important.

  13. Gene Association with Leprosy: A Review of Published Data

    PubMed Central

    Mazini, Priscila Saamara; Alves, Hugo Vicentin; Reis, Pâmela Guimarães; Lopes, Ana Paula; Sell, Ana Maria; Santos-Rosa, Manuel; Visentainer, Jeane Eliete Laguila; Rodrigues-Santos, Paulo

    2016-01-01

    Leprosy is a chronic infectious disease caused by an obligate intracellular bacterium known as Mycobacterium leprae. Exposure to the bacillus is necessary, but this alone does not mean an individual will develop clinical symptoms of the disease. In recent years, several genes have been associated with leprosy and the innate immune response pathways converge on the main hypothesis that genes are involved in the susceptibility for the disease in two distinct steps: for leprosy per se and in the development of the different clinical forms. These genes participate in the sensing, main metabolic pathway of immune response activation and, subsequently, on the evolution of the disease into its clinical forms. The aim of this review is to highlight the role of innate immune response in the context of leprosy, stressing their participation in the signaling and targeting processes in response to bacillus infection and on the evolution to the clinical forms of the disease. PMID:26793196

  14. Patterns and trends of leprosy in Mexico: 1989-2009.

    PubMed

    Larrea, Maria Rupérez; Carreño, Maria Cristina; Fine, Paul E M

    2012-06-01

    Data from the Mexican national leprosy control programme 1989-2009 are described and analysed. After initial increases associated with the introduction of MDT and the start of the global elimination initiative in the early 1990 s, both prevalence and incidence declined dramatically throughout most of the country. Reported prevalence fell below 1 per 10000 in 1994 and has remained below that level ever since. There is considerable geographic heterogeneity, with highest case detection rates in western states bordering the Pacific and lowest in the south east. Reasons for these geographic differences are unclear. There is evidence of increases in average age of cases, and in proportions male and MB, as in several other populations with declining leprosy. There is some evidence of increasing leprosy in states bordering on Texas, USA, where M. leprae is known to be harboured in armadillos. The relevance of armadillos for leprosy in Mexico is unclear but a priority question. PMID:22997694

  15. Leprosy: a review of laboratory and therapeutic aspects - Part 2*

    PubMed Central

    Lastória, Joel Carlos; de Abreu, Marilda Aparecida Milanez Morgado

    2014-01-01

    Leprosy is a chronic infectious condition caused by Mycobacterium leprae(M. leprae). It is endemic in many regions of the world and a public health problem in Brazil. Additionally, it presents a wide spectrum of clinical manifestations, which are dependent on the interaction between M. leprae and host, and are related to the degree of immunity to the bacillus. The diagnosis of this disease is a clinical one. However, in some situations laboratory exams are necessary to confirm the diagnosis of leprosy or classify its clinical form. This article aims to update dermatologists on leprosy, through a review of complementary laboratory techniques that can be employed for the diagnosis of leprosy, including Mitsuda intradermal reaction, skin smear microscopy, histopathology, serology, immunohistochemistry, polymerase chain reaction, imaging tests, electromyography, and blood tests. It also aims to explain standard multidrug therapy regimens, the treatment of reactions and resistant cases, immunotherapy with bacillus Calmette-Guérin (BCG) vaccine and chemoprophylaxis. PMID:24937811

  16. Sensitivity and specificity of the FLA-ABS test for leprosy in Mexican populations.

    PubMed

    Amezcua, M E; Escobar-Gutiérrez, A; Mayén, E; Cázares, J V

    1987-06-01

    The epidemiological surveillance for leprosy must include several clinical and laboratory procedures. The FLA-ABS test of Abe could be a useful tool for this purpose because it allows the demonstration of an effective contact with Mycobacterium leprae. In order to establish the specificity, sensitivity, and predictability of the FLA-ABS test under Mexican conditions, we studied sera collected from six groups of individuals: 60 healthy donors from a nonendemic area, 57 cases hospitalized for conditions other than infectious diseases from a general hospital in a nonendemic area, 72 patients with active pulmonary tuberculosis, 26 healthy individuals from an endemic area, 100 patients with polar lepromatous leprosy (LLp), and 123 household contacts of patients with LLp. The FLA-ABS test was negative with sera from the first four groups. Strong positive reactions were found in all LLp patients except one; the false-negative results could be attributed to successful treatment and a long-standing cure in this patient. Analysis of these results shows 100% specificity, 99% sensitivity, and predictability values of the test of 100% for positive results and 99% for negative ones. In addition, none of the 20 randomly selected sera from LLp patients were positive with crossreacting mycobacteria. Because 87.8% of the household contacts were positive in the absence of clinical manifestations of leprosy, it is possible to conclude that a positive result by itself is not enough to establish an early diagnosis of the disease, especially among inhabitants of endemic areas.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3298474

  17. [The stigma in the social representation of leprosy].

    PubMed

    Romero-Salazar, A; Parra, M C; Moya-Hernández, C; Rujano, R; Salas, J

    1995-01-01

    Social representation of leprosy in active patients under medical control is made up elements that come from the medical discourse and also from the discourse that about this disease circulates in society. This syncretism is expressed in each context a specific way on the components of the representation notion, beliefs, attitudes and behaviors - making of it a complex reality. On account of beliefs importance, whose depth and roots are linked to the thousand of years this disease has been known and to the seclusion practices in force till recent times, it would be comprehensible the predominance of elements related to common sense or popular knowledge. Nevertheless, as the representation is a collective construction, its fundamental features would be defined according to the specific characteristics of the group. To this respect, the main finding of this research referred to: first, the limited knowledge around this disease and the existence of beliefs and inadequated attitudes for controlling programs of active patients registered in the Maracaibo Service of Sanitary Dermatology located in Venezuela (Servicio de Dermatologia Sanitaria de Maracaibo (SDSMJ, Venezuela); second, a predominance of a congnitive dimension of representation, notions and beliefs relate to the role of fortune and fate, sexual promiscuity or heritage in the contagion; third, a patient's tendency to reproduce a disqualified stereotype and hide the disease due to an exaggerated rejection fear.

  18. Factors Contributing to the Delay in Diagnosis and Continued Transmission of Leprosy in Brazil – An Explorative, Quantitative, Questionnaire Based Study

    PubMed Central

    Henry, Mary; GalAn, Noêmi; Teasdale, Katherine; Prado, Renata; Amar, Harpreet; Rays, Marina S.; Roberts, Lesley; Siqueira, Pedro; de Wildt, Gilles; Virmond, Marcos; Das, Pranab K.

    2016-01-01

    Background Leprosy is a leading cause of preventable disability worldwide. Delay in diagnosis of patients augments the transmission of infection, and allows progression of disease and more severe disability. Delays in diagnosis greater than ten years have been reported in Brazil. To reduce this delay, it is important to identify factors that hinder patients from presenting to doctors, and those that delay doctors from diagnosing patients once they have presented. This study aimed to explore factors associated with the delayed diagnosis of leprosy in Brazil. Methodology/ Principal Findings This is an exploratory study using a self-constructed questionnaire delivered to patients attending three leprosy referral clinics across three states in Brazil. Data were analysed to determine associations between variables and the time taken for participants to present to the health-service, and between variables and the time taken for doctors to diagnose participants once they had presented. Participants who suspected they had leprosy but feared community isolation were 10 times more likely to wait longer before consulting a doctor for their symptoms (OR 10.37, 95% CI 2.18–49.45, p = 0.003). Participants who thought their symptoms were not serious had a threefold greater chance of waiting longer before consulting than those who did (OR 3.114, 95% CI 1.235–7.856, p = 0.016). Forty-two point six per cent of participants reported initially receiving a diagnosis besides leprosy. These had a three times greater chance of receiving a later diagnosis of leprosy compared to those not misdiagnosed or not given a diagnosis (OR 2.867, 95% CI 1.288–6.384, p = 0.010). Conclusions/ Significance This study implies a need for patient education regarding leprosy symptoms and the reduction of stigma to encourage patients to present. The high rate of misdiagnosis reported suggests a need to increase clinician suspicion of leprosy. Further education regarding disease symptoms in medical

  19. Leprosy and stigma in the context of international migration.

    PubMed

    White, Cassandra

    2011-06-01

    If it can be argued that no single attribute or condition (leprosy included) is inherently or universally considered to be 'deeply discrediting,' to quote Goffman, then we must consider how external factors shape stigma associated with that condition in different cultural and socioeconomic contexts. Often, an analysis of what is perceived to be stigma towards people affected by leprosy uncovers other prejudices or stigmatising attitudes associated with class, gender, and/or ethnic inequalities in that society. The movement of people across international borders adds new dimensions to the experience of leprosy, as affected individuals confront different sets of understandings of the disease among healthcare professionals, friends, family, and employers in host and sending countries. Preconceptions of the immigrant 'other' in host countries may be bound up with notions of disease and danger, further complicating the experience of leprosy treatment for immigrants. Drawing on the work of others and on early stage qualitative research on leprosy among Brazilian immigrants to the United States, this paper will consider the ways in which immigration and transnational processes could affect the experience of stigma among immigrants affected by leprosy. PMID:21888139

  20. A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy

    PubMed Central

    Mani, Mohan Zachariah; Kanish, Bimal; Kwatra, Kanwardeep; Chaudhary, Paulina R.; Bhatia, Anuradha

    2015-01-01

    We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection. PMID:26692613

  1. A case of secondary syphilis with HIV, resembling borderline lepromatous leprosy.

    PubMed

    Mani, Mohan Zachariah; Kanish, Bimal; Kwatra, Kanwardeep; Chaudhary, Paulina R; Bhatia, Anuradha

    2015-01-01

    We are reporting an unusual case of secondary syphilis, in a homosexual male patient, which resembled borderline lepromatous leprosy, and in whom the diagnosis was considered on clinical grounds. The patient also had concomitant HIV infection, with asymptomatic neurosyphilis. His rapid plasma reagin test was reactive in 1:128 dilution. He improved with three standard, weekly injections of benzathine penicillin, along with 2 g of intravenous ceftriaxone daily for 15 days. This case is being reported to highlight the need for a high index of suspicion in diagnosing unusual cases of secondary syphilis, especially in those with concomitant HIV infection. PMID:26692613

  2. Evaluation of surgical treatments for leprosy sequelae using the Salsa and Dash scales☆☆☆

    PubMed Central

    Pinho, Adriano Bastos; Borghesan, Flaviano Henrique Pelloso; Lotufo, Marcelo Neves; Allet, Maurício de Araújo

    2014-01-01

    Objective to compare the SALSA and risk awareness scales with the DASH scale in assessments on leprosy surgery. Method before the operation and 90 days afterwards, we applied the tests to 14 patients (11 females and three males) of ages from 28 to 67 years, who were operated between November 2011 and May 2012. Results the patients were evaluated after the operation using the SALSA and DASH scales, to measure their relationships and results. Conclusion despite the small sample, this study showed that there were similar relationships of results between the SALSA/risk awareness and DASH scales. PMID:26229815

  3. Clinical and histopathological evaluation of the effect of addition of immunotherapy with Mw vaccine to standard chemotherapy in borderline leprosy.

    PubMed

    Kamal, R; Natrajan, M; Katoch, K; Arora, M

    2012-01-01

    This study reports detailed analysis of clinical parameters and clearance of granuloma in borderline leprosy patients treated with immunotherapy and chemotherapy. It aims to assess the additive effect of immunotherapy (Mwvaccine) with standard MDT on clinical status of untreated borderline leprosy cases and on granuloma fraction of untreated borderline leprosy cases. Patients attending the OPD were serially recruited in two groups. A total of 150 cases in one treatment (trial) group (Mw vaccine plus MDT) and 120 cases in another treatment (control) group (MDT only) of border line leprosy have been included. After the formal written consent, detailed clinical examination, charting, smear examination of all untreated borderline patients of both groups was done, biopsies were taken from the active lesions of all patients of both groups at start of therapy and every six month thereafter till the completion of therapy. The same procedure was repeated every six months during the follow-up period. Standard MDT was given to all the patients of both groups according to type of disease. Mw vaccine 0.1 ml (0.5 x 10(9) bacilli) was injected intra-dermally at the start of therapy and every six months in addition to chemotherapy to the treatment group. The BT cases were followed up after 6 doses of MDT and 2 doses of Mw vaccine, and, the BB, BL cases were followed up after 24 doses of MDT plus 5 doses of Mw vaccine. Clinically, greater and faster improvement was observed in all the clinical parameters, faster attainment of smear negativity and two episodes of lepra reaction occurred in cases treated with combined chemotherapy and immunotherapy, as compared to controls (chemotherapy alone) wherein clinical improvement was slower in all parameters, slower attainment of smear negativity in bacillary index and seven showed the occurrence of reactions, histipathologically in addition to more rapid clearance of granuloma in immunotherapy treated group, a significant finding was an

  4. Mycobacterium haemophilum infection with prominent facial manifestation mimicking leprosy.

    PubMed

    Ishii, Kentaro; Ishii, Norihisa; Nakanaga, Kazue; Nakano, Kazuaki; Saito, Ikuo; Asahina, Akihiko

    2015-10-01

    Mycobacterium haemophilum is a slow-growing non-tuberculous mycobacterium that is rarely known to cause human skin infection, particularly in immunocompromised patients. We recently experienced a 69-year-old Japanese woman with this infection who had been under immunosuppressive treatment for recalcitrant rheumatoid arthritis. The patient showed disseminated erythematous plaques and subcutaneous nodules on the face and extremities, and interestingly, the face manifested with a striking "facies leontina" appearance. Biopsy revealed abscess and granulomatous dermatitis with the involvement of peripheral nerve bundles and the presence of innumerable acid-fast bacilli, thus necessitating differentiation from lepromatous leprosy. M. haemophilum was identified by molecular characterization as well as by successful culture with iron supplements. Although drug susceptibility testing indicated responsiveness to multiple antibiotics administrated simultaneously for the treatment, it took over 6 months to achieve significant improvement, and we also employed concurrent oral potassium iodide administration and repeated surgical excision. This case highlights the importance of continuous combination therapy for successful outcome in this rare infection. Furthermore, application of potassium iodide for mycobacterial infection warrants further evaluation by accumulating more cases. PMID:26017241

  5. Studies on T cell subsets and functions in leprosy.

    PubMed Central

    Bach, M A; Chatenoud, L; Wallach, D; Phan Dinh Tuy, F; Cottenot, F

    1981-01-01

    T cell subsets and T cell functions were explored in 31 leprosy patients with the following methods: determination of the percentages of the different T cell subpopulations defined by monoclonal antibodies directed at total T cells, helper T cells and suppressor/cytotoxic T cells; measurement of the in vitro proliferative responses to mitogens; study of the concanavalin A-induced suppressive activity, assessed on MLC; measurement of delayed-type hypersensitivity by skin testing. The confrontation between immunological lepromatous patients without type-2 reaction (erythema nodosum leprosum), (2) lepromatous patients without ENL (erythema nodosum leprosum), (2) lepromatous patients was recent ENL and (3) tuberculoid patients. Unexpectedly, groups 1 and 3, although differing strongly in their clinical status and their sensitivity to lepromin (absent in group 1 and strong in group 3), showed a similar immunological profile with a normal percentage of T cells and a normal distribution of T cells among the major T cell subset contrasting with a moderate decrease of proliferative responses to mitogens and impaired delayed-type hypersensitivity reactions. Concanavalin A-induced suppressive activity was type-2 reaction) strongly differed from both other groups, showing striking abnormalities other groups, showing striking abnormalities of the repartition of the T cell subsets, with increased percentages of helper T cells and decreased percentages of suppressor T cells, and elevated proliferative responses to mitogens. Concanavalin A-induced suppressive activity was reduced in most patients of this group. It is suggested that this imbalance between T cell subsets contributes to the occurrence of ENL reactions in lepromatous patients. PMID:6459897

  6. Treatment of Peripheral Neuropathy in Leprosy: The Case for Nerve Decompression.

    PubMed

    Wan, Eric L; Rivadeneira, Andres F; Jouvin, Renato Martinez; Dellon, A Lee

    2016-03-01

    Plastic surgery has a tradition of caring for patients with facial deformity and hand deformity related to leprosy. The approach, however, to the progressive deformity and disability related to chronic nerve compression is underappreciated in the world today. A cohort of patients with leprous neuropathy from an indigenous area of leprosy in Ecuador was evaluated for the presence of chronic peripheral nerve compression, and 12 patients were chosen for simultaneous upper and lower extremity, unilateral, nerve decompression at multiple levels along the course of each nerve. The results at 1 year of follow-up show that 6 patients improved into the excellent category and 4 patients improved into the good category for improved function. Based on the early results in this small cohort of patients with leprous neuropathy, an approach to peripheral nerve decompression, encompassing the concept of multiple crush at multiple levels of each nerve, seems to offer optimism to improve upper and lower extremity limb function. Long-term studies with quality-of-life outcomes would be welcome. PMID:27257567

  7. Should household contact examination in a low endemic situation of leprosy continue?

    PubMed

    Chen, Shumin; Zhang, Lin; Liu, Diangchang; Liu, Bing

    2003-06-01

    After more than 40 yrs of effort, leprosy is finally under control in Shandong province with only 50 to 70 new cases detected each year in the past 10 yrs. Contact examination is still compulsory and household contacts will be followed for 5 to 10 yrs, as directed by the guidelines of the national leprosy control program. In order to assess the value of contact examination in terms of case finding in a low endemic situation of leprosy in Shandong, we analyzed the data regarding all newly diagnosed leprosy cases in the past 11 yrs using the data abstracted from the national leprosy recording and reporting system, and a questionnaire-based survey to see how many incident leprosy cases would be detected if we followed the policy for contact examination of leprosy in Shandong. The results showed that 252 out of 547 leprosy cases diagnosed from 1990 to 2001 reported they had contact with different categories of primary leprosy cases. Among them, 90 cases had household primary leprosy cases. The mean incubation of the 252 index cases was 23 yrs. If we followed the national policy for contact tracing for 5 or 10 yrs, then only 12 (13.3%) and 10 (11.1%) of the 90 cases whose source of infection was household contacts would have been detected, respectively. Therefore, other approaches should be sought, in order to detect the few incident leprosy cases as early as possible in such a low endemic situation of leprosy in Shandong. PMID:12914131

  8. Decreased Cutaneous Resonance Running Time in Cured Leprosy Subjects

    PubMed Central

    Song, S.P.; Elias, P.M.; Lv, C.Z.; Shi, Y.J.; Guang, P.; Zhang, X.J.; Feingold, K.R.; Man, M.Q.

    2009-01-01

    Background/Objectives Leprosy prominently involves both the skin and peripheral neural tissues and some symptoms persist after microbial cure. Because alterations in the dermis also occur in leprosy, we assessed here whether there were changes in cutaneous resonance running time (CRRT), a parameter that is influenced by collagen properties, in cured leprosy subjects. Methods A reviscometer was used to measure the CRRT at various directions on the dorsal hand and the flexural forearms of 76 cured leprosy subjects aged 50–85 years and 68 age-matched normal subjects. Results In comparison to normal subjects, CRRTs on the hands and the forearms were significantly reduced in all directions in cured leprosy, except at the 1–7, 2–8 and 3–9 o'clock directions on the forearms. CRRTs were reduced significantly at both the 4–10 and 5–11 o'clock directions on the forearm in lepromatous (73.33 ± 4.19 at 4–10 o'clock and 67.44 ± 2.71 at 5–11 o'clock direction) and borderline lepromatous types (77.58 ± 5.84 at 4–10 o'clock and 79.85 ± 6.81 at 5–11 o'clock direction) as compared with normal (143.10 ± 7.75 at 4–10 o'clock and 125.18 ± 8.14 at 5–11 o'clock direction). On the hand, CRRTs at all directions, except that at 4–10 o'clock direction, were also significantly reduced in lepromatous and borderline lepromatous types in comparison with normal. Significant differences in CRRT at some directions were found among the various subtypes of leprosy. Conclusion CRRTs were abnormal in the cured leprosy subjects as a whole, but varied with leprosy subtypes, which suggested that the extent of reduction of CRRTs correlates with the severity of immune alteration. These results suggest that CRRT measurements could be a useful approach to quantify the extent of some residual abnormalities in cured leprosy and perhaps could also be used to evaluate the efficacy of treatment. PMID:19648783

  9. The Burden of Leprosy in Cameroon: Fifteen Years into the Post-elimination Era

    PubMed Central

    Tabah, Earnest Njih; Nsagha, Dickson Shey; Bissek, Anne-Cecile Zoung-Kanyi; Bratschi, Martin W.; Njamnshi, Theophilus Ngeh; Plushke, Gerd; Njamnshi, Alfred Kongnyu

    2016-01-01

    Background Cameroon achieved the elimination target of leprosy in 2000, and has maintained this status ever since. However, a number of health districts in the country continue to report significant numbers of leprosy cases. The aim of this study was to assess the burden of leprosy in Cameroon from 2000 to 2014. Methods We obtained and analysed using the new leprosy burden concept of analysis, leprosy surveillance data collected between 2000 and 2014 from the National Leprosy Control Programme. Principal findings Cameroon achieved leprosy elimination in 2000, registering a prevalence rate of 0.94/10,000 population. The prevalence rate dropped further to reach 0.20/10,000 population (78% reduction) in 2014. Similarly, the new case detection rate dropped from 4.88/100,000 population in 2000 to 1.46/100,000 population (85.3% reduction) in 2014. All 10 regions of the country achieved leprosy elimination between 2000 and 2014; however, 10 health districts were still to do so by 2014. The number of high-leprosy-burden regions decreased from 8 in 2000 to 1 in 2014. Seven and two regions were respectively medium and low-burdened at the end of 2014. At the health districts level, 18 remained at the high-leprosy-burdened level in 2014. Conclusion The leprosy prevalence and detection rates as well as the overall leprosy burden in Cameroon have dropped significantly between 2000 and 2014. However, a good number of health districts remain high-leprosy-burdened. The National Leprosy Control Programme should focus efforts on these health districts in the next coming years in order to further reduce the burden of leprosy in the country. PMID:27732603

  10. [Perceptions regarding leprosy and resulting handicaps prior to diagnosis in Recife, Brazil].

    PubMed

    Feliciano, K V; Kovacs, M H; Sevilla, E; Alzate, A

    1998-05-01

    This article reports on a case-control study conducted in Recife, Brazil, between November 1993 and July 1994, to determine how leprosy patients' perceptions and notions influence disease management and use of health services. The sample was composed of 183 residents of Recife between the ages of 20 and 70 years who sought diagnostic services in the dermatology clinics of two referral centers situated in the third, fourth, and sixth political and administrative regions. Sixty-four patients having handicaps or their precursor lesions were classified as cases; the remaining 119 were used as controls. All were diagnosed during the study period. For the analysis, adjustments were made for sex, age, schooling, and a previous history of Hansen's disease among patients. The study revealed the simultaneous presence of two types of "invisibility" of the disease in an area where endemicity is increasing: 1) for patients in both groups, the low frequency of spontaneous explanatory models related to the illness, even in the presence of disease, and 2) for health professionals, the limitations of detection methods. Since such deficiencies affect decisions bearing on individual and collective disease management, they are a risk factor in and of themselves and stand in the way of eliminating leprosy as a public health problem.

  11. The armadillo as a model for peripheral neuropathy in leprosy.

    PubMed

    Truman, Richard W; Ebenezer, Gigi J; Pena, Maria T; Sharma, Rahul; Balamayooran, Gayathriy; Gillingwater, Thomas H; Scollard, David M; McArthur, Justin C; Rambukkana, Anura

    2014-01-01

    Leprosy (also known as Hansen's Disease) is a chronic infectious disease caused by Mycobacterium leprae that primarily targets the peripheral nervous system; skin, muscle, and other tissues are also affected. Other than humans, nine-banded armadillos (Dasypus novemcinctus) are the only natural hosts of M. leprae, and they are the only laboratory animals that develop extensive neurological involvement with this bacterium. Infection in the armadillo closely recapitulates many of the structural, physiological, and functional aspects of leprosy seen in humans. Armadillos can be useful models of leprosy for basic scientific investigations into the pathogenesis of leprosy neuropathy and its associated myopathies, as well as for translational research studies in piloting new diagnostic methods or therapeutic interventions. Practical and ethical constraints often limit investigation into human neuropathies, but armadillos are an abundant source of leprotic neurologic fibers. Studies with these animals may provide new insights into the mechanisms involved in leprosy that also might benefit the understanding of other demyelinating neuropathies. Although there is only a limited supply of armadillo-specific reagents, the armadillo whole genomic sequence has been completed, and gene expression studies can be employed. Clinical procedures, such as electrophysiological nerve conduction testing, provide a functional assessment of armadillo nerves. A variety of standard histopathological and immunopathological procedures including Epidermal Nerve Fiber Density (ENFD) analysis, Schwann Cell Density, and analysis for other conserved cellular markers can be used effectively with armadillos and will be briefly reviewed in this text. PMID:24615444

  12. Inheritance and heritability of resistance to citrus leprosis.

    PubMed

    Bastianel, Marinês; de Oliveira, Antonio Carlos; Cristofani, Mariângela; Filho, Oliveiro Guerreiro; Freitas-Astúa, Juliana; Rodrigues, Vandeclei; Astúa-Monge, Gustavo; Machado, Marcos Antônio

    2006-10-01

    ABSTRACT The genetic inheritance of resistance to leprosis, the most important viral disease of citrus in Brazil, was characterized through the phenotypic assessment of 143 hybrids resulting from crosses between tangor 'Murcott' (Citrus sinensis x C. reticulata) and sweet orange 'Pêra' (C. sinensis), considered to be resistant and susceptible to the disease, respectively. All plants were grafted onto Rangpur lime (C. limonia) and inoculated with Citrus leprosis virus, cytoplasmic type through the infestation with viruliferous mites, Brevipalpus phoenicis. The experiments were arranged in a completely randomized block design with 10 replicates. Incidence and severity of the disease in leaves and stems as well as plant growth parameters (plant height and stem diameter) were recorded for 3 years after the infestation with the viruliferous mites. The average values of all variables were analyzed using principal component analysis, discriminant factorial analysis, estimation of the clonal repeatability coefficients, and frequency of the distributions of the average values for each measured variable. The principal component analysis resulted in the identification of at least two groups with resistance and susceptibility to leprosis, respectively. About 99% of all hybrids were correctly classified according to the discriminant factorial analysis. The broad-sense heritability coefficients for characteristics associated with incidence and severity of leprosis ranged from 0.88 to 0.96. The data suggest that the inheritance of resistance to leprosis may be controlled by only a few genes. PMID:18943497

  13. Geographic determinants of leprosy in Karonga District, Northern Malawi.

    PubMed

    Sterne, J A; Pönnighaus, J M; Fine, P E; Malema, S S

    1995-12-01

    Researchers do not understand how geographical differences relate to the risk of contracting leprosy. The study of such differences, however, may provide clues about the natural history of the disease. The authors report findings from an analysis of the geographical distribution of leprosy in Karonga District, a rural area in Northern Malawi, between 1979 and 1989. Findings are based data from two total population surveys. The areas of residence were determined using aerial photographs, which allowed the identification of households, roads, rivers, and the lake shore. Analysis revealed that incidence rates were 2-3 times higher in the north compared to the south of the district, and lowest in the semi-urban district capital. The north has higher rainfall and more fertile soil. There was no overall association between the incidence of leprosy and population density, although the highest rates were observed in the least densely populated areas. Considering the entire district, incidence rates increased with increasing distance from a main road, but declined with increasing distance from a river or from the shore of Lake Malawi. This negative association with proximity to rivers may reflect the larger number of rivers in the north of the district. Apparent differences in incidence rates between groups speaking different languages reflected confounding by area of residence. The authors conclude that there is a marked variation, not explained by socioeconomic or cultural factors, in the incidence of leprosy within Karonga District. These results are consistent with literature which associates the environment, especially proximity to water, with leprosy.

  14. First genetic evidence of leprosy in early medieval Austria.

    PubMed

    Gausterer, Christian; Stein, Christina; Teschler-Nicola, Maria

    2015-04-01

    Leprosy used to be a widespread, dreaded disease in Europe during the middle ages, and it still remains an important health problem in some parts of the world today. Herein, we present data on the earliest 'Austrian' (an adult female from the early medieval period) proven to have suffered from leprosy. Manifestations of the disease were first identified during a systematic screening of pathological changes in skeletons recovered from an archaeological site in Pottenbrunn (Lower Austria). In the present study, DNA extracts from selected cranial and postcranial bone samples were investigated using polymerase chain reaction primers specific to the Mycobacterium leprae (M. leprae) repetitive element (RLEP). M. leprae traces were detected in extracts from nasal and palatine bones. Sequence analysis of informative polymorphic sites supports previous reports indicating that European M. leprae strains fall into single nucleotide polymorphism group 3. In summary, these findings put Austria on the map of confirmed leprosy cases in ancient Europe.

  15. First genetic evidence of leprosy in early medieval Austria.

    PubMed

    Gausterer, Christian; Stein, Christina; Teschler-Nicola, Maria

    2015-04-01

    Leprosy used to be a widespread, dreaded disease in Europe during the middle ages, and it still remains an important health problem in some parts of the world today. Herein, we present data on the earliest 'Austrian' (an adult female from the early medieval period) proven to have suffered from leprosy. Manifestations of the disease were first identified during a systematic screening of pathological changes in skeletons recovered from an archaeological site in Pottenbrunn (Lower Austria). In the present study, DNA extracts from selected cranial and postcranial bone samples were investigated using polymerase chain reaction primers specific to the Mycobacterium leprae (M. leprae) repetitive element (RLEP). M. leprae traces were detected in extracts from nasal and palatine bones. Sequence analysis of informative polymorphic sites supports previous reports indicating that European M. leprae strains fall into single nucleotide polymorphism group 3. In summary, these findings put Austria on the map of confirmed leprosy cases in ancient Europe. PMID:25007893

  16. Leprosy: ancient disease remains a public health problem nowadays*

    PubMed Central

    Noriega, Leandro Fonseca; Chiacchio, Nilton Di; Noriega, Angélica Fonseca; Pereira, Gilmayara Alves Abreu Maciel; Vieira, Marina Lino

    2016-01-01

    Despite being an ancient disease, leprosy remains a public health problem in several countries - particularly in India, Brazil and Indonesia. The current operational guidelines emphasize the evaluation of disability from the time of diagnosis and stipulate as fundamental principles for disease control: early detection and proper treatment. Continued efforts are needed to establish and improve quality leprosy services. A qualified primary care network that is integrated into specialized service and the development of educational activities are part of the arsenal in the fight against the disease, considered neglected and stigmatizing. PMID:27579761

  17. Leprosy: ancient disease remains a public health problem nowadays.

    PubMed

    Noriega, Leandro Fonseca; Chiacchio, Nilton Di; Noriega, Angélica Fonseca; Pereira, Gilmayara Alves Abreu Maciel; Vieira, Marina Lino

    2016-01-01

    Despite being an ancient disease, leprosy remains a public health problem in several countries -particularly in India, Brazil and Indonesia. The current operational guidelines emphasize the evaluation of disability from the time of diagnosis and stipulate as fundamental principles for disease control: early detection and proper treatment. Continued efforts are needed to establish and improve quality leprosy services. A qualified primary care network that is integrated into specialized service and the development of educational activities are part of the arsenal in the fight against the disease, considered neglected and stigmatizing. PMID:27579761

  18. Diffuse leprosy with “deck-chair” sign

    PubMed Central

    Shenoy, M. Manjunath; Bendigeri, Mukhtar Ahmed; Kamath, Prshanth R.; Vishal, B.

    2015-01-01

    A 55-year-old male presented with asymptomatic extensive skin lesions since one year. He was found to have diffuse lesions involving the face, trunk, arms, and thighs along with symmetric peripheral nerve thickening. Bacteriological and histopathological examination confirmed lepromatous leprosy. There was a conspicuous sparing of the abdominal creases and axillae from the infiltrative lesions suggesting a positive “deck-chair” sign. This sign has been described in the past with papulo-erythroderma of Ofuji and certain other disorders. Leprosy may be now included among the causes of “deck-chair” sign. PMID:26009719

  19. Misericordia and leprosy in the 20th century.

    PubMed

    Grzybowski, Andrzej; Sak, Jarosław; Korecki, Krzysztof

    2016-01-01

    Leprosy, which in particular affects poor people of developing countries, was also a challenge for social and charitable activities. This was possible due to the engagement of "great community workers," people who devoted their professional and family life, passions, and their own material goods to conduct socio-medical activities among leprosy affected persons. This contribution discusses the work of the lepro-activists of international fame, Albert Schweitzer and Mother Teresa of Calcutta, as well as those who are less well known, Wanda Maria Błeńska and Marian Żelazek. PMID:26773618

  20. Diabetic foot--what can we learn from leprosy? Legacy of Dr Paul W. Brand.

    PubMed

    Boulton, Andrew J M

    2012-02-01

    Leprosy and diabetes, though two very different conditions, may both result in severe loss of sensation in the feet, which are then a great risk of painless injury and ulceration. Seminal observations made by the late Dr Paul W. Brand, a surgeon working with leprosy patients in South India in the mid-20th century, resulted in the subsequent development of treatments to manage insensitive foot ulcers that are today entirely applicable to patients with diabetes. As a consequence of his research, the recognition of the relationship between insensitivity, repetitive pressures and skin breakdown has helped our understanding of the aetiopathogenesis of neuropathic foot lesions in diabetes: the development of the total contact cast and other casting devices to treat such lesions forms the basis of management of diabetic foot lesions with off-loading devices that are widely used in the 21st century in diabetic foot clinics around the world. Moreover, observations by Brand that the foot 'heats up before it breaks down' resulted in more recent research showing that self-skin temperature monitoring might help reduce the incidence of recurrent neuropathic foot ulcers in diabetes. In summary, Brand's understanding of 'the gift of pain' that, when lost, results in the late complications of diabetic neuropathy has guided the prevention, diagnosis and management of diabetic foot problems in the 21st century.

  1. Identification and molecular characterization of nuclear Citrus leprosis virus, an unassigned Dichorhavirus genus member associated with citrus leprosis disease in Mexico

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis is a difficult viral disease causing significant damage to citrus fruit in South America and Central America. The disease is marked by dramatic lesions on fruit, leaves and stems resulting in unmarketable product. Citrus leprosis virus cytoplasmic type (CiLV-C) was detected in states...

  2. Disease and disease control. International Leprosy Congress, Beijing, 7-12 September 1998. Workshop report.

    PubMed

    Smith, W C

    1999-03-01

    Four workshops were conducted during the congress under the disease control theme. The workshops were on the issues of defining disease and antibacterial therapy, early case detection, sustaining leprosy control in low endemic situations, and the prevention of disability. These workshops spanned the spectrum of disease and its consequences through from early detection, the definition of disease to the prevention of disability. All of these topics being important contemporary issues challenging leprosy control programmes world wide. Despite the broad spectrum of the topics it was interesting to see that a number of important themes emerged which were common to all topics. It is possible to identify five major themes arising from the output of the workshops which are now described below. Each of the workshops adopted broad and comprehensive approaches to their topic. In the past, there has been narrowness in defining disease in terms of the need for chemotherapy. The approach taken in the workshop now is for a much more comprehensive approach looking at all the consequences of the disease process rather than the requirement for antibacterial chemotherapy. Similarly broad approaches were taken to low endemic situations, considering comprehensive approaches which are inclusive rather than exclusive. Disability prevention also continues this same theme of comprehensive approaches based on multidisciplinary involvement in prevention of the consequences of the disease process. The second major theme to be identified in the output of the workshops was the importance of relevance to patients and people affected by leprosy. It is no longer adequate to view programmes in terms of their acceptance to those running the programmes. Control programmes must be acceptable to the people they are designed to benefit. This even impacts on definitions of disease in terms of what matters to patients rather than only restricting this to disease pathology. Similarly, approaches to

  3. The first international leprosy conference, Berlin, 1897: the politics of segregation.

    PubMed

    Pandya, S S

    2004-01-01

    The present paper examines the first attempts to internationalise the problem of leprosy, a subject hitherto overlooked by historians of imperialism and disease. The last decade of the nineteenth century saw many in the civilised countries of the imperialist West gripped by a paranoia about an invasion of leprosy via germ-laden immigrants and returning expatriates who had acquired the infection in leprosy endemic colonial possessions. Such alarmists clamoured for the adoption of vigorous leper segregation policies in such colonies. But the contagiousness of leprosy did not go unquestioned by other westerners. The convocation in Berlin of the first international meeting on leprosy revealed the interplay of differing and sometimes incompatible views about the containment of leprosy by segregation. The roles of officials from several countries, as well as the roles of five protagonists (Albert Ashmead, Jules Goldschmidt, Edvard Ehlers. Armauer Hansen, and Phineas Abraham) in the shaping of the Berlin Conference are here examined.

  4. New Insights into the Geographic Distribution of Mycobacterium leprae SNP Genotypes Determined for Isolates from Leprosy Cases Diagnosed in Metropolitan France and French Territories

    PubMed Central

    Reibel, Florence; Chauffour, Aurélie; Brossier, Florence; Jarlier, Vincent; Cambau, Emmanuelle; Aubry, Alexandra

    2015-01-01

    Background Between 20 and 30 bacteriologically confirmed cases of leprosy are diagnosed each year at the French National Reference Center for mycobacteria. Patients are mainly immigrants from various endemic countries or living in French overseas territories. We aimed at expanding data regarding the geographical distribution of the SNP genotypes of the M. leprae isolates from these patients. Methodology/Principal findings Skin biopsies were obtained from 71 leprosy patients diagnosed between January 2009 and December 2013. Data regarding age, sex and place of birth and residence were also collected. Diagnosis of leprosy was confirmed by microscopic detection of acid-fast bacilli and/or amplification by PCR of the M. leprae-specific RLEP region. Single nucleotide polymorphisms (SNP), present in the M. leprae genome at positions 14 676, 1 642 875 and 2 935 685, were determined with an efficiency of 94% (67/71). Almost all patients were from countries other than France where leprosy is still prevalent (n = 31) or from French overseas territories (n = 36) where leprosy is not totally eradicated, while only a minority (n = 4) was born in metropolitan France but have lived in other countries. SNP type 1 was predominant (n = 33), followed by type 3 (n = 17), type 4 (n = 11) and type 2 (n = 6). SNP types were concordant with those previously reported as prevalent in the patients’ countries of birth. SNP types found in patients born in countries other than France (Comoros, Haiti, Benin, Congo, Sri Lanka) and French overseas territories (French Polynesia, Mayotte and La Réunion) not covered by previous work correlated well with geographical location and history of human settlements. Conclusions/Significance The phylogenic analysis of M. leprae strains isolated in France strongly suggests that French leprosy cases are caused by SNP types that are (a) concordant with the geographic origin or residence of the patients (non-French countries, French overseas territories

  5. De Novo Histoid Leprosy: A Case Report from a Post-Elimination Area

    PubMed Central

    Bhat, Yasmeen J; Hassan, Iffat; Yaseen, Atiya; Wani, Rohi

    2015-01-01

    Histoid leprosy is an uncommon variant of lepromatous leprosy that usually follows treatment failure. Occasionally it occurs de novo without any history of previous inadequate or irregular treatment. We, hereby, report a case of de novo histoid leprosy in a 25-year-old man from the post-elimination area of Kashmir, where the prevalence rate of the disease was reported to be 0.17/10000 in March, 2013 (NLEP). PMID:25814742

  6. Type II reaction without erythema nodosum leprosum masquerading as lymphoma.

    PubMed

    Mahajan, Rahul; Dogra, Sunil; Kaur, Inderjeet; Yadav, Savita; Saikia, Uma Nahar; Budania, Anil

    2012-12-01

    Lepromatous leprosy is a multisystem disease that can involve many organ systems, with lymph nodes a common extra-cutaneous site to be affected. Rarely, multibacillary leprosy can be confused with other diseases like lymphomas and connective tissue diseases. Herein we report a patient of lepromatous leprosy with Type II lepra reaction involving lymph nodes who presented with generalised lymphadenopathy, acquired ichthyosis and constitutional symptoms but no cutaneous lesions to suggest erythema nodosum leprosum, and who was initially misdiagnosed as a case of Hodgkin's lymphoma. PMID:23614256

  7. Tuberculosis and Leprosy: Classical Granulomatous Diseases in the Twenty-First Century.

    PubMed

    Scollard, David M; Dacso, Mara M; Abad-Venida, Ma Luisa

    2015-07-01

    Leprosy and tuberculosis are chronic mycobacterial infections that elicit granulomatous inflammation. Both infections are curable, but granulomatous injury to cutaneous structures, including cutaneous nerves in leprosy, may cause permanent damage. Both diseases are major global concerns: tuberculosis for its high prevalence and mortality, and leprosy for its persistent global presence and high rate of neuropathic disability. Cutaneous manifestations of both leprosy and tuberculosis are frequently subtle and challenging in dermatologic practice and often require a careful travel and social history and a high index of suspicion.

  8. Tele-education on leprosy: evaluation of an educational strategy.

    PubMed

    Paixão, Maurício Pedreira; Miot, Hélio Amante; Wen, Chao Lung

    2009-01-01

    The purpose of this research was to evaluate educational strategies applied to a tele-education leprosy course. The curriculum was for members of the Brazilian Family Health Team and was made available through the Sao Paulo Telehealth Portal. The course educational strategy was based on a constructivist learning model where interactivity was emphasized. Authors assessed motivational aspects of the course using the WebMAC Professional tool. Forty-eight healthcare professionals answered the evaluation questionnaire. Adequate internal consistency was achieved (Cronbach's alpha = 0.79). More than 95% of queried items received good evaluations. Multidimensional analysis according to motivational groups of questions (STIMULATING, MEANINGFUL, ORGANIZED, EASY-TO-USE) showed high agreement. According to WebMAC's criteria, it was considered an "awesome course." The tele-educational strategies implemented for leprosy disclosed high motivational scores.

  9. The Meaning of Leprosy and Everyday Experiences: An Exploration in Cirebon, Indonesia

    PubMed Central

    Peters, Ruth M. H.; Dadun; Lusli, Mimi; Miranda-Galarza, Beatriz; van Brakel, Wim H.; Zweekhorst, Marjolein B. M.; Damayanti, Rita; Seda, Francisia S. S. E.; Bunders, Joske F. G.; Irwanto

    2013-01-01

    It is imperative to consider the meaning of leprosy and everyday experiences of people affected by leprosy and key persons in the community if one aims to make leprosy services more effective, which appears necessary in Indonesia given the large numbers of new cases detected annually. However, little is written in the international literature about the experiences of people currently being treated for leprosy, those cured, or other key informants. This paper analyses the narratives of the people by drawing upon in-depth interviews with 53 participants and 20 focus groups discussions. The participants were purposively selected. We provide insights into the experiences of people and the meaning they give to leprosy and highlight aspect of aetiology, spirituality, religion, darkening of the skin, and sorcery. We also examine experiences of seeking care and focused on the impact of the disease in particular on the elderly and children. In conclusion, the continued need for implementation of leprosy services in Indonesia is very evident. The diversities in people's experiences with leprosy indicate a demand for responsive leprosy services to serve the diverse needs, including services for those formally declared to be “cured.” PMID:23577037

  10. The meaning of leprosy and everyday experiences: an exploration in cirebon, indonesia.

    PubMed

    Peters, Ruth M H; Dadun; Lusli, Mimi; Miranda-Galarza, Beatriz; van Brakel, Wim H; Zweekhorst, Marjolein B M; Damayanti, Rita; Seda, Francisia S S E; Bunders, Joske F G; Irwanto

    2013-01-01

    It is imperative to consider the meaning of leprosy and everyday experiences of people affected by leprosy and key persons in the community if one aims to make leprosy services more effective, which appears necessary in Indonesia given the large numbers of new cases detected annually. However, little is written in the international literature about the experiences of people currently being treated for leprosy, those cured, or other key informants. This paper analyses the narratives of the people by drawing upon in-depth interviews with 53 participants and 20 focus groups discussions. The participants were purposively selected. We provide insights into the experiences of people and the meaning they give to leprosy and highlight aspect of aetiology, spirituality, religion, darkening of the skin, and sorcery. We also examine experiences of seeking care and focused on the impact of the disease in particular on the elderly and children. In conclusion, the continued need for implementation of leprosy services in Indonesia is very evident. The diversities in people's experiences with leprosy indicate a demand for responsive leprosy services to serve the diverse needs, including services for those formally declared to be "cured."

  11. Influence of the Brevipalpus phoenicis endosymbiont Cardinium sp. in the transmission of Citrus leprosis virus.

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis is a viral disease of significant economic and environmental impact in Brazil and some other countries in the Americas. Citrus leprosis virus (CiLV), its causal agent, is transmitted by Brevipalpus phoenicis (Acari: Tenuipalpidae), a polyphagous mite that reproduces through thelytoko...

  12. Diffuse Lepromatous Leprosy Due to Mycobacterium lepromatosis in Quintana Roo, Mexico

    PubMed Central

    Quintanilla, Marco

    2015-01-01

    A 43-year-old woman of Mayan origin from Quintana Roo, Mexico, was diagnosed with diffuse lepromatous leprosy. The etiologic bacillus was determined to be Mycobacterium lepromatosis instead of Mycobacterium leprae. This case likely represents the first report of this leprosy form and its agent in the southeastern tip of Mexico. PMID:26311856

  13. Genome assembly of citurs leprosis virus nuclear type reveals a close association with orchid fleck virus

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis is a difficult viral disease causing significant damage to citrus fruit in South America and Central America. The disease is marked by dramatic lesions on fruit, leaves and stems resulting in unmarketable product. Citrus leprosis virus cytoplasmic type (CiLV-C) was detected in states...

  14. Genome Assembly of Citrus Leprosis Virus Nuclear Type Reveals a Close Association with Orchid Fleck Virus

    PubMed Central

    Stone, Andrew; Otero-Colina, Gabriel; Wei, Gang; Choudhary, Nandlal; Achor, Diann; Shao, Jonathan; Levy, Laurene; Nakhla, Mark K.; Hollingsworth, Charla R.; Hartung, John S.; Schneider, William L.

    2013-01-01

    The complete genome of citrus leprosis virus nuclear type (CiLV-N) was identified by small RNA sequencing utilizing leprosis-affected citrus samples collected from the state of Querétaro, Mexico. The nucleotide identity and phylogenetic analysis indicate that CiLV-N is very closely related to orchid fleck virus, which typically infects Cymbidium species. PMID:23887919

  15. Communities of the afflicted: constituting leprosy through place in South India.

    PubMed

    Staples, James

    2014-01-01

    With the promotion of community-based rehabilitation (CBR) as a solution to health-related issues across the global South, leprosy colonies have long been out of vogue for nongovernmental organizations and State institutions alike. Such colonies, however, have endured. As is being increasingly recognized by those working in the leprosy field, such places have played a particular role not only in the provision of leprosy-related care but also in forging new and collective identities for people affected by leprosy that might otherwise not have been possible. In this article, I draw on ethnographic fieldwork in one such colony in coastal Andhra Pradesh, South India, and explore the values invested in it as a particular kind of place; its geographical location on the peripheries; and its architecture and layout (inspired in part by colonial sanatoriums), which have particular implications for how leprosy and its ramifications are constituted and managed.

  16. Leprosy in England and Wales 1953–2012: surveillance and challenges in low incidence countries

    PubMed Central

    Fulton, Nicholas; Anderson, Laura F; Watson, John M; Abubakar, Ibrahim

    2016-01-01

    Objective To review all notified cases of leprosy in England and Wales between 1953 and 2012. Design National surveillance study of all reported cases. Setting England and Wales. Outcome Number and characteristics of reported cases. Results During this period, a total of 1449 leprosy cases were notified. The incidence fell from 356 new cases notified between 1953 and 1962 to 139 new cases between 2003 and 2012. Where data were available, leprosy was more common in men, 15–45 year olds and those from the Indian subcontinent. There was considerable undernotification in 2001–2012. Conclusions The high level of under-reporting indicates a need for improved surveillance in the UK. Public Health England, in collaboration with the UK Panel of Leprosy opinion, has revised the UK Memorandum on Leprosy in order to provide updated guidance on diagnostic procedures, treatment, case management, contact tracing and notification. PMID:27142858

  17. Mycobacterium leprae DNA associated with type 1 reactions in single lesion paucibacillary leprosy treated with single dose rifampin, ofloxacin, and minocycline.

    PubMed

    Sousa, Ana Lucia O M; Stefani, Mariane M A; Pereira, Gisner A S; Costa, Mauricio B; Rebello, Paula F; Gomes, Maria Katia; Narahashi, Kazue; Gillis, Thomas P; Krahenbuhl, James L; Martelli, Celina M T

    2007-11-01

    Leprosy affects skin and peripheral nerves, and acute inflammatory type 1 reactions (reversal reaction) can cause neurologic impairment and disabilities. Single skin lesion paucibacillary leprosy volunteers (N = 135) recruited in three Brazilian endemic regions, treated with single-dose rifampin, ofloxacin, and minocycline (ROM), were monitored for 3 years. Poor outcome was defined as type 1 reactions with or without neuritis. IgM anti-phenolic glycolipid I, histopathology, Mitsuda test, and Mycobacterium leprae DNA polymerase chain reaction (ML-PCR) were performed at baseline. chi(2) test, Kaplan-Meir curves, and Cox proportional hazards were applied. The majority of volunteers were adults with a mean age of 30.5 +/- 15.4 years; 44.4% were ML-PCR positive. During follow-up, 14.8% of the patients had a poor clinical outcome, classified as a type 1 reaction. Older age (> or = 40 years), ML-PCR positivity, and lesion size > 5 cm were associated with increased risk. In multivariate analysis, age (> or = 40 years) and ML-PCR positivity remained baseline predictors of type 1 reaction among monolesion leprosy patients.

  18. Serological responses to prednisolone treatment in leprosy reactions: study of TNF-α, antibodies to phenolic glycolipid-1, lipoarabinomanan, ceramide and S100-B

    PubMed Central

    2014-01-01

    Background Corticosteroids have been extensively used in the treatment of immunological reactions and neuritis in leprosy. The present study evaluates the serological response to steroid treatment in leprosy reactions and neuritis. Methods Seven serological markers [TNF-α, antibodies to Phenolic glycolipid-1 (PGL-1 IgM and IgG), Lipoarabinomannan (LAM IgG1 and IgG3), C2-Ceramide and S100 B] were analyzed longitudinally in 72 leprosy patients before, during and after the reaction. At the onset of reaction these patients received a standard course of prednisolone. The levels of the above markers were measured by Enzyme linked immunosorbent assay (ELISA) and compared with the individuals own value in the month prior to the reaction and presented as percentage increase. Results One month before the reaction individuals showed a varying increase in the level of different markers such as TNF-α (53%) and antibodies to Ceramide (53%), followed by to PGL-1 (51%), S100B (50%) and LAM (26%). The increase was significantly associated with clinical finding of nerve pain, tenderness and new nerve function impairment. After one month prednisolone therapy, there was a fall in the levels [TNF-α (60%), C2-Ceramide (54%), S100B (67%), PGL-1(47%) and LAM (52%)] with each marker responding differently to steroid. Conclusion Reactions in leprosy are inflammatory processes wherein a rise in set of serological markers can be detected a month before the clinical onset of reaction, some of which remain elevated during their action and steroid treatment induces a variable fall in the levels, and this forms the basis for a variable individual response to steroid therapy. PMID:25070345

  19. Impact of leprosy on the quality of life.

    PubMed Central

    Joseph, G. A.; Rao, P. S.

    1999-01-01

    Leprosy is considered by many as not merely a medical condition, but as a condition encompassing psychological, socioeconomic and spiritual dimensions that dehabilitate an individual progressively, unless properly cared for. The present study was undertaken to document the nature and extent of decreases in the quality of life (QOL) of an affected person. The World Health Organization questionnaire on quality of life was given to a representative random sample of 50 leprosy-affected persons and 50 unaffected individuals in the Bommasamudram Taluk of Chittoor District, Andhra Pradesh, India. This questionnaire explores the following six domains; physical; psychological; level of independence; social relationships; spiritual; and environmental. The mean QOL score of the cases was significantly lower than that of the controls with the exception of the spiritual domain. The mean total score for women was higher than that of males in each domain and age group. Males with deformities had a significantly lower score than those with no visible deformities. Although the scores for females with deformities were also lower than those without deformities, the differences were not statistically significant. Analyses of economic status versus the QOL scores clearly showed that they were positively correlated. The study revealed that quality of life decreased progressively in leprosy-affected persons. Women had a better QOL score than men in almost every domain. Given the secondary role of women in Indian rural society, this may simply imply an acceptance of their situation. The findings are discussed in comparison with other diseases and in the context of a poor socioeconomic environment. With modern amenities, better education and higher expectations, the perception of an individual regarding his or her own quality of life is bound to change. The need for frequent assessments and further studies along these lines is emphasized. PMID:10427937

  20. The discovery of the causes of leprosy: A computational analysis

    SciTech Connect

    Corruble, V.; Ganascia, J.G.

    1996-12-31

    The role played by the inductive inference has been studied extensively in the field of Scientific Discovery. The work presented here tackles the problem of induction in medical research. The discovery of the causes of leprosy is analyzed and simulated using computational means. An inductive algorithm is proposed, which is successful in simulating some essential steps in the progress of the understanding of the disease. It also allows us to simulate the false reasoning of previous centuries through the introduction of some medical a priori inherited form archaic medicine. Corroborating previous research, this problem illustrates the importance of the social and cultural environment on the way the inductive inference is performed in medicine.

  1. Biblical leprosy: an anachronism whose time has come.

    PubMed

    Kaplan, D L

    1993-03-01

    Although there is a growing consensus that biblical leprosy was indeed not Hansen's disease, there has been no agreement as to the disease or diseases described in the Bible. Biblical scholars have recently provided valuable insights regarding the interpretation of the original text on the cutaneous diseases described in Leviticus, chapter 13. It is suggested by the author that no particular cutaneous disease was meant to be implicated. Rather the passages were written to exonerate persons whose only "sin" was to have an obvious cutaneous disorder.

  2. Reactional state in lepromatous leprosy simulating Sweet's syndrome.

    PubMed

    Das, Tanima; Ghosh, Sandip; Kundu, Arup K; Maity, Anupam

    2013-11-01

    Erythema nodosum leprosum (ENL) or Type-2 lepra reaction is a manifestation of type-III hypersensitivity response, and usually occurs in certain cases of lepromatous and borderline lepromatous leprosy. ENL may present as widespread crops of erythematous, inflamed nodules and papules. Rare variants of ENL mimicking pemphigus or Sweet's syndrome (SS) have been documented. Here, we report an unusual case of persistent ENL in a 52-year-old lady, which we could diagnose with the help of skin biopsy and histopathological examination. PMID:24974510

  3. Knowledge and Attitude about Leprosy among Indian Dental Students in Faridabad

    PubMed Central

    Sharma, Ankur; Jain, Vishal; Virjee, Karim; Singh, Shilpi

    2016-01-01

    Introduction Role of dentists in prevention and sustainable care of leprosy is known. Changing leprosy scenario has led to requirement of change in leprosy education. However, knowledge and attitude of dental students on leprosy remains unknown. Aim Hence a study was conducted to assess knowledge and attitude of dental students about Leprosy. Materials and Methods A questionnaire based, cross-sectional survey was conducted among 350 undergraduate and the postgraduate dental students of two dental colleges in Faridabad, India. The score for knowledge ranged from 0 to 16 and scores for attitude ranged from 0 to 26. These scores were further coded as poor, fair and good. Results Mean knowledge score for the sample was 7.64±3.23. A total of 32.29% participants were under poor knowledge category; 57.42% had fair knowledge about Leprosy while 10.29% had good knowledge. Mean attitude score was 15.5 ± 5.98. A total of 30.57% had poor attitude scores, 42.57% had fair scores while 26.86% had good attitude scores. Univariate analysis showed year of training to be a significant predictor for knowledge level (t=7.12; p<0.001). Conclusion The results indicate need for three important changes towards Leprosy in Dentistry. These changes are need for incorporation of leprosy education in Dentistry, need for incorporation of problem based as well as evidence based learning in Dentistry integrated with general health and need for reestablishing public health programs for Leprosy utilizing dental workforce. PMID:27135001

  4. Evaluation of a sustained 7-year health education campaign on leprosy in Rufiji District, Tanzania.

    PubMed

    van den Broek, J; O'Donoghue, J; Ishengoma, A; Masao, H; Mbega, M

    1998-03-01

    To assess the impact of a 7-year intensive health education campaign about leprosy delivered by workers of the Kindwitwi Leprosy Trust to schoolchildren and general public in Rufiji District. Knowledge, attitude and beliefs towards leprosy were measured in Rufiji and compared to neighbouring Kisarawe District as control. Lessons learned from this analysis may be useful for the planning and evaluating of health education campaigns. Interview of schoolchildren, general public, community leaders, traditional healers and medical staff in both districts. A stratified randomized sampling scheme was used, with stratification for urban and rural settings. A representative sample of schoolchildren, general public, community leaders, traditional healers and medical staff in Rufiji District and in the control area of Kisarawe District was interviewed. The interviews were partly structured and partly open. The results of the interviews were analysed in the context of epidemiological leprosy data from 1985 till 1995, and demographic data of both districts. Data entry and statistical analysis was done using FileMaker Pro, Stata and Excel computer packages. We did not observe positive effects of the health education campaign on the indicators regarding early diagnosis of leprosy with less disability. Leprosy case detection was declining in both districts. We found that the campaign had a favourable impact on the knowledge and the attitude of schoolchildren in Rufiji District. We could demonstrate a relationship between increased knowledge of leprosy and a positive, less stigmatizing attitude. Knowledge of leprosy was better in Rufiji as compared to Kisarawe, but only among schoolchildren. We found indications that low level of education, rural residence, older age, female gender and Moslem religion were associated with stigmatizing attitudes and beliefs towards leprosy. Knowledge about leprosy reactions among medical staff interviewed was not optimal. The exact outcome of the

  5. Citrus leprosis and its status in Florida and Texas: past and present.

    PubMed

    Childers, C C; Rodrigues, J C V; Derrick, K S; Achor, D S; French, J V; Welbourn, W C; Ochoa, R; Kitajima, E W

    2003-01-01

    According to published reports from 1906 to 1968, leprosis nearly destroyed the Florida citrus industry prior to 1925. This was supported with photographs showing typical leprosis symptoms on citrus leaves, fruit, and twigs. Support for the past occurrence of citrus leprosis in Florida includes: (1) presence of twig lesions in affected orange blocks in addition to lesions on fruits and leaves and corresponding absence of similar lesions on grapefruit; (2) yield reduction and die-back on infected trees; and (3) spread of the disease between 1906 and 1925. Transmission electron microscopy (TEM) examination of tissue samples from leprosis-like injuries to orange and grapefruit leaves from Florida in 1997, and fruits from grapefruit and sweet orange varieties from Texas in 1999 and 2000 did not contain leprosis-like viral particles or viroplasm inclusions. In contrast, leprosis viroplasm inclusions were readily identified by TEM within green non-senescent tissues surrounding leprosis lesions in two of every three orange leaf samples and half of the fruit samples obtained from Piracicaba, Brazil. Symptoms of leprosis were not seen in any of the 24,555 orange trees examined across Florida during 2001 and 2002. The authors conclude that citrus leprosis no longer exists in Florida nor occurs in Texas citrus based on: (1) lack of leprosis symptoms on leaves, fruit, and twigs of sweet orange citrus varieties surveyed in Florida: (2) failure to find virus particles or viroplasm inclusion bodies in suspect samples from both Florida and Texas examined by TEM; (3) absence of documented reports by others on the presence of characteristic leprosis symptoms in Florida; (4) lack of its documented occurrence in dooryard trees or abandoned or minimal pesticide citrus orchard sites in Florida. In view of the serious threat to citrus in the U.S., every effort must be taken to quarantine the importation of both citrus and woody ornamental plants that serve as hosts for Brevipalpus

  6. Knowledge and work performance of multi-purpose workers under national leprosy eradication programme in Satara district, Maharashtra.

    PubMed

    Mohite, R V; Mohite, V R

    2012-01-01

    After integration of leprosy services into general health care services, peripheral health care workers played important role in leprosy elimination. The objectives of present study are to assess the knowledge and work performance of multi-purpose workers and it's correlation towards eradication of leprosy under national leprosy eradication programme in Satara district. The cross sectional study was conducted over a period of 6 months includes 71 Primary health centres (PHCs) and 6 Urban leprosy centres (ULCs) providing leprosy services to whole Satara district, Maharashtra. Random sampling technique was used to select study subjects (Multi-purpose workers, MPWs) and data was collected by using pre-tested semi structured proforma by personal interview method. Percentage distribution and statistical association between knowledge and work performance was analysed. More than 88.31% MPWs had good knowledge about leprosy and National leprosy eradication programme (NLEP), similarly more than 88.42% showed good work performance under NLEP in Satara district. Significant statistical association was existed between age and work experience of MPWs with their work performance under NLEP (chi2=11.2, p=0.023* and chi2=10.1, p=0.038*). Significant correlation was also observed between knowledge of MPWs about leprosy and NLEP with their work performance under NLEP (r=0.66, p=0.001*). Satara district achieved leprosy elimination which was mainly due to very good knowledge and quality work performance by multi-purpose workers.

  7. Molecular mimicry between Mycobacterium leprae proteins (50S ribosomal protein L2 and Lysyl-tRNA synthetase) and myelin basic protein: a possible mechanism of nerve damage in leprosy.

    PubMed

    Singh, Itu; Yadav, Asha Ram; Mohanty, Keshar Kunja; Katoch, Kiran; Sharma, Prashant; Mishra, Bishal; Bisht, Deepa; Gupta, U D; Sengupta, Utpal

    2015-04-01

    Autoantibodies against various components of host are known to occur in leprosy. Nerve damage is the primary cause of disability associated with leprosy. The aim of this study was to detect the level of autoantibodies and lympho-proliferative response against myelin basic protein (MBP) in leprosy patients (LPs) and their correlation with clinical phenotypes of LPs. Further, probable role of molecular mimicry in nerve damage of LPs was investigated. We observed significantly high level of anti-MBP antibodies in LPs across the spectrum and a positive significant correlation between the level of anti-MBP antibodies and the number of nerves involved in LPs. We report here that 4 B cell epitopes of myelin A1 and Mycobacterium leprae proteins, 50S ribosomal L2 and lysyl tRNA synthetase are cross-reactive. Further, M. leprae sonicated antigen hyperimmunization was responsible for induction of autoantibody response in mice which could be adoptively transferred to naive mice. For the first time our findings suggest the role of molecular mimicry in nerve damage in leprosy.

  8. Combination chemoprophylaxis and immunoprophylaxis in reducing the incidence of leprosy

    PubMed Central

    Duthie, Malcolm S; Balagon, Marivic F

    2016-01-01

    Leprosy is a complex infectious disease caused by Mycobacterium leprae that is a leading cause of nontraumatic peripheral neuropathy. Current control strategies, with a goal of early diagnosis and treatment in the form of multidrug therapy, have maintained new case reports at ~225,000 per year. Diagnostic capabilities are limited and even with revisions to multidrug therapy regimen, treatment can still require up to a year of daily drug intake. Although alternate chemotherapies or adjunct immune therapies that could provide shorter or simpler treatment regimen appear possible, only a limited number of trials have been conducted. More proactive strategies appear necessary in the drive to elimination. As a prevention strategy, most chemoprophylaxis campaigns to date have provided about a 2-year protective window. Vaccination, in the form of a single bacillus Calmette–Guérin (BCG) immunization, generally provides ~50% reduction in leprosy cases. Adapting control strategies to provide both chemoprophylaxis and immunoprophylaxis has distinct appeal, with chemoprophylaxis theoretically buttressed by vaccination to generate immediate protection that can be sustained in the long term. We also discuss simple assays measuring biomarkers as surrogates for disease development or replacements for invasive, but not particularly sensitive, direct measures of M. leprae infection. Such assays could facilitate the clinical trials required to develop these new chemoprophylaxis, immunoprophylaxis strategies, and transition into wider use. PMID:27175099

  9. Citrus leprosis virus vectored by Brevipalpus phoenicis (Acari: Tenuipalpidae) on citrus in Brazil.

    PubMed

    Rodrigues, J C V; Kitajima, E W; Childers, C C; Chagas, C M

    2003-01-01

    Citrus leprosis is caused by Citrus leprosis virus (CiLV) that is transmitted by mites in the genus Brevipalpus (Acari: Tenuipalpidae). This disease directly reduces production and the life span of the citrus plant. The main symptoms of the disease include lesions on fruits, leaves, and twigs or small branches, causing premature fruit drop, defoliation, and death of the twigs or branches leading to serious tree decline. Leprosis is a highly destructive disease of citrus, wherever it occurs. The Brazilian citrus industry spends over 100 million US dollars annually on acaricides to control the vector, Brevipalpus phoenicis (Geijskes). This review contains information about the history of the etiology of citrus leprosis, its geographical distribution, host range, the role of the mite vectors, viral morphology and relationships with the infected cell, and transmissibility of the virus by the mite. In addition, data on the mite-virus-plant relationship, disease damage, and strategies for controlling disease spread are presented.

  10. Leprosy presenting as a non-healing ulcer and associated unusual myth.

    PubMed

    Yadav, Pravesh; Verma, Prashant; Singal, Archana

    2015-09-01

    A case of a 70 year old lady with borderline tuberculoid leprosy who presented with a chronic ulcer and associated myth has been illustrated. The need for awareness programmes focusing on these types. of myths has been stressed. PMID:26665366

  11. Leprosy presenting as a non-healing ulcer and associated unusual myth.

    PubMed

    Yadav, Pravesh; Verma, Prashant; Singal, Archana

    2015-09-01

    A case of a 70 year old lady with borderline tuberculoid leprosy who presented with a chronic ulcer and associated myth has been illustrated. The need for awareness programmes focusing on these types. of myths has been stressed.

  12. Citrus leprosis virus vectored by Brevipalpus phoenicis (Acari: Tenuipalpidae) on citrus in Brazil.

    PubMed

    Rodrigues, J C V; Kitajima, E W; Childers, C C; Chagas, C M

    2003-01-01

    Citrus leprosis is caused by Citrus leprosis virus (CiLV) that is transmitted by mites in the genus Brevipalpus (Acari: Tenuipalpidae). This disease directly reduces production and the life span of the citrus plant. The main symptoms of the disease include lesions on fruits, leaves, and twigs or small branches, causing premature fruit drop, defoliation, and death of the twigs or branches leading to serious tree decline. Leprosis is a highly destructive disease of citrus, wherever it occurs. The Brazilian citrus industry spends over 100 million US dollars annually on acaricides to control the vector, Brevipalpus phoenicis (Geijskes). This review contains information about the history of the etiology of citrus leprosis, its geographical distribution, host range, the role of the mite vectors, viral morphology and relationships with the infected cell, and transmissibility of the virus by the mite. In addition, data on the mite-virus-plant relationship, disease damage, and strategies for controlling disease spread are presented. PMID:14756415

  13. A Retrospective Study of the Epidemiology of Leprosy in Cebu: An Eleven-Year Profile

    PubMed Central

    Scheelbeek, Pauline F. D.; Balagon, Marivic V. F.; Orcullo, Florenda M.; Maghanoy, Armi A.; Abellana, Junie; Saunderson, Paul R.

    2013-01-01

    Background Cebu has been one of the most leprosy endemic areas in the Philippines. Despite the high coverage rates of multiple drug therapy (MDT) and high BCG-vaccine coverage in children, leprosy control authorities believe that leprosy transmission and incidence (as evidence by continuing new case detection in both adults and children) have not declined as expected, once leprosy had been eliminated. In response to the concerns communicated by the authorities regarding ongoing leprosy transmission in Cebu, this study aims to examine the evidence for the hypothesized ongoing transmission, both in children and adults. Furthermore, it will be assessed which groups and areas are experiencing a continuing risk of leprosy infection; this can form a starting point for more targeted approaches to leprosy control. Methodology & Principal Findings Case records from 2000–2010 were retrospectively collected from the Leonard Wood Memorial Clinic archives, and all other clinics on the island where leprosy was treated. Between 2000 and 2010, 3288 leprosy cases were detected. The overall five year case notification rate (CNR) dropped significantly from 47.35 (2001–2005) to 29.21 cases (2006–2010) per 100.000 population. Smaller CNRs were reported for children; however the decline in child-CNR over the same period was minimal. Furthermore, no increase in median age of notification in children or adults was found between 2000 and 2010. Population-adjusted clustering of leprosy cases was mainly detected in urban and peri-urban areas. Conclusions & Significance Although the overall CNR declined significantly, CNR seems to be rather static in lower risk populations and areas. Cases are mainly found in urban areas, however CNRs in these areas decline at a much faster rate than in the lower endemic rural areas. A similar situation was found when comparing adults and children: CNRs observed in children were lower than in adults, but further decline (and elimination) of these

  14. Ancient Skeletal Evidence for Leprosy in India (2000 B.C.)

    PubMed Central

    Robbins, Gwen; Tripathy, V. Mushrif; Misra, V. N.; Mohanty, R. K.; Shinde, V. S.; Gray, Kelsey M.; Schug, Malcolm D.

    2009-01-01

    Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae that affects almost 250,000 people worldwide. The timing of first infection, geographic origin, and pattern of transmission of the disease are still under investigation. Comparative genomics research has suggested M. leprae evolved either in East Africa or South Asia during the Late Pleistocene before spreading to Europe and the rest of the World. The earliest widely accepted evidence for leprosy is in Asian texts dated to 600 B.C. Methodology/Principal Findings We report an analysis of pathological conditions in skeletal remains from the second millennium B.C. in India. A middle aged adult male skeleton demonstrates pathological changes in the rhinomaxillary region, degenerative joint disease, infectious involvement of the tibia (periostitis), and injury to the peripheral skeleton. The presence and patterning of lesions was subject to a process of differential diagnosis for leprosy including treponemal disease, leishmaniasis, tuberculosis, osteomyelitis, and non-specific infection. Conclusions/Significance Results indicate that lepromatous leprosy was present in India by 2000 B.C. This evidence represents the oldest documented skeletal evidence for the disease. Our results indicate that Vedic burial traditions in cases of leprosy were present in northwest India prior to the first millennium B.C. Our results also support translations of early Vedic scriptures as the first textual reference to leprosy. The presence of leprosy in skeletal material dated to the post-urban phase of the Indus Age suggests that if M. leprae evolved in Africa, the disease migrated to India before the Late Holocene, possibly during the third millennium B.C. at a time when there was substantial interaction among the Indus Civilization, Mesopotamia, and Egypt. This evidence should be impetus to look for additional skeletal and molecular evidence of leprosy in India and Africa to confirm the African origin of

  15. An evaluation of the future role of non-governmental organizations currently engaged in leprosy control in India.

    PubMed

    Vaz, W; Jacob, A J; Rajendran, A

    1995-06-01

    The mass implementation of short term multi-drug therapy in India, has led to dramatic falls in the prevalence of leprosy. This paper addresses the future role of non-governmental organizations currently involved in leprosy control. This evaluation is based on current trends in leprosy control, projected health needs in the future and the necessity to maximize health care outputs in the face of limited resources.

  16. Tinea Barbae: In Released from Treatment (RFT) Hansen’s Disease Patient

    PubMed Central

    Giri, VC; Singh, Hosanna; Kumar, Vinod; Ali, Showkath

    2014-01-01

    Hansen Disease (leprosy) is a chronic inflammatory infectious disease that primarily targets skin, nerves and other internal organs (testis, liver etc.) caused by the acid fast intracellular bacilli, Mycobacterium leprae. Clinical presentation occurs with a wide spectrum including hypo pigmented anaesthetic patches, raised erythematous plaques and nodules and thickened peripheral nerves showing tenderness. The most important complication is the disability and deformity. The diagnosis of leprosy is frequently delayed because of its similarity with other more common skin conditions prevailing in some non endemic areas. We present a rare case report of tinea barbae in an old treated case of leprosy. This case is one of the rarest fungal infection in leprosy patient searched in PUBMED as there were other more tinea infection involving various sites in body which sometimes misdiagnosed as leprosy. PMID:25177622

  17. Inflammatory Mediators of Leprosy Reactional Episodes and Dental Infections: A Systematic Review

    PubMed Central

    Cortela, D. C. B.; de Souza Junior, A. L.; Virmond, M. C. L.; Ignotti, E.

    2015-01-01

    Reactional episodes in leprosy are a result of complex interactions between the immune system, Mycobacterium leprae, and predisposing factors, including dental infections. To determine the main inflammatory mediators in the immunopathological process of dental infections and leprosy reactions, we conducted a systematic review of primary literature published between 1996 and 2013. A three-stage literature search was performed (Stage I, “leprosy reactions” and “inflammatory mediators”; Stage II, “dental infections” and “inflammatory mediators”; and Stage III, “leprosy reactions,” “dental infections,” and “inflammatory mediators”). Of the 911 eligible publications, 10 were selected in Stage I, 68 in Stage II, and 1 in Stage III. Of the 27 studied inflammatory mediators, the main proinflammatory mediators were IL-6, IFN-γ, TNF-α, IL-1β, and IL-17; the main anti-inflammatory mediators were IL-10 and IL-4. Serum IL-6 and TNF-α concentrations were significant during periodontal and reactional lesion evolution; IFN-γ and IL-1β were associated with types 1 and 2 reactions and chronic periodontal disease. The proinflammatory mediators in dental infections and leprosy reactions, especially IL-6 and TNF-α, were similar across studies, regardless of the laboratory technique and sample type. IFN-γ and IL-1β were significant for leprosy reactions and periodontal diseases. This pattern was maintained in serum. PMID:26339136

  18. Integrative literature review of the reported uses of serological tests in leprosy management.

    PubMed

    Fabri, Angélica da Conceição Oliveira Coelho; Carvalho, Ana Paula Mendes; Vieira, Nayara Figueiredo; Bueno, Isabela de Caux; Rodrigues, Rayssa Nogueira; Monteiro, Thayenne Barrozo Mota; Correa-Oliveira, Rodrigo; Duthie, Malcolm S; Lana, Francisco Carlos Félix

    2016-04-01

    An integrative literature review was conducted to synthesize available publications regarding the potential use of serological tests in leprosy programs. We searched the databases Literatura Latino-Americana e do Caribe em Ciências da Saúde, Índice Bibliográfico Espanhol em Ciências da Saúde, Acervo da Biblioteca da Organização Pan-Americana da Saúde, Medical Literature Analysis and Retrieval System Online, Hanseníase, National Library of Medicine, Scopus, Ovid, Cinahl, and Web of Science for articles investigating the use of serological tests for antibodies against phenolic glycolipid-I (PGL-I), ML0405, ML2331, leprosy IDRI diagnostic-1 (LID-1), and natural disaccharide octyl-leprosy IDRI diagnostic-1 (NDO-LID). From an initial pool of 3.514 articles, 40 full-length articles fulfilled our inclusion criteria. Based on these papers, we concluded that these antibodies can be used to assist in diagnosing leprosy, detecting neuritis, monitoring therapeutic efficacy, and monitoring household contacts or at-risk populations in leprosy-endemic areas. Thus, available data suggest that serological tests could contribute substantially to leprosy management.

  19. The Impact of Leprosy on Marital Relationships and Sexual Health among Married Women in Eastern Nepal.

    PubMed

    van 't Noordende, Anna T; van Brakel, Wim H; Banstola, Nandlal; Dhakal, Krishna P

    2016-01-01

    Background. Leprosy is one of the most stigmatized diseases known today. The stigma surrounding leprosy can be a major burden and affects many dimensions of a person's life, including intimate relationships. We aimed to investigate the experiences of women affected by leprosy regarding marital life and sexuality, comparing these to the experiences of women with other physical disabilities and to those of able-bodied women in South-East Nepal. Methods. This study used a qualitative approach and a cross-sectional, nonrandom survey design. Thirty women underwent in-depth interviews about their marital and sexual relationship by means of a semi-structured interview guide. These thirty women included ten women affected by leprosy, ten women with other physical disabilities, and ten able-bodied women living in South-East Nepal. Results. We found that many women faced violence and abuse in their marriages. However, women affected by leprosy appeared to face more problems with regard to their marital and sexual relationships than women with physical disabilities and able-bodied women. Some of these related to the fear of leprosy. Conclusions. Further research is recommended to investigate the extent of this problem and ways to ameliorate the situation of the affected women. Education and counselling at diagnosis may help prevent many of the problems reported. PMID:27047548

  20. Role Bending: Complex Relationships Between Viruses, Hosts, and Vectors Related to Citrus Leprosis, an Emerging Disease.

    PubMed

    Roy, Avijit; Hartung, John S; Schneider, William L; Shao, Jonathan; Leon, Guillermo; Melzer, Michael J; Beard, Jennifer J; Otero-Colina, Gabriel; Bauchan, Gary R; Ochoa, Ronald; Brlansky, Ronald H

    2015-07-01

    Citrus leprosis complex is an emerging disease in the Americas, associated with two unrelated taxa of viruses distributed in South, Central, and North America. The cytoplasmic viruses are Citrus leprosis virus C (CiLV-C), Citrus leprosis virus C2 (CiLV-C2), and Hibiscus green spot virus 2, and the nuclear viruses are Citrus leprosis virus N (CiLV-N) and Citrus necrotic spot virus. These viruses cause local lesion infections in all known hosts, with no natural systemic host identified to date. All leprosis viruses were believed to be transmitted by one species of mite, Brevipalpus phoenicis. However, mites collected from CiLV-C and CiLV-N infected citrus groves in Mexico were identified as B. yothersi and B. californicus sensu lato, respectively, and only B. yothersi was detected from CiLV-C2 and CiLV-N mixed infections in the Orinoco regions of Colombia. Phylogenetic analysis of the helicase, RNA-dependent RNA polymerase 2 domains and p24 gene amino acid sequences of cytoplasmic leprosis viruses showed a close relationship with recently deposited mosquito-borne negevirus sequences. Here, we present evidence that both cytoplasmic and nuclear viruses seem to replicate in viruliferous Brevipalpus species. The possible replication in the mite vector and the close relationship with mosquito borne negeviruses are consistent with the concept that members of the genus Cilevirus and Higrevirus originated in mites and citrus may play the role of mite virus vector. PMID:25775106

  1. The Impact of Leprosy on Marital Relationships and Sexual Health among Married Women in Eastern Nepal

    PubMed Central

    van 't Noordende, Anna T.; Banstola, Nandlal; Dhakal, Krishna P.

    2016-01-01

    Background. Leprosy is one of the most stigmatized diseases known today. The stigma surrounding leprosy can be a major burden and affects many dimensions of a person's life, including intimate relationships. We aimed to investigate the experiences of women affected by leprosy regarding marital life and sexuality, comparing these to the experiences of women with other physical disabilities and to those of able-bodied women in South-East Nepal. Methods. This study used a qualitative approach and a cross-sectional, nonrandom survey design. Thirty women underwent in-depth interviews about their marital and sexual relationship by means of a semi-structured interview guide. These thirty women included ten women affected by leprosy, ten women with other physical disabilities, and ten able-bodied women living in South-East Nepal. Results. We found that many women faced violence and abuse in their marriages. However, women affected by leprosy appeared to face more problems with regard to their marital and sexual relationships than women with physical disabilities and able-bodied women. Some of these related to the fear of leprosy. Conclusions. Further research is recommended to investigate the extent of this problem and ways to ameliorate the situation of the affected women. Education and counselling at diagnosis may help prevent many of the problems reported. PMID:27047548

  2. Role Bending: Complex Relationships Between Viruses, Hosts, and Vectors Related to Citrus Leprosis, an Emerging Disease.

    PubMed

    Roy, Avijit; Hartung, John S; Schneider, William L; Shao, Jonathan; Leon, Guillermo; Melzer, Michael J; Beard, Jennifer J; Otero-Colina, Gabriel; Bauchan, Gary R; Ochoa, Ronald; Brlansky, Ronald H

    2015-07-01

    Citrus leprosis complex is an emerging disease in the Americas, associated with two unrelated taxa of viruses distributed in South, Central, and North America. The cytoplasmic viruses are Citrus leprosis virus C (CiLV-C), Citrus leprosis virus C2 (CiLV-C2), and Hibiscus green spot virus 2, and the nuclear viruses are Citrus leprosis virus N (CiLV-N) and Citrus necrotic spot virus. These viruses cause local lesion infections in all known hosts, with no natural systemic host identified to date. All leprosis viruses were believed to be transmitted by one species of mite, Brevipalpus phoenicis. However, mites collected from CiLV-C and CiLV-N infected citrus groves in Mexico were identified as B. yothersi and B. californicus sensu lato, respectively, and only B. yothersi was detected from CiLV-C2 and CiLV-N mixed infections in the Orinoco regions of Colombia. Phylogenetic analysis of the helicase, RNA-dependent RNA polymerase 2 domains and p24 gene amino acid sequences of cytoplasmic leprosis viruses showed a close relationship with recently deposited mosquito-borne negevirus sequences. Here, we present evidence that both cytoplasmic and nuclear viruses seem to replicate in viruliferous Brevipalpus species. The possible replication in the mite vector and the close relationship with mosquito borne negeviruses are consistent with the concept that members of the genus Cilevirus and Higrevirus originated in mites and citrus may play the role of mite virus vector.

  3. Role of PGL-I antibody detection in the diagnosis of pure neural leprosy.

    PubMed

    Jardim, Marcia R; Antunes, Sergio L G; Simons, Brian; Wildenbeest, Joanne G; Nery, José Augusto C; Illarramendi, Ximena; Moraes, Milton O; Martinez, Alejandra N; Oskam, Linda; Faber, William R; Sarno, Euzenir N; Sampaio, Elizabeth P; Bührer-Sékula, Samira

    2005-09-01

    Pure neural leprosy (PNL) is difficult to diagnose because skin lesions and acid-fast bacilli (AFB) in slit smears are absent. At present, the gold standard for PNL diagnosis is the histopathological examination of a peripheral nerve biopsy. Even so, detection of bacteria is difficult and histological findings may be non-specific. Furthermore, nerve biopsy is an invasive procedure that is only possible in specialized centres. Therefore, there is a need for additional diagnostic methods that may help to confirm the clinical diagnosis of PNL. In the present study, an additional laboratory test, the ELISA for anti-phenolic glycolipid I (PGL-I) IgM antibodies, was performed on 103 individuals with clinical and neurophysiological signs of peripheral neuropathy, of which 67 were diagnosed as PNL patients and 36 remained as 'not diagnosed as PNL', as well as on a control group of 34 patients with other neurological diseases. An antibody response was present in 14/67 (21%) of the patients diagnosed as PNL as compared with 3/34 (9%) of controls. Anti-PGL-I positivity was observed in 5/8 (63%) of the AFB positive cases. Patients whose diagnosis was confirmed solely by Mycobacterium leprae PCR on the nerve sample had 4/25 (16%) seropositivity. In addition, anti-PGL-I antibodies were detected in 9/40 (23%) of the PNL patients who were PCR negative for M. leprae DNA. Moreover, two patients who showed clinical and eletrophysiological manifestations suggestive of PNL were diagnosed with the help of their positive test results in the anti-PGL-I ELISA. In conclusion, detection of antibodies against PGL-I in patients with peripheral neuropathy is useful as an additional laboratory test to help PNL diagnosis.

  4. The role of ERBB2 gene polymorphisms in leprosy susceptibility.

    PubMed

    Rêgo, Jamile Leão; Oliveira, Joyce Moura; Santana, Nadja de Lima; Machado, Paulo Roberto Lima; Castellucci, Léa Cristina

    2015-01-01

    Mycobacterium leprae infects skin and peripheral nerves causing deformities and disability. The M. leprae bacterium binds to ErbB2 on the Schwann cell surface causing demyelination and favoring spread of the bacilli and causing nerve injury. Polymorphisms at the ERBB2 gene were previously investigated as genetic risk factors for leprosy in two Brazilian populations but with inconsistent results. Herein we extend the analysis of ERBB2 variants to a third geographically distinct population in Brazil. Our results show that there is no association between the genotyped SNPs and the disease (p>0.05) in this population. A gene set or pathway analysis under the genomic region of ERBB2 will be necessary to clarify its regulation under M. leprae stimulus.

  5. THE CULTIVATION OF THE LEPROSY BACILLUS AND THE EXPERIMENTAL PRODUCTION OF LEPROSY IN THE JAPANESE DANCING MOUSE.

    PubMed

    Duval, C W

    1910-09-01

    Pure cultures of an acid-fast bacillus were cultivated upon special media from the human tissues in four cases of leprosy. The nature of the growth, morphological characters and tinctorial properties do not differ for any of the cultures and correspond closely to the bacilli in the human leprous tubercles. That the bacillus of leprosy will multiply and continue to do so indefinitely outside of the animal body was first demonstrated by Clegg who cultivated an acid-fast organism from leprosy tissue in the presence of ameba and their symbiotics. Not only have I been able to confirm Clegg's work, but in addition I have succeeded in growing the bacillus in pure culture and in reproducing the disease in the Japanese dancing mouse, thereby establishing its identity. This species of animal acquires the infection in four to six weeks after intraperitoneal or subcutaneous inoculation with either emulsions of fresh leprous tissue or the pure cultures of B. leprae. Comparatively few bacilli are necessary to infect the mouse; and the mode of inoculation does not seem to make any appreciable difference in respect to the nature and time of development of the lesion. The experimental lesions are proliferative in character and identical with those in the human subject. Macroscopically they appear as glistening, white nodules which, in the early stages of development, resemble miliary tubercles. In my experience neither the cultures nor the bacilli directly from the human tissues have shown any evidence of multiplication or given rise to lesions when injected into the ordinary laboratory animals such as guinea pigs, rabbits, gray and white mice and rats, although repeated attempts have been made to infect these animals. B. leprae will not only multiply but it will colonize on a plain agar medium seeded with a pure culture of encysted ameba (Plate LVIII, Fig. 5), and upon an agar or banana medium prepared with a I per cent. solution of cystein and tryptophane. Colonization occurs in

  6. Factors Associated with Migration in Individuals Affected by Leprosy, Maranhão, Brazil: An Exploratory Cross-Sectional Study

    PubMed Central

    Murto, C.; Kaplan, C.; Ariza, L.; Schwarz, K.; Alencar, C. H.; da Costa, L. M. M.; Heukelbach, J.

    2013-01-01

    In Brazil, leprosy is endemic and concentrated in high-risk clusters. Internal migration is common in the country and may influence leprosy transmission and hamper control efforts. We performed a cross-sectional study with two separate analyses evaluating factors associated with migration in Brazil's Northeast: one among individuals newly diagnosed with leprosy and the other among a clinically unapparent population with no symptoms of leprosy for comparison. We included 394 individuals newly diagnosed with leprosy and 391 from the clinically unapparent population. Of those with leprosy, 258 (65.5%) were birth migrants, 105 (26.6%) were past five-year migrants, and 43 (10.9%) were circular migrants. In multivariate logistic regression, three independent factors were found to be significantly associated with migration among those with leprosy: (1) alcohol consumption, (2) separation from family/friends, and (3) difficulty reaching the healthcare facility. Separation from family/friends was also associated with migration in the clinically unapparent population. The health sector may consider adapting services to meet the needs of migrating populations. Future research is needed to explore risks associated with leprosy susceptibility from life stressors, such as separation from family and friends, access to healthcare facilities, and alcohol consumption to establish causal relationships. PMID:24194769

  7. Causative organism and host response. International Leprosy Congress, Beijing, 7-12 September 1998. Workshop report.

    PubMed

    Krahenbuhl, J L

    1999-03-01

    Whether or not the leprosy elimination target is met in all endemic countries by the year 2000, the MDT programme will have greatly reduced worldwide prevalence. However, our workshop chairmen were asked to ignore the prevalence-based leprosy 'elimination' programme and focus on recommendations for a long term, incidence-based eradication target where transmission is blocked. They were asked to be concerned with basic leprosy research goals in the post 2000 era. The members of our workshops are actively productive workers, committed to their special interests. They are fully cognizant of the obstacles faced daily in working with leprosy and M. leprae, the requirement for clever experimental design even with the availability of the powerful tools of molecular biology which can now be brought to bear on some of the research obstacles. They are also aware of our lack of understanding about leprosy and M. leprae. How do you block transmission if you don't know how infection is transmitted? Can infection be detected, diagnosis made earlier? Is there a non-human reservoir host, a carrier state, an environmental source? What is the basis of M. leprae's predilection for nerves, the mechanisms underlying reactions? What needs to be targeted to treat reactions? Can a vaccine play a role? There is nothing startling in the workshops' recommendations. Other individuals and groups of experts have made the same suggestions, with slightly varying priorities. What one can read between the lines of these reports, is a sense of urgency to get as much done as soon as possible. Worldwide interest in leprosy will soon be diminished, not by design but as a consequence of the laudable success of the MDT programme. The experiment is still underway, but chemotherapy alone, killing bacilli in the detectable human host, does not appear to be the answer to blocking transmission. A number of goals must be addressed while there are still intact national and international leprosy programmes

  8. History and Diversity of Citrus leprosis virus Recorded in Herbarium Specimens.

    PubMed

    Hartung, John S; Roy, Avijit; Fu, Shimin; Shao, Jonathan; Schneider, William L; Brlansky, Ronald H

    2015-09-01

    Leprosis refers to two diseases of citrus that present similar necrotic local lesions, often surrounded by chlorotic haloes on citrus. Two distinct viruses are associated with this disease, one that produces particles primarily in the nucleus of infected plant cells (Citrus leprosis virus nuclear type [CiLV-N]; Dichorhavirus) and another type that produces particles in the cytoplasm of infected plant cells (Citrus leprosis virus cytoplasmic type [CiLV-C]; Cilevirus). Both forms are transmitted by Brevipalpid mites and have bipartite, single-stranded, RNA genomes. CiLV-C and CiLV-N are present in South and Central America and as far north as parts of Mexico. Although leprosis disease was originally described from Florida, it disappeared from there in the 1960s. The United States Department of Agriculture-Agricultural Research Service maintains preserved citrus specimens identified at inspection stations 50 or more years ago with symptoms of citrus leprosis. We isolated RNA from these samples and performed degradome sequencing. We obtained nearly full-length genome sequences of both a typical CiLV-C isolate intercepted from Argentina in 1967 and a distinct CiLV-N isolate obtained in Florida in 1948. The latter is a novel form of CiLV-N, not known to exist anywhere in the world today. We have also documented the previously unreported presence of CiLV-N in Mexico in the mid-20th century.

  9. Human behavioural research applied to the leprosy control programme of Sarawak, Malaysia.

    PubMed

    Chen, P C

    1986-09-01

    In 1984, in Sarawak, there were a total of 1,099 recorded cases of leprosy for a population of 1.3 million. However, for each case recorded, it is estimated that two others remain undiagnosed as a consequence of the stigmatization associated with leprosy. For the five year period, 1979-1983, an average of 29 new cases were detected each year of which 8.6 (30%) were deformed due to the late stages at which it was being reported. To increase the case-finding rate, human behavioural research was applied to the leprosy control programme so as to develop culture-specific health education packages aimed at self diagnosis and self referral in order to detect the large pool of undiagnosed cases hidden behind the veil of aversion, fear and ignorance. This was achieved through anthropological studies to identify how the various major ethnic groups perceived leprosy and their attitudes towards leprosy. Taking into account these findings, health education packages aimed at adults as well as children were developed for the Chinese as well as the non-Chinese, and consisted of newspaper articles, cartoon tape-slides, cartoon story books and posters.

  10. History and Diversity of Citrus leprosis virus Recorded in Herbarium Specimens.

    PubMed

    Hartung, John S; Roy, Avijit; Fu, Shimin; Shao, Jonathan; Schneider, William L; Brlansky, Ronald H

    2015-09-01

    Leprosis refers to two diseases of citrus that present similar necrotic local lesions, often surrounded by chlorotic haloes on citrus. Two distinct viruses are associated with this disease, one that produces particles primarily in the nucleus of infected plant cells (Citrus leprosis virus nuclear type [CiLV-N]; Dichorhavirus) and another type that produces particles in the cytoplasm of infected plant cells (Citrus leprosis virus cytoplasmic type [CiLV-C]; Cilevirus). Both forms are transmitted by Brevipalpid mites and have bipartite, single-stranded, RNA genomes. CiLV-C and CiLV-N are present in South and Central America and as far north as parts of Mexico. Although leprosis disease was originally described from Florida, it disappeared from there in the 1960s. The United States Department of Agriculture-Agricultural Research Service maintains preserved citrus specimens identified at inspection stations 50 or more years ago with symptoms of citrus leprosis. We isolated RNA from these samples and performed degradome sequencing. We obtained nearly full-length genome sequences of both a typical CiLV-C isolate intercepted from Argentina in 1967 and a distinct CiLV-N isolate obtained in Florida in 1948. The latter is a novel form of CiLV-N, not known to exist anywhere in the world today. We have also documented the previously unreported presence of CiLV-N in Mexico in the mid-20th century. PMID:25961338

  11. Tuberculosis and leprosy infections in the Marshallese population of Arkansas, USA.

    PubMed

    Cardenas, Victor Manuel; Orloff, Mohammed S; Kaminaga, Joseph; Cardenas, Irma Carrillo; Brown, Joeline; Hainline-Williams, Sandra; Duthie, Malcolm S; Gonzalez-Puche, Angela C; Mukasa, Leonard; Patil, Naveen; Mcelfish, Pearl Ann; Bates, Joseph H

    2016-03-01

    The cross-immunity between tuberculosis and leprosy is unknown. The aim of this pilot study was to evaluate the occurrence of Mycobacterium tuberculosis and M. leprae infection in Marshallese adult volunteers in Springdale, Arkansas, U.S.A., a population that experiences high rates of leprosy and tuberculosis. We used immunodiagnostic testing for tuberculosis and leprosy infection and found significant prevalence of latent tuberculosis infection (19.0%), and asymptomatic Mycobacterium leprae infection (22.2%). We found a negative association between presence of antibodies to Mycobacterium leprae and a positive interferon-γ release assay for Mycobacterium tuberculosis infection, prevalence odds ratio = 0.1 (95% CI = 0.0, 0.9). Although these findings require confirmation on a larger scale, they are supportive of the existence of cross-immunity.

  12. Bone Changes in an Italian Ancient Human Skeleton--Possibly Caused by Leprosy.

    PubMed

    Rubini, M; Zaio, P

    2015-01-01

    Leprosy is an infectious disease caused by Mycobacterium leprae and Mycobacterium lepromatosis. In the last stage it can afflict the skeleton with a series of specific and non-specific bone changes. The possibility of studyingthe skeleton of an individual who lived in the pre-antibiotic era (Roman period) with skeletal changes in the rhino-maxillary region and hand and foot bones, permitted skeletal lesions to be analyzed directly. In addition, the localization and the complexity of the bony lesions could be attributed to the presence of leprosy. The importance of this approach was the possibility to verify the nature and typology of the primary and secondary bone changes in leprosy in absence of clinical therapy.

  13. Seasonal and spatial trends in the detectability of leprosy in wild armadillos.

    PubMed Central

    Truman, R. W.; Kumaresan, J. A.; McDonough, C. M.; Job, C. K.; Hastings, R. C.

    1991-01-01

    A survey for leprosy among 565 armadillos from Louisiana and Texas found IgM antibodies to the phenolic glycolipid-1 antigen of Mycobacterium leprae in 16% of the animals. There were no geographic trends in the distribution of prevalence rates between the sites and the disease probably has a much greater range. Repeat observations in one location showed significant seasonal variations in the observable antibody prevalence rate, but the yearly average remained similar. Infected armadillos tended to be heavier, and the females usually had plasma progesterone concentrations indicative of sexual maturity. Using these characteristics to stratify the populations into adult and sub-adult cohorts, variations in the observable leprosy prevalence rate were seen to be proportional to changes in the age structure of the populations. Leprosy appears to be maintained in steady state within some regions, and nearly a third of the adult armadillos in Louisiana and Texas harbour M. leprae. PMID:2050208

  14. Why person affected by leprosy did not look after their plantar ulcer? Experience from Pakokku zone, Myanmar.

    PubMed

    Win, Le Le; Shwe, San; Maw, Win; Ishida, Yutaka; Myint, Kyaw; Mar, Kyi Kyi; Min, Thandar; Oo, Phyo Min; Khine, Aye Win

    2010-09-01

    A cross-sectional study was carried out to identify methods of caring plantar ulcers in leprosy patients and the underlying causes of poor plantar ulcer care during January and February 2008. This was conducted in Pakokku zone as it was one of the "9 selected townships of the Disabilities survey, i.e., Basic Health Staff project 2003/4", which was funded by Japan International Cooperation Agency. After getting consent, all available leprosy cases, i.e., 101 cases with foot disability grade 2 were interviewed with the pre-tested questionnaire. Among 101 cases, 13 cases who took care of their ulcer poorly and 20 who did none of the recommended measures were recruited for in-depth interview (IDI). The subjects were largely old people, males and people with no marriage partner. The majority had earned money by doing sedentary job. Prolongation of ulcers was observed in 78 cases. Most had been suffering from ulcers for years. When asking face-to-face interview, all the recommended care measures were not reported. Among these recommended measures, a large number of respondents reported about soaking measure. However, these reported measures were contradicted to the preventive methods which they disclosed in IDI. Plantar ulcer care seemed to be an individualised practice. The individual ways of performing were related to their view of ulcer, the environment, and occupation, and custom, communication with family and health staff. The findings identified the actual practice of plantar ulcer care in study areas. It is suggested that the current performance of planar ulcer care is inadequate and more attention should be given to achieve the target set by the programme as a recommendation. PMID:20857653

  15. Antibodies to tubulin in patients with parasitic infections.

    PubMed Central

    Howard, M K; Gull, K; Miles, M A

    1987-01-01

    Sera from a total of 268 patients with protozoan, helminth, bacterial (leprosy and tuberculosis) infections or appropriate controls, were assayed for anti-tubulin antibodies in an indirect enzyme-linked immunosorbent assay (ELISA), using purified tubulin as antigen. Levels of serum anti-tubulin antibody were significantly elevated in 67% of patients with visceral leishmaniasis, in 60% of patients with cutaneous leishmaniasis, in 89% of patients with onchocerciasis, in 100% of patients with schistosomiasis, and in 94% of patients with leprosy. Little or no increase in anti-tubulin antibody levels was seen in sera from patients with malaria (Plasmodium vivax) or tuberculosis. PMID:3115642

  16. Type 2 lepra reaction in an immunocompromised patient precipitated by filariasis.

    PubMed

    Singh, Satyendra Kumar; Sharma, Taniya; Rai, Tulika; Prabhu, Anand

    2014-01-01

    Though patients affected with both acquired immuno deficiency syndrome (AIDS) and leprosy commonly present with type 1 lepra reaction, there are few isolated reports of type 2 lepra reaction in retropositive patients affected with leprosy. We are presenting a case report of 35-year-old male affected with AIDS, tubercular lymphadenitis, and lepromatous leprosy with recurrent episodes of type 2 lepra reaction manifesting as erythema nodosum leprosum (ENL). Dipstick enzyme-linked immunosorbent assay (ELISA) for filarial antigen was also positive. The patient was treated with 100 mg thalidomide daily, 300 mg diethylcarbamazine, and modified multidrug therapy (MDT) for leprosy. He responded well and has not had any further reaction in the last 6 months. PMID:24958985

  17. [For the sacrifice of isolation: leprosy and philanthropy in Argentina and Brazil, 1930-1946].

    PubMed

    Leandro, José Augusto

    2013-01-01

    Patronato de Leprosos, in Argentina, and Federação das Sociedades de Assistência aos Lázaros e Defesa Contra a Lepra, in Brazil, were created as institutions designed to help people with leprosy and their families. Headed by women from the ruling classes, these entities took very similar actions, despite the different national contexts in which they operated, both supplementing leprosy healthcare policies in their respective countries. This article aims to demonstrate the similarities in the strategies adopted by both philanthropic institutions, which, in the 1930s and 1940s, acted in harmony with the physicians who supported compulsory isolation. PMID:24141922

  18. Insights from animal models on the immunogenetics of leprosy: a review.

    PubMed

    Adams, Linda B; Pena, Maria T; Sharma, Rahul; Hagge, Deanna A; Schurr, Erwin; Truman, Richard W

    2012-12-01

    A variety of host immunogenetic factors appear to influence both an individual's susceptibility to infection with Mycobacterium leprae and the pathologic course of the disease. Animal models can contribute to a better understanding of the role of immunogenetics in leprosy through comparative studies helping to confirm the significance of various identified traits and in deciphering the underlying mechanisms that may be involved in expression of different disease related phenotypes. Genetically engineered mice, with specific immune or biochemical pathway defects, are particularly useful for investigating granuloma formation and resistance to infection and are shedding new light on borderline areas of the leprosy spectrum which are clinically unstable and have a tendency toward immunological complications. Though armadillos are less developed in this regard, these animals are the only other natural hosts of M. leprae and they present a unique opportunity for comparative study of genetic markers and mechanisms associable with disease susceptibility or resistance, especially the neurological aspects of leprosy. In this paper, we review the recent contributions of genetically engineered mice and armadillos toward our understanding of the immunogenetics of leprosy. PMID:23283472

  19. History and diversity of Citrus leprosis virus recorded in herbarium specimens

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis disease is at the same time an emerging, a current and a historical problem. Two distinct viruses are associated with this disease, one that produces particles primarily in the nucleus of infected plant cells (CiLV-N; Dichorhavirus) and another, much more widespread type that produc...

  20. Dealing with Stigma: Experiences of Persons Affected by Disabilities and Leprosy

    PubMed Central

    Zweekhorst, Marjolein B. M.; Miranda-Galarza, Beatriz; Peters, Ruth M. H.; Cummings, Sarah; Seda, Francisia S. S. E.; Bunders, Joske F. G.; Irwanto

    2015-01-01

    Persons affected by leprosy or by disabilities face forms of stigma that have an impact on their lives. This study seeks to establish whether their experiences of stigma are similar, with a view to enabling the two groups of people to learn from each other. Accounts of experiences of the impact of stigma were obtained using in-depth interviews and focus group discussion with people affected by leprosy and by disabilities not related to leprosy. The analysis shows that there are a lot of similarities in impact of stigma in terms of emotions, thoughts, behaviour, and relationships between the two groups. The main difference is that those affected by leprosy tended to frame their situation in medical terms, while those living with disabilities described their situation from a more social perspective. In conclusion, the similarities offer opportunities for interventions and the positive attitudes and behaviours can be modelled in the sense that both groups can learn and benefit. Research that tackles different aspects of stigmatization faced by both groups could lead to inclusive initiatives that help individuals to come to terms with the stigma and to advocate against exclusion and discrimination. PMID:25961008

  1. Dealing with stigma: experiences of persons affected by disabilities and leprosy.

    PubMed

    Lusli, Mimi; Zweekhorst, Marjolein B M; Miranda-Galarza, Beatriz; Peters, Ruth M H; Cummings, Sarah; Seda, Francisia S S E; Bunders, Joske F G; Irwanto

    2015-01-01

    Persons affected by leprosy or by disabilities face forms of stigma that have an impact on their lives. This study seeks to establish whether their experiences of stigma are similar, with a view to enabling the two groups of people to learn from each other. Accounts of experiences of the impact of stigma were obtained using in-depth interviews and focus group discussion with people affected by leprosy and by disabilities not related to leprosy. The analysis shows that there are a lot of similarities in impact of stigma in terms of emotions, thoughts, behaviour, and relationships between the two groups. The main difference is that those affected by leprosy tended to frame their situation in medical terms, while those living with disabilities described their situation from a more social perspective. In conclusion, the similarities offer opportunities for interventions and the positive attitudes and behaviours can be modelled in the sense that both groups can learn and benefit. Research that tackles different aspects of stigmatization faced by both groups could lead to inclusive initiatives that help individuals to come to terms with the stigma and to advocate against exclusion and discrimination.

  2. A university extension course in leprosy: telemedicine in the Amazon for primary healthcare.

    PubMed

    Paixão, Maurício Pedreira; Miot, Hélio Amante; de Souza, Pedro Elias; Haddad, Ana Estela; Wen, Chao Lung

    2009-01-01

    There is a high prevalence of leprosy in the Amazon region of Brazil. We have developed a distance education course in leprosy for training staff of the Family Health Teams (FHTs). The course was made available through a web portal. Tele-educational resources were mediated by professors and coordinators, and included the use of theoretical content available through the web, discussion lists, Internet chat, activity diaries, 3-D video animations (Virtual Human on Leprosy), classes in video streaming and case simulation. Sixty-five FHT staff members were enrolled. All of them completed the course and 47 participants received a certificate at the end of the course. At the end of the course, 48 course-evaluation questionnaires were answered. A total of 47 participants (98%) considered the course as excellent. The results demonstrate the feasibility of an interactive, tele-education model as an educational resource for staff in isolated regions. Improvements in diagnostic skills should increase diagnostic suspicion of leprosy and may contribute to early detection.

  3. Role bending: complex relationships between viruses, hosts and vectors related to citrus leprosis, an emerging disease

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis is a difficult viral disease causing significant damage to citrus fruit in South America and Central America. The disease is marked by dramatic lesions on fruit, leaves and stems, resulting in an unmarketable product. The disease is caused by a set of unrelated cytoplasmic cileviruse...

  4. Asymptomatic Leprosy Infection among Blood Donors May Predict Disease Development and Suggests a Potential Mode of Transmission.

    PubMed

    Goulart, Isabela Maria Bernardes; Araujo, Sergio; Filho, Adilson Botelho; de Paiva, Paulo Henrique Ribeiro; Goulart, Luiz Ricardo

    2015-10-01

    Blood donor samples (1,007) were assessed for anti-phenolic glycolipid 1 (PGL-1) IgM antibodies and Mycobacterium leprae DNA presence, which had 3.8% and 0.3% positivity, respectively. After a 5-year follow-up period, six individuals with positive markers developed leprosy, raising the hypothesis that asymptomatic infection among blood donors may be an undisclosed mode of leprosy transmission via transfusion.

  5. Leprosy as a multilayered biosocial phenomenon: The comparison of institutional responses and illness narratives of an endemic disease in Brazil and an imported disease in Portugal.

    PubMed

    Cruz, Alice

    2016-01-01

    This paper questions the relation between human health and society from the case study of leprosy. To discuss the cultural and social mediator factors of both the experience of leprosy and outcomes of medical practices, it examines the biomedical twist in the dialectic between citizenship and public good that aimed to turn leprosy into a disease like any other, with the advent of multidrug therapy during the 1980s. Such analysis is based on a multisited ethnography, developed between 2008 and 2013 in two divergent contexts from the global South and North: Brazil, which remains the country in the world with the highest relative cases of leprosy, and Portugal, in which leprosy has become an imported disease. The main results of this research point to the limits of a pharmaceuticalized governmentality of leprosy and to heterogeneous medicalization's processes, which evince the determinacy of historical intersections between the State and civil society, as well as the corollaries of the former in medical care. This paper concludes with an analysis of the partition between biomedical cure and the healing of leprosy, which unveils the intermediation of institutional and extrainstitutional factors in access to health and in the cure of leprosy. It is finally argued that such intermediation requires a public health approach that might resocialize leprosy through a paradigmatic shift toward intersectoral and participatory operational strategies.

  6. Association of IL10 Polymorphisms and Leprosy: A Meta-Analysis

    PubMed Central

    Alvarado-Arnez, Lucia Elena; Amaral, Evaldo P.; Sales-Marques, Carolinne; M. B. Durães, Sandra; C. Cardoso, Cynthia; Nunes Sarno, Euzenir; G. Pacheco, Antonio; C. F. Lana, Francisco; Ozório Moraes, Milton

    2015-01-01

    Leprosy is a chronic infectious disease that depends on the interplay of several factors. Single nucleotide polymorphisms (SNPs) in host immune related genes have been consistently suggested as participants in susceptibility towards disease. Interleukin-10 (IL-10) is a crucial immunomodulatory cytokine in mycobacterial pathogenesis and especially the -819C>T SNP (rs1800871) has been tested in several case-control studies indicating association with leprosy risk, although a recent consensus estimate is still missing. In this study, we evaluated the association of the -819C>T SNP and leprosy in two new Brazilian family-based populations. Then, we performed meta-analysis for this polymorphism summarizing published studies including these Brazilian family-based groups. Finally, we also retrieved published studies for other distal and proximal IL10 polymorphisms: -3575 T>A (rs1800890), -2849 G>A (rs6703630), -2763 C>A (rs6693899), -1082 G>A (rs1800896) and -592 C>A (rs1800872). Results from meta-analysis supported a significant susceptibility association for the -819T allele, with pooled Odds Ratio of 1.22 (CI = 1.11–1.34) and P-value = 3x10–5 confirming previous data. This result remained unaltered after inclusion of the Brazilian family-based groups (OR = 1.2, CI = 1.10–1.31, P-value = 2x10–5). Also, meta-analysis confirmed association of -592 A allele and leprosy outcome (OR = 1.24, CI = 1.03–1.50, P-value = 0.02). In support of this, linkage disequilibrium analysis in 1000 genomes AFR, EUR, ASN and AMR populations pointed to r2 = 1.0 between the -592C>A and -819C>T SNPs. We found no evidence of association for the other IL10 polymorphisms analyzed for leprosy outcome. Our results reinforce the role of the -819C>T as a tag SNP (rs1800871) and its association with leprosy susceptibility. PMID:26340474

  7. Trends in leprosy over fifty years in Gudiyatham Taluk, Vellore, Tamil Nadu.

    PubMed

    Norman, G; Raja Samuel Bhushanam, J D; Samuel, P

    2006-01-01

    This paper presents epidemiological trends over a fifty-year period observed in a defined population served by the Schieffelin Leprosy Research and Training Centre (SLR & TC), Karigiri, Vellore District in Tamil Nadu. It covers three distinct periods, namely, the pre-MDT era with dapsone monotherapy, the MDT era under a vertical leprosy control programme and the MDT era after leprosy control services were integrated into the general health services. Prevalence rates have declined steadily from 125 per 10,000 population at the time of introduction of MDT in 1982 to 5 per 10,000 at the time of integration in 1997 to less than 1 per 10,000 in 2005. The new case-detection rate was 5.4 per 10,000 when the field programme started in 1962, and held steady at 15-20 per 10,000 between 1970 and 1980. It then showed a gradual fall from 10.8 per 10,000 in 1985 to 3.9 at the time of integration, and continued to fall in the post-integration period and was 0.8 per 10,000 in 2005. The mean age at detection showed a gradual increase from 23.4 years in the dapsone era to 31.2 years in the post-integration period. The male: female ratio showed a preponderance of males almost throughout the reference period. While polar types of leprosy (TT & LL) were common in the dapsone era, more of borderline leprosy (BT & BL) cases was seen more recently. MB rates that were high initially, declined steadily during monotherapy and stabilized between 10% and 12% during the vertical MDT programme and is showing an increase in the post-integration-period. The proportion of cases with Grade 2 disability at registration showed a gradual decline during the monotherapy period, remained relatively unchanged at 8%-10% during the the MDT period, and showed a sharp rise in the immediate post-integration period before falling. Analysis of trends of leprosy in a well-defined geographical population over a fifty-year period gives useful information on how the disease has evolved over the years. It provides

  8. Effect of the Brazilian Conditional Cash Transfer and Primary Health Care Programs on the New Case Detection Rate of Leprosy

    PubMed Central

    Nery, Joilda Silva; Pereira, Susan Martins; Rasella, Davide; Penna, Maria Lúcia Fernandes; Aquino, Rosana; Rodrigues, Laura Cunha; Barreto, Mauricio Lima; Penna, Gerson Oliveira

    2014-01-01

    Background Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy. Methodology/Principal Findings We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004–2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI  = 0.74–0.83) and significantly increased in municipalities with FHP coverage in the medium (72–95%) (Risk Ratio 1.05; 95% CI  = 1.02–1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI  = 1.08–1.17). Conclusions At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence. PMID:25412418

  9. Cholesterol dynamics in macrophages implication for the bacteriology and pathology of leprosy.

    PubMed

    Kato, L

    1979-01-01

    M. leprae in the host multiplies abundantly in macrophages rich in cholesterol. Host-grown leprosy bacilli have an extremely high cholesterol content and in this respect they occupy a unique place among procariotic cells. M. leprae takes up cholesterol from the environment and it is not clear whether it can synthesize cholesterol and if so from which precursors. Mycobacteria can be grown from leprous tissues in primary cultures only in the presence of cholesterol. These strains quickly adapt to in vitro substrates and are able to synthesize cholesterol from still-unknown chemical entities, which are also sources of carbon and energy. These still unknown substrates will probably have to be discovered before cultivation of these elusive microorganisms is achieved and we approach a better understanding of the chemical mediators in the cellular defence and/or pathology of leprosy.

  10. [Chaulmoogra oil as scientific knowledge: the construction of a treatment for leprosy].

    PubMed

    dos Santos, Fernando Sergio Dumas; de Souza, Letícia Pumar Alves; Siani, Antonio Carlos

    2008-01-01

    The article investigates how knowledge of medicinal plants and related treatment practices are assimilated and transformed. Taking as its focus the use of chaulmoogra oil to treat leprosy, it examines how information on this plant was incorporated and transformed into scientifically validated knowledge when 'Brazilian chaulmoogra' came onto the scene. Pointing to the addition of chaulmoogra byproducts to the Instituto Oswaldo Cruz's production agenda in the 1920s, the study establishes links between productive processes and relates these to the period's scientific context. From the late nineteenth century until the 1940s, chaulmoogra oil was the great hope in efforts to cure leprosy. During this period, chaulmoogric treatment earned a place as scientific knowledge thanks to research studies conducted in laboratories throughout the Western world.

  11. Description of Corynebacterium tuberculostearicum sp. nov., a leprosy-derived Corynebacterium.

    PubMed

    Brown, S; Lanéelle, M A; Asselineau, J; Barksdale, L

    1984-01-01

    Leprosy-derived corynebacteria (LDC) have been extensively studied over the past decade. A composite of their biological properties (cell morphology, staining reactions, cellular inclusions and guanine-plus-cytosine content of their deoxyribonucleic acid; 16 strains studied) and their chemical structures (peptidoglycan type, major cell wall polysaccharide, major glycolipid as well as characteristic mycolic acids) appears to define them as members of the genus Corynebacterium. In relation to other corynebacteria found in humans, including "JK corynebacteria", they seem to be distinct. They are here named Corynebacterium tuberculostearicum sp. nov. because they produce a 10-methyloctadecanoic (tuberculostearic) acid (8 strains studied). This and some of their other attributes are considered in relation to properties of leprosy bacilli and Mycobacterium leprae.

  12. New sonographic measures of peripheral nerves: a tool for the diagnosis of peripheral nerve involvement in leprosy

    PubMed Central

    Frade, Marco Andrey Cipriani; Nogueira-Barbosa, Marcello Henrique; Lugão, Helena Barbosa; Furini, Renata Bazan; Marques, Wilson; Foss, Norma Tiraboschi

    2013-01-01

    To evaluate ultrasonographic (US) cross-sectional areas (CSAs) of peripheral nerves, indexes of the differences between CSAs at the same point (∆CSAs) and between tunnel (T) and pre-tunnel (PT) ulnar CSAs (∆TPTs) in leprosy patients (LPs) and healthy volunteers (HVs). Seventy-seven LPs and 49 HVs underwent bilateral US at PT and T ulnar points, as well as along the median (M) and common fibular (CF) nerves, to calculate the CSAs, ∆CSAs and ∆TPTs. The CSA values in HVs were lower than those in LPs (p < 0.0001) at the PT (5.67/9.78 mm2) and T (6.50/10.94 mm2) points, as well as at the M (5.85/8.48 mm2) and CF (8.17/14.14 mm2) nerves. The optimum CSA- receiver operating characteristic (ROC) points and sensitivities/specificities were, respectively, 6.85 mm2 and 68-85% for the PT point, 7.35 mm2 and 71-78% for the T point, 6.75 mm2 and 62-75% for the M nerve and 9.55 mm2 and 81-72% for the CF nerve. The ∆CSAs of the LPs were greater than those of the HVs at the PT point (4.02/0.85; p = 0.007), T point (3.71/0.98; p = 0.0005) and CF nerve (2.93/1.14; p = 0.015), with no difference found for the M nerve (1.41/0.95; p = 0.17). The optimum ∆CSA-ROC points, sensitivities, specificities and p-values were, respectively, 1.35, 49%, 80% and 0.003 at the PT point, 1.55, 55-85% and 0.0006 at the T point, 0.70, 58-50% and 0.73 for the M nerve and 1.25, 54-67% and 0.022 for the CF nerve. The ∆TPT in the LPs was greater than that in the HVs (4.43/1.44; p <0.0001). The optimum ∆TPT-ROC point was 2.65 (90% sensitivity/41% specificity, p < 0.0001). The ROC analysis of CSAs showed the highest specificity and sensitivity at the PT point and CF nerve, respectively. The PT and T ∆CSAs had high specificities (> 80%) and ∆TPT had the highest specificity (> 90%). New sonographic peripheral nerve measurements (∆CSAs and ∆TPT) provide an important methodological improvement in the detection of leprosy neuropathy. PMID:23778664

  13. Hemicrania continua-like headache with leprosy: casual or causal association?

    PubMed

    Prakash, Sanjay; Dholakia, Saumil Y

    2008-07-01

    Hemicrania continua is a strictly unilateral, moderate to severe, continuous, indomethacin-responsive primary headache disorder with ipsilateral autonomic cranial symptoms at the time of exacerbations. We describe a 30-year-old woman with a 4-month history of indomethacin-responsive hemicrania continua-like headache and one-month history of mononeuritis multiplex due to leprosy. Indomethacin was successfully weaned off after completion of antileprotic therapy.

  14. Leprosy and the Adaptation of Human Toll-Like Receptor 1

    PubMed Central

    Wong, Sunny H.; Gochhait, Sailesh; Malhotra, Dheeraj; Pettersson, Fredrik H.; Teo, Yik Y.; Khor, Chiea C.; Rautanen, Anna; Chapman, Stephen J.; Mills, Tara C.; Srivastava, Amit; Rudko, Aleksey; Freidin, Maxim B.; Puzyrev, Valery P.; Ali, Shafat; Aggarwal, Shweta; Chopra, Rupali; Reddy, Belum S. N.; Garg, Vijay K.; Roy, Suchismita; Meisner, Sarah; Hazra, Sunil K.; Saha, Bibhuti; Floyd, Sian; Keating, Brendan J.; Kim, Cecilia; Fairfax, Benjamin P.; Knight, Julian C.; Hill, Philip C.; Adegbola, Richard A.; Hakonarson, Hakon; Fine, Paul E. M.; Pitchappan, Ramasamy M.; Bamezai, Rameshwar N. K.; Hill, Adrian V. S.; Vannberg, Fredrik O.

    2010-01-01

    Leprosy is an infectious disease caused by the obligate intracellular pathogen Mycobacterium leprae and remains endemic in many parts of the world. Despite several major studies on susceptibility to leprosy, few genomic loci have been replicated independently. We have conducted an association analysis of more than 1,500 individuals from different case-control and family studies, and observed consistent associations between genetic variants in both TLR1 and the HLA-DRB1/DQA1 regions with susceptibility to leprosy (TLR1 I602S, case-control P = 5.7×10−8, OR = 0.31, 95% CI = 0.20–0.48, and HLA-DQA1 rs1071630, case-control P = 4.9×10−14, OR = 0.43, 95% CI = 0.35–0.54). The effect sizes of these associations suggest that TLR1 and HLA-DRB1/DQA1 are major susceptibility genes in susceptibility to leprosy. Further population differentiation analysis shows that the TLR1 locus is extremely differentiated. The protective dysfunctional 602S allele is rare in Africa but expands to become the dominant allele among individuals of European descent. This supports the hypothesis that this locus may be under selection from mycobacteria or other pathogens that are recognized by TLR1 and its co-receptors. These observations provide insight into the long standing host-pathogen relationship between human and mycobacteria and highlight the key role of the TLR pathway in infectious diseases. PMID:20617178

  15. Ancient DNA analysis - An established technique in charting the evolution of tuberculosis and leprosy.

    PubMed

    Donoghue, Helen D; Spigelman, Mark; O'Grady, Justin; Szikossy, Ildikó; Pap, Ildikó; Lee, Oona Y-C; Wu, Houdini H T; Besra, Gurdyal S; Minnikin, David E

    2015-06-01

    Many tuberculosis and leprosy infections are latent or paucibacillary, suggesting a long time-scale for host and pathogen co-existence. Palaeopathology enables recognition of archaeological cases and PCR detects pathogen ancient DNA (aDNA). Mycobacterium tuberculosis and Mycobacterium leprae cell wall lipids are more stable than aDNA and restrict permeability, thereby possibly aiding long-term persistence of pathogen aDNA. Amplification of aDNA, using specific PCR primers designed for short fragments and linked to fluorescent probes, gives good results, especially when designed to target multi-copy loci. Such studies have confirmed tuberculosis and leprosy, including co-infections. Many tuberculosis cases have non-specific or no visible skeletal pathology, consistent with the natural history of this disease. M. tuberculosis and M. leprae are obligate parasites, closely associated with their human host following recent clonal distribution. Therefore genotyping based on single nucleotide polymorphisms (SNPs) can indicate their origins, spread and phylogeny. Knowledge of extant genetic lineages at particular times in past human populations can be obtained from well-preserved specimens where molecular typing is possible, using deletion analysis, microsatellite analysis and whole genome sequencing. Such studies have identified non-bovine tuberculosis from a Pleistocene bison from 17,500 years BP, human tuberculosis from 9000 years ago and leprosy from over 2000 years ago.

  16. Impact of migration on new case detection rates in leprosy in Gudiyatham Taluk, Tamil Nadu, India.

    PubMed

    Samuel, P; Bushanam, J D R S; Ebenezer, M; Richard, J

    2012-01-01

    Migration of persons affected by leprosy was hinted at as early as 1929 (Bhaskara Rao 1930). All new cases of leprosy in Isfahan Province (Iran) were found to be migrants (Asilian et al 2005). Chudasama (2007) suspected increase in leprosy cases in Surat district to migration. These suggest migration contributes to new cases. This study was done to find out 1. Extent of migration among new cases, 2. Characteristics of migrants, 3. Occupational pattern 4.Reasons for migration. 5. Place of origin of migrants 6. Assimilation of migrants into the society. Trained staff collected information regarding migration using special questionnaire from all 222 new untreated cases from the field area of Community Health department during 2004 to 2008. Migrants were 10.4%. Distribution of place of residence, age, gender, marital status, education, mode of detection, Ridley-Jopling and MB/PB classifications of migrants were not significantly different from that of nonmigrants. Grade 2 deformities were more among migrants. All migrants found occupation. Mostly men migrated for job and women for joining their husbands. The role of migration in increasing the number of new cases cannot be minimized. Enhanced efforts should be made to provide adequate medical, health and rehabilitation services for them also. PMID:23720895

  17. Leprosy in children and adolescents under 15 years old in an urban centre in Brazil.

    PubMed

    Santos, Selton Diniz; Penna, Gerson Oliveira; Costa, Maria da Conceição Nascimento; Natividade, Marcio Santos; Teixeira, Maria Glória

    2016-05-24

    This original study describes the intra-urban distribution of cases of leprosy in residents under 15 years old in Salvador, Bahia, Brazil; the study also identifies the environment in which Mycobacterium leprae is being transmitted. The cases were distributed by operational classification, clinical forms, type of contact and the addresses were geo-referenced by neighborhood. Between 2007 and 2011, were reported 145 cases of leprosy in target population living in Salvador, corresponding to detection rates of 6.21, 6.14, 5.58, 5.41 and 6.88/100,000 inhabitants, respectively. The spatial distribution of the disease was focal. Of the 157 neighborhoods of Salvador, 44 (28.6%) notified cases of leprosy and in 22 (50%) of these were detected more than 10 cases per 100,000 inhabitants. The infectious forms were found in 40% of cases. Over 90% of cases had been living in Salvador for more than five years. Overall, 52.6% reported having had contact with another infected individual inside the household and 25% in their social circle. In Salvador, M. leprae transmission is established. The situation is a major concern, since transmission is intense at an early age, indicating that this endemic disease is expanding and contacts extend beyond individual households. PMID:27223655

  18. Leprosy in children and adolescents under 15 years old in an urban centre in Brazil

    PubMed Central

    Santos, Selton Diniz; Penna, Gerson Oliveira; Costa, Maria da Conceição Nascimento; Natividade, Marcio Santos; Teixeira, Maria Glória

    2016-01-01

    This original study describes the intra-urban distribution of cases of leprosy in residents under 15 years old in Salvador, Bahia, Brazil; the study also identifies the environment in which Mycobacterium leprae is being transmitted. The cases were distributed by operational classification, clinical forms, type of contact and the addresses were geo-referenced by neighborhood. Between 2007 and 2011, were reported 145 cases of leprosy in target population living in Salvador, corresponding to detection rates of 6.21, 6.14, 5.58, 5.41 and 6.88/100,000 inhabitants, respectively. The spatial distribution of the disease was focal. Of the 157 neighborhoods of Salvador, 44 (28.6%) notified cases of leprosy and in 22 (50%) of these were detected more than 10 cases per 100,000 inhabitants. The infectious forms were found in 40% of cases. Over 90% of cases had been living in Salvador for more than five years. Overall, 52.6% reported having had contact with another infected individual inside the household and 25% in their social circle. In Salvador, M. leprae transmission is established. The situation is a major concern, since transmission is intense at an early age, indicating that this endemic disease is expanding and contacts extend beyond individual households. PMID:27223655

  19. Comparative morpho-anatomical studies of the lesions caused by citrus leprosis virus on sweet orange.

    PubMed

    Marques, João P R; Kitajima, Elliot W; Freitas-Astúa, Juliana; Appezzato-da-Glória, Beatriz

    2010-06-01

    The leprosis disease shows a viral etiology and the citrus leprosis virus is considered its etiologic agent. The disease may show two types of cytopatologic symptom caused by two virus: nuclear (CiLV-N) and cytoplasmic (CiLV-C) types. The aim of this study was to compare the morpho-anatomical differences in the lesions caused by leprosis virus-cytoplasmic and nuclear types in Citrus sinensis (L.) Osbeck 'Pêra'. Leaf and fruit lesions were collected in Piracicaba/São Paulo (cytoplasmic type) and Monte Alegre do Sul/São Paulo and Amparo/São Paulo (nuclear type). The lesions were photographed and then fixed in Karnovsky solution, dehydrated in a graded ethylic series, embedded in hydroxy-ethyl methacrylate resin (Leica Historesin), sectioned (5 microm thick), stained and mounted in synthetic resin. The digital images were acquired in a microscope with digital video camera. Leaf and fruit lesions caused by the two viruses were morphologically distinct. Only the lesion caused by CiLV-N virus presented three well-defined regions. In both lesions there was the accumulation of lipidic substances in necrotic areas that were surrounded by cells with amorphous or droplets protein. Only leaf and fruit lesions caused by CiLV-N virus exhibited traumatic gum ducts in the vascular bundles.

  20. Ancient DNA analysis - An established technique in charting the evolution of tuberculosis and leprosy.

    PubMed

    Donoghue, Helen D; Spigelman, Mark; O'Grady, Justin; Szikossy, Ildikó; Pap, Ildikó; Lee, Oona Y-C; Wu, Houdini H T; Besra, Gurdyal S; Minnikin, David E

    2015-06-01

    Many tuberculosis and leprosy infections are latent or paucibacillary, suggesting a long time-scale for host and pathogen co-existence. Palaeopathology enables recognition of archaeological cases and PCR detects pathogen ancient DNA (aDNA). Mycobacterium tuberculosis and Mycobacterium leprae cell wall lipids are more stable than aDNA and restrict permeability, thereby possibly aiding long-term persistence of pathogen aDNA. Amplification of aDNA, using specific PCR primers designed for short fragments and linked to fluorescent probes, gives good results, especially when designed to target multi-copy loci. Such studies have confirmed tuberculosis and leprosy, including co-infections. Many tuberculosis cases have non-specific or no visible skeletal pathology, consistent with the natural history of this disease. M. tuberculosis and M. leprae are obligate parasites, closely associated with their human host following recent clonal distribution. Therefore genotyping based on single nucleotide polymorphisms (SNPs) can indicate their origins, spread and phylogeny. Knowledge of extant genetic lineages at particular times in past human populations can be obtained from well-preserved specimens where molecular typing is possible, using deletion analysis, microsatellite analysis and whole genome sequencing. Such studies have identified non-bovine tuberculosis from a Pleistocene bison from 17,500 years BP, human tuberculosis from 9000 years ago and leprosy from over 2000 years ago. PMID:25773651

  1. A novel virus of the genus Cilevirus causing symptoms similar to citrus leprosis.

    PubMed

    Roy, Avijit; Choudhary, Nandlal; Guillermo, Leon M; Shao, Jonathan; Govindarajulu, Ananthakrishnan; Achor, Diann; Wei, G; Picton, D D; Levy, L; Nakhla, M K; Hartung, John S; Brlansky, R H

    2013-05-01

    Citrus leprosis in Colombia was previously shown to be caused by cytoplasmic Citrus leprosis virus (CiLV-C). In 2011, enzyme-linked immunosorbent assay and reverse-transcription polymerase chain reaction (RT-PCR)-based diagnostic methods failed to identify CiLV-C from citrus samples with symptoms similar to citrus leprosis; however, virions similar to CiLV-C were observed in the cytoplasm of the symptomatic leaves by transmission electron microscopy. Furthermore, the causal organism was transmitted by the false spider mite, Brevipalpus phoenicis, to healthy citrus seedlings. A library of small RNAs was constructed from symptomatic leaves and used as the template for Illumina high-throughput parallel sequencing. The complete genome sequence and structure of a new bipartite RNA virus was determined. RNA1 (8,717 nucleotides [nt]) contained two open reading frames (ORFs). ORF1 encoded the replication module, consisting of five domains: namely, methyltransferase (MTR), cysteine protease-like, FtsJ-MTR, helicase (Hel), and RNA-dependent RNA polymerase (RdRp); whereas ORF2 encoded the putative coat protein. RNA2 (4,989 nt) contained five ORFs that encode the movement protein (MP) and four hypothetical proteins (p7, p15, p24, and p61). The structure of this virus genome resembled that of CiLV-C except that it contained a long 3' untranslated terminal region and an extra ORF (p7) in RNA2. Both the RNA1 and RNA2 of the new virus had only 58 and 50% nucleotide identities, respectively, with known CiLV-C sequences and, thus, it appears to be a novel virus infecting citrus. Phylogenetic analyses of the MTR, Hel, RdRp, and MP domains also indicated that the new virus was closely related to CiLV-C. We suggest that the virus be called Citrus leprosis virus cytoplasmic type 2 (CiLV-C2) and it should be unambiguously classified as a definitive member of the genus Cilevirus. A pair of CiLV-C2 genome-specific RT-PCR primers was designed and validated to detect its presence in citrus

  2. A novel virus of the genus Cilevirus causing symptoms similar to citrus leprosis.

    PubMed

    Roy, Avijit; Choudhary, Nandlal; Guillermo, Leon M; Shao, Jonathan; Govindarajulu, Ananthakrishnan; Achor, Diann; Wei, G; Picton, D D; Levy, L; Nakhla, M K; Hartung, John S; Brlansky, R H

    2013-05-01

    Citrus leprosis in Colombia was previously shown to be caused by cytoplasmic Citrus leprosis virus (CiLV-C). In 2011, enzyme-linked immunosorbent assay and reverse-transcription polymerase chain reaction (RT-PCR)-based diagnostic methods failed to identify CiLV-C from citrus samples with symptoms similar to citrus leprosis; however, virions similar to CiLV-C were observed in the cytoplasm of the symptomatic leaves by transmission electron microscopy. Furthermore, the causal organism was transmitted by the false spider mite, Brevipalpus phoenicis, to healthy citrus seedlings. A library of small RNAs was constructed from symptomatic leaves and used as the template for Illumina high-throughput parallel sequencing. The complete genome sequence and structure of a new bipartite RNA virus was determined. RNA1 (8,717 nucleotides [nt]) contained two open reading frames (ORFs). ORF1 encoded the replication module, consisting of five domains: namely, methyltransferase (MTR), cysteine protease-like, FtsJ-MTR, helicase (Hel), and RNA-dependent RNA polymerase (RdRp); whereas ORF2 encoded the putative coat protein. RNA2 (4,989 nt) contained five ORFs that encode the movement protein (MP) and four hypothetical proteins (p7, p15, p24, and p61). The structure of this virus genome resembled that of CiLV-C except that it contained a long 3' untranslated terminal region and an extra ORF (p7) in RNA2. Both the RNA1 and RNA2 of the new virus had only 58 and 50% nucleotide identities, respectively, with known CiLV-C sequences and, thus, it appears to be a novel virus infecting citrus. Phylogenetic analyses of the MTR, Hel, RdRp, and MP domains also indicated that the new virus was closely related to CiLV-C. We suggest that the virus be called Citrus leprosis virus cytoplasmic type 2 (CiLV-C2) and it should be unambiguously classified as a definitive member of the genus Cilevirus. A pair of CiLV-C2 genome-specific RT-PCR primers was designed and validated to detect its presence in citrus

  3. Gnawing Pains, Festering Ulcers, and Nightmare Suffering: Selling Leprosy as a Humanitarian Cause in the British Empire, c. 1890-1960

    PubMed Central

    Vongsathorn, Kathleen

    2014-01-01

    When British attention was drawn to the issue of leprosy in the Empire, humanitarian organisations rose to take on responsibility for the ‘fight against leprosy’. In an effort to fundraise for a distant cause at a time when hundreds of charities competed for the financial support of British citizens, fundraisers developed propaganda to set leprosy apart from all other humanitarian causes. They drew on leprosy’s relationship with Christianity, its debilitating symptoms, and the supposed vulnerability of leprosy sufferers in order to mobilise Britain’s sense of humanitarian, Christian, and patriotic duty. This article traces the emergence of leprosy as a popular imperial humanitarian cause in modern Britain and analyses the narratives of religion, suffering, and disease that they created and employed in order to fuel their growth and sell leprosy as a British humanitarian cause. PMID:24932060

  4. Termination of the leprosy isolation policy in the US and Japan : Science, policy changes, and the garbage can model

    PubMed Central

    Sato, Hajime; Frantz, Janet E

    2005-01-01

    Background In both the US and Japan, the patient isolation policy for leprosy /Hansen's disease (HD) was preserved along with the isolation facilities, long after it had been proven to be scientifically unnecessary. This delayed policy termination caused a deprivation of civil liberties of the involuntarily confined patients, the fostering of social stigmas attached to the disease, and an inefficient use of health resources. This article seeks to elucidate the political process which hindered timely policy changes congruent with scientific advances. Methods Examination of historical materials, supplemented by personal interviews. The role that science played in the process of policy making was scrutinized with particular reference to the Garbage Can model. Results From the vantage of history, science remained instrumental in all period in the sense that it was not the primary objective for which policy change was discussed or intended, nor was it the principal driving force for policy change. When the argument arose, scientific arguments were employed to justify the patient isolation policy. However, in the early post-WWII period, issues were foregrounded and agendas were set as the inadvertent result of administrative reforms. Subsequently, scientific developments were more or less ignored due to concern about adverse policy outcomes. Finally, in the 1980s and 1990s, scientific arguments were used instrumentally to argue against isolation and for the termination of residential care. Conclusion Contrary to public expectations, health policy is not always rational and scientifically justified. In the process of policy making, the role of science can be limited and instrumental. Policy change may require the opening of policy windows, as a result of convergence of the problem, policy, and political streams, by effective exercise of leadership. Scientists and policymakers should be attentive enough to the political context of policies. PMID:15771781

  5. Characterization of a proposed dichorhavirus associated with the citrus leprosis disease and analysis of the host response.

    PubMed

    Cruz-Jaramillo, José Luis; Ruiz-Medrano, Roberto; Rojas-Morales, Lourdes; López-Buenfil, José Abel; Morales-Galván, Oscar; Chavarín-Palacio, Claudio; Ramírez-Pool, José Abrahán; Xoconostle-Cázares, Beatriz

    2014-07-07

    The causal agents of Citrus leprosis are viruses; however, extant diagnostic methods to identify them have failed to detect known viruses in orange, mandarin, lime and bitter orange trees with severe leprosis symptoms in Mexico, an important citrus producer. Using high throughput sequencing, a virus associated with citrus leprosis was identified, belonging to the proposed Dichorhavirus genus. The virus was termed Citrus Necrotic Spot Virus (CNSV) and contains two negative-strand RNA components; virions accumulate in the cytoplasm and are associated with plasmodesmata-channels interconnecting neighboring cells-suggesting a mode of spread within the plant. The present study provides insights into the nature of this pathogen and the corresponding plant response, which is likely similar to other pathogens that do not spread systemically in plants.

  6. Characterization of a Proposed Dichorhavirus Associated with the Citrus Leprosis Disease and Analysis of the Host Response

    PubMed Central

    Cruz-Jaramillo, José Luis; Ruiz-Medrano, Roberto; Rojas-Morales, Lourdes; López-Buenfil, José Abel; Morales-Galván, Oscar; Chavarín-Palacio, Claudio; Ramírez-Pool, José Abrahán; Xoconostle-Cázares, Beatriz

    2014-01-01

    The causal agents of Citrus leprosis are viruses; however, extant diagnostic methods to identify them have failed to detect known viruses in orange, mandarin, lime and bitter orange trees with severe leprosis symptoms in Mexico, an important citrus producer. Using high throughput sequencing, a virus associated with citrus leprosis was identified, belonging to the proposed Dichorhavirus genus. The virus was termed Citrus Necrotic Spot Virus (CNSV) and contains two negative-strand RNA components; virions accumulate in the cytoplasm and are associated with plasmodesmata—channels interconnecting neighboring cells—suggesting a mode of spread within the plant. The present study provides insights into the nature of this pathogen and the corresponding plant response, which is likely similar to other pathogens that do not spread systemically in plants. PMID:25004279

  7. Pure neuritic leprosy: Resolving diagnostic issues in acid fast bacilli (AFB)-negative nerve biopsies: A single centre experience from South India

    PubMed Central

    Hui, Monalisa; Uppin, Megha S.; Challa, Sundaram; Meena, A. K.; Kaul, Subhash

    2015-01-01

    Background and Purpose: Demonstration of lepra bacilli is essential for definite or unequivocal diagnosis of pure neuritic leprosy (PNL) on nerve biopsy. However, nerves always do not show bacilli owing to the changes of previous therapy or due to low bacillary load in tuberculoid forms. In absence of granuloma or lepra bacilli, other morphologic changes in endoneurium and perineurium can be of help in making a probable diagnosis of PNL and treating the patient with multidrug therapy. Materials and Methods: Forty-six biopsies of PNL were retrospectively reviewed and histologic findings were compared with 25 biopsies of non leprosy neuropathies (NLN) including vasculitic neuropathy and chronic inflammatory demyelinating polyneuropathy (CIDP). The distribution of endoneurial infiltrate and fibrosis, perineurial thickening, and myelin abnormalities were compared between PNL and NLN biopsies and analyzed by Chi-square test. Results: Out of 46 PNL casses, 24 (52.17 %) biopsies were negative for acid fast bacilli (AFB). In these cases, the features which favor a diagnosis of AFB-negative PNL were endoneurial infiltrate (51.1%), endoneurial fibrosis (54.2%), perineurial thickening (70.8%), and reduced number of myelinated nerve fibers (75%). Interpretation and Conclusion: Nerve biopsy is an efficient tool to diagnose PNL and differentiate it from other causes of NLN. In absence of AFB, the diagnosis of PNL is challenging. In this article, we have satisfactorily evaluated the various hisopthological features and found that endoneurial inflammation, dense fibrosis, and reduction in the number of myelinated nerve fibers are strong supportive indicators of PNL regardless of AFB positivity. PMID:26425006

  8. Health-related quality of life, depression, and self-esteem in adolescents with leprosy-affected parents: results of a cross-sectional study in Nepal

    PubMed Central

    2013-01-01

    Background Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children. Methods A cross-sectional study was conducted in the Lalitpur and Kathmandu districts of Nepal. Adolescents with leprosy-affected parents (n = 102; aged 11–17 years) and those with parents unaffected by leprosy (n = 115; 11–17 years) were investigated. Self-reported data from adolescents were collected using the Kinder Lebensqualität Fragebogen (KINDLR) questionnaire to assess HRQOL, the Center for Epidemiological Studies-Depression Scale (CES-D), and the Rosenberg Self-esteem Scale (RSES). Analysis of covariance (ANCOVA) was used to compare scores between the two groups. Multiple regression analysis was conducted to explore the determinants of HRQOL for adolescents with leprosy-affected parents. Results ANCOVA revealed that the KINDLR and RSES scores were significantly lower among adolescents with leprosy-affected parents compared with unaffected parents. However, the scores of “Friends” and “School” subscales of KINDLR were similar between the two groups. The CES-D score was significantly higher among adolescents with leprosy-affected parents than for adolescents with unaffected parents. The KINDLR scores for adolescents with both parents affected (n = 41) were significantly lower than the scores for those with one parent affected (n = 61). Multiple regression analysis revealed that adolescents with leprosy-affected parents who had higher levels of depressive symptoms were more likely to have lower KINDLR scores. A similar result was seen for adolescents where both parents had leprosy. Conclusions Adolescents with leprosy-affected parents had higher levels of depressive symptoms, lower levels of self-esteem, and lower HRQOL compared with adolescents whose parents were

  9. A 35-kilodalton protein is a major target of the human immune response to Mycobacterium leprae.

    PubMed Central

    Triccas, J A; Roche, P W; Winter, N; Feng, C G; Butlin, C R; Britton, W J

    1996-01-01

    The control of leprosy will be facilitated by the identification of major Mycobacterium leprae-specific antigens which mirror the immune response to the organism across the leprosy spectrum. We have investigated the host response to a 35-kDa protein of M. leprae. Recombinant 35-kDa protein purified from Mycobacterium smegmatis resembled the native antigen in the formation of multimeric complexes and binding by monoclonal antibodies and sera from leprosy patients. These properties were not shared by two forms of 35-kDa protein purified from Escherichia coli. The M. smegmatis-derived 35-kDa protein stimulated a gamma interferon-secreting T-cell proliferative response in the majority of paucibacillary leprosy patients and healthy contacts of leprosy patients tested. Cellular responses to the protein in patients with multibacillary leprosy were weak or absent, consistent with hyporesponsiveness to M. leprae characteristic of this form of the disease. Almost all leprosy patients and contacts recognized the 35-kDa protein by either a T-cell proliferative or an immunoglobulin G antibody response, whereas few tuberculosis patients recognized the antigen. This specificity was confirmed in guinea pigs, with the 35-kDa protein eliciting strong delayed-type hypersensitivity in M. leprae-sensitized animals but not in those sensitized with Mycobacterium tuberculosis or Mycobacterium bovis BCG. Therefore, the M. leprae 35-kDa protein appears to be a major and relatively specific target of the human immune response to M. leprae and is a potential component of a diagnostic test to detect exposure to leprosy or a vaccine to combat the disease. PMID:8945562

  10. Spatial patterns of leprosy in a hyperendemic state in Northern Brazil, 2001-2012

    PubMed Central

    Monteiro, Lorena Dias; Martins-Melo, Francisco Rogerlândio; Brito, Aline Lima; Alencar, Carlos Henrique; Heukelbach, Jorg

    2015-01-01

    ABSTRACT OBJECTIVE To describe the spatial patterns of leprosy in the Brazilian state of Tocantins. METHODS This study was based on morbidity data obtained from the Sistema de Informações de Agravos de Notificação (SINAN – Brazilian Notifiable Diseases Information System), of the Ministry of Health. All new leprosy cases in individuals residing in the state of Tocantins, between 2001 and 2012, were included. In addition to the description of general disease indicators, a descriptive spatial analysis, empirical Bayesian analysis and spatial dependence analysis were performed by means of global and local Moran’s indexes. RESULTS A total of 14,542 new cases were recorded during the period under study. Based on the annual case detection rate, 77.0% of the municipalities were classified as hyperendemic (> 40 cases/100,000 inhabitants). Regarding the annual case detection rate in < 15 years-olds, 65.4% of the municipalities were hyperendemic (10.0 to 19.9 cases/100,000 inhabitants); 26.6% had a detection rate of grade 2 disability cases between 5.0 and 9.9 cases/100,000 inhabitants. There was a geographical overlap of clusters of municipalities with high detection rates in hyperendemic areas. Clusters with high disease risk (global Moran’s index: 0.51; p < 0.001), ongoing transmission (0.47; p < 0.001) and late diagnosis (0.44; p < 0.001) were identified mainly in the central-north and southwestern regions of Tocantins. CONCLUSIONS We identified high-risk clusters for transmission and late diagnosis of leprosy in the Brazilian state of Tocantins. Surveillance and control measures should be prioritized in these high-risk municipalities. PMID:26603352

  11. Transmission of Citrus leprosis virus C by Brevipalpus phoenicis (Geijskes) to Alternative Host Plants Found in Citrus Orchards

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The equivalent of US$ 75 million is spent each year in Brazil to control Brevipalpus phoenicis, a mite vector of Citrus leprosis virus C (CiLV-C). In this study we investigated the possibility that hedgerows, windbreaks, and weeds normally found in citrus orchards could host CiLV-C. Mites reared on ...

  12. Osteological, biomolecular and geochemical examination of an early anglo-saxon case of lepromatous leprosy.

    PubMed

    Inskip, Sarah A; Taylor, G Michael; Zakrzewski, Sonia R; Mays, Simon A; Pike, Alistair W G; Llewellyn, Gareth; Williams, Christopher M; Lee, Oona Y-C; Wu, Houdini H T; Minnikin, David E; Besra, Gurdyal S; Stewart, Graham R

    2015-01-01

    We have examined a 5th to 6th century inhumation from Great Chesterford, Essex, UK. The incomplete remains are those of a young male, aged around 21-35 years at death. The remains show osteological evidence of lepromatous leprosy (LL) and this was confirmed by lipid biomarker analysis and ancient DNA (aDNA) analysis, which provided evidence for both multi-copy and single copy loci from the Mycobacterium leprae genome. Genotyping showed the strain belonged to the 3I lineage, but the Great Chesterford isolate appeared to be ancestral to 3I strains found in later medieval cases in southern Britain and also continental Europe. While a number of contemporaneous cases exist, at present, this case of leprosy is the earliest radiocarbon dated case in Britain confirmed by both aDNA and lipid biomarkers. Importantly, Strontium and Oxygen isotope analysis suggest that the individual is likely to have originated from outside Britain. This potentially sheds light on the origins of the strain in Britain and its subsequent spread to other parts of the world, including the Americas where the 3I lineage of M. leprae is still found in some southern states of America. PMID:25970602

  13. Immunodiagnosis of Citrus leprosis virus C using a polyclonal antibody to an expressed putative coat protein.

    PubMed

    Choudhary, Nandlal; Roy, Avijit; Guillermo, Leon M; Picton, D D; Wei, G; Nakhla, M K; Levy, L; Brlansky, R H

    2013-11-01

    Citrus leprosis virus C (CiLV-C), a causal agent for citrus leprosis disease, is present in South and Central America and is a threat for introduction into the U.S. citrus industry. A specific, inexpensive and reliable antibody based detection system is needed for the rapid identification of CiLV-C. The CiLV-C is very labile and has not been purified in sufficient amount for antibody production. The p29 gene of CiLV-C genome that codes for the putative coat protein (PCP) was codon optimized for expression in Escherichia coli and synthesized in vitro. The optimized gene was sub-cloned into the bacterial expression vector pDEST17 and transferred into E. coli BL21AI competent cells. The expression of PCP containing N-terminal His-tag was optimized by induction with l-arabinose. Induced cells were disrupted by sonication and expressed PCP was purified by affinity chromatography using Ni-NTA agarose. The purified expressed PCP was then used as an immunogen for injections into rabbits to produce polyclonal antibody (PAb). The PAb specific to the expressed PCP was identified using Western blotting. The antibody was successfully used to detect CiLV-C in the symptomatic CiLV-C infected tissues using double antibody sandwich-enzyme-linked-immunosorbent (DAS-ELISA), indirect ELISA and dot-blot immunoassay (DBIA) formats.

  14. The armadillo: a model for the neuropathy of leprosy and potentially other neurodegenerative diseases.

    PubMed

    Sharma, Rahul; Lahiri, Ramanuj; Scollard, David M; Pena, Maria; Williams, Diana L; Adams, Linda B; Figarola, John; Truman, Richard W

    2013-01-01

    Leprosy (also known as Hansen's disease) is an infectious peripheral neurological disorder caused by Mycobacterium leprae that even today leaves millions of individuals worldwide with life-long disabilities. The specific mechanisms by which this bacterium induces nerve injury remain largely unknown, mainly owing to ethical and practical limitations in obtaining affected human nerve samples. In addition to humans, nine-banded armadillos (Dasypus novemcinctus) are the only other natural host of M. leprae, and they develop a systemically disseminated disease with extensive neurological involvement. M. leprae is an obligate intracellular parasite that cannot be cultivated in vitro. Because of the heavy burdens of bacilli they harbor, nine-banded armadillos have become the organism of choice for propagating large quantities of M. leprae, and they are now advancing as models of leprosy pathogenesis and nerve damage. Although armadillos are exotic laboratory animals, the recently completed whole genome sequence for this animal is enabling researchers to undertake more sophisticated molecular studies and to develop armadillo-specific reagents. These advances will facilitate the use of armadillos in piloting new therapies and diagnostic regimens, and will provide new insights into the oldest known infectious neurodegenerative disorder. PMID:23223615

  15. Chemical definition, cloning, and expression of the major protein of the leprosy bacillus.

    PubMed

    Rivoire, B; Pessolani, M C; Bozic, C M; Hunter, S W; Hefta, S A; Mehra, V; Brennan, P J

    1994-06-01

    The decline in prevalence of leprosy is not necessarily matched by a fall in incidence, emphasizing the need for new antigens to measure disease transmission and reservoirs of infection. Mycobacterium leprae obtained from armadillo tissues was disrupted and subjected to differential centrifugation to arrive at preparations of cell wall, cytoplasmic membrane, and cytosol. By committing 0.3 g of M. leprae to the task, it was possible to isolate from the cytosol and fully define the major cytosolic protein. Amino-terminus sequencing and chemical and enzymatic cleavage, followed by more sequencing and fast atom bombardment-mass spectrometry of fragments, allowed description of the entire amino acid sequence of a protein of 10,675-Da molecular mass. The sequence derived by chemical means is identical to that deduced previously from DNA analysis of the gene of a 10-kDa protein, a GroES analog. The work represents the first complete chemical definition of an M. leprae protein. PCR amplification of the 10-kDa protein gene, when cloned into Escherichia coli with a pTRP expression vector, allowed production of the recombinant protein. Chemical analysis of the expressed protein demonstrated that it exactly reflected the native protein. The recombinant major cytosolic protein appears to be a promising reagent for skin testing, still probably the most appropriate and pragmatic means of measuring incidence of leprosy.

  16. DNA methylation in leprosy-associated bacteria: Mycobacterium leprae and Corynebacterium tuberculostearicum.

    PubMed

    Hottat, F; Coene, M; Cocito, C

    1988-01-01

    The DNAs of two kinds of microorganisms from human leprosy lesion, Mycobacterium leprae and Corynebacterium tuberculostearicum (also known as "leprosy-derived corynebacterium" or LDC), have been analysed and compared with the genomes of reference bacteria of the CMN group (genera Corynebacterium, Mycobacterium and Nocardia). The guanine-plus-cytosine content (% GC) of DNA was determined by a double-labelling procedure, which is unaffected by the presence of modified and unusual bases (that alter both buoyant density and mid-melting-point determinations). Accordingly, the DNAs of seven LDC strains had GC values of 54-56 mol %, and that of armadillo-grown M. leprae a value of 54.8 +/- 0.9 mol %. Restriction patterns disclosed no methylated cytosine in the DNA sequences CCGG, GGCC, AGCT and GATC of either LDC or M. leprae DNA. N6-methyl adenine was present in the sequence GATC of all LDC strains, but was missing from the genomes of all others CMN organisms analysed, including M. leprae. By HPLC analysis of LDC-DNA hydrolysates, it was found that N6-methyladenine amounted to 1.8% of total DNA adenine, and was present exclusively within GATC sequences, which appeared all to be methylated. It is concluded that LDC represent a group of corynebacteria endowed with high genetic homogeneity and a unique restriction pattern, whereby their genome is easily distinguished from that of M. leprae, which has a similar base composition.

  17. Osteological, Biomolecular and Geochemical Examination of an Early Anglo-Saxon Case of Lepromatous Leprosy

    PubMed Central

    Inskip, Sarah A.; Taylor, G. Michael; Zakrzewski, Sonia R.; Mays, Simon A.; Pike, Alistair W. G.; Llewellyn, Gareth; Williams, Christopher M.; Lee, Oona Y-C; Wu, Houdini H. T.; Minnikin, David E.; Besra, Gurdyal S.; Stewart, Graham R.

    2015-01-01

    We have examined a 5th to 6th century inhumation from Great Chesterford, Essex, UK. The incomplete remains are those of a young male, aged around 21–35 years at death. The remains show osteological evidence of lepromatous leprosy (LL) and this was confirmed by lipid biomarker analysis and ancient DNA (aDNA) analysis, which provided evidence for both multi-copy and single copy loci from the Mycobacterium leprae genome. Genotyping showed the strain belonged to the 3I lineage, but the Great Chesterford isolate appeared to be ancestral to 3I strains found in later medieval cases in southern Britain and also continental Europe. While a number of contemporaneous cases exist, at present, this case of leprosy is the earliest radiocarbon dated case in Britain confirmed by both aDNA and lipid biomarkers. Importantly, Strontium and Oxygen isotope analysis suggest that the individual is likely to have originated from outside Britain. This potentially sheds light on the origins of the strain in Britain and its subsequent spread to other parts of the world, including the Americas where the 3I lineage of M. leprae is still found in some southern states of America. PMID:25970602

  18. Chromoblastomycosis in a resident of a leprosarium.

    PubMed

    Dashatwar, Digambar; Kar, Sumit; Gangane, Nitin; Pol, Vijay; Madke, Bhushan; Kulkarni, Sandeep; Singh, Neha

    2015-03-01

    Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. The lesion begins as a pink, scaly papule or warty growth. We report a case of chromoblastomycosis occurring in a multibacillary leprosy patient, who had already been released from treatment (RFT). The diagnosis was confirmed by the presence of sclerotic bodies (Medlar bodies/copper penny bodies). Systemic antifungal treatment has been found effective. The case is being reported in view of the association of two diseases and the dramatic clinical response to systemic treatment with Itraconazole.

  19. Chromoblastomycosis in a resident of a leprosarium.

    PubMed

    Dashatwar, Digambar; Kar, Sumit; Gangane, Nitin; Pol, Vijay; Madke, Bhushan; Kulkarni, Sandeep; Singh, Neha

    2015-03-01

    Chromoblastomycosis is caused by dematiaceous fungi. It develops after inoculation of the organism into the skin. The lesion begins as a pink, scaly papule or warty growth. We report a case of chromoblastomycosis occurring in a multibacillary leprosy patient, who had already been released from treatment (RFT). The diagnosis was confirmed by the presence of sclerotic bodies (Medlar bodies/copper penny bodies). Systemic antifungal treatment has been found effective. The case is being reported in view of the association of two diseases and the dramatic clinical response to systemic treatment with Itraconazole. PMID:26065153

  20. Lepromatous leprosy and perianal tuberculosis: a case report and literature review

    PubMed Central

    2014-01-01

    Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is usually well-controlled by multidrug therapy (MDT), the disease may be aggravated by acute inflammatory reaction episodes that cause permanent tissue damage particularly to peripheral nerves. Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection. Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade. Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic. PMID:25180030

  1. Characterization of a virus infecting Citrus volkameriana with citrus leprosis-like symptoms.

    PubMed

    Melzer, Michael J; Sether, Diane M; Borth, Wayne B; Hu, John S

    2012-01-01

    A Citrus volkameriana tree displaying symptoms similar to citrus leprosis on its leaves and bark was found in Hawaii. Citrus leprosis virus C (CiLV-C)-specific detection assays, however, were negative for all tissues tested. Short, bacilliform virus-like particles were observed by transmission electron microscopy in the cytoplasm of symptomatic leaves but not in healthy controls. Double-stranded (ds) RNAs ≈8 and 3 kbp in size were present in symptomatic leaf tissue but not in healthy controls. Excluding poly(A) tails, the largest molecule, RNA1, was 8,354 bp in length. The ≈3 kbp dsRNA band was found to be composed of two distinct molecules, RNA2 and RNA3, which were 3,169 and 3,113 bp, respectively. Phylogenetic analyses indicated that the RNA-dependent RNA polymerase (RdRp) domain located in RNA1 was most closely related to the RdRp domain of CiLV-C. A reverse-transcription polymerase chain reaction assay developed for the detection of this virus was used to screen nearby citrus trees as well as Hibiscus arnottianus plants with symptoms of hibiscus green spot, a disease associated with infection by Hibiscus green spot virus (HGSV). All nearby citrus trees tested negative with the assay; however, symptomatic H. arnottianus plants were positive. All three RNAs were present in symptomatic H. arnottianus and were >98% identical to the RNAs isolated from C. volkameriana. We contend that the virus described in this study is HGSV, and propose that it be the type member of a new virus genus, Higrevirus.

  2. Molecular Analysis of a Leprosy Immunotherapeutic Bacillus Provides Insights into Mycobacterium Evolution

    PubMed Central

    Raghuvanshi, Saurabh; Khurana, Jitendra P.; Tyagi, Akhilesh K.; Tyagi, Anil K.; Hasnain, Seyed E.

    2007-01-01

    Background Evolutionary dynamics plays a central role in facilitating the mechanisms of species divergence among pathogenic and saprophytic mycobacteria. The ability of mycobacteria to colonize hosts, to proliferate and to cause diseases has evolved due to its predisposition to various evolutionary forces acting over a period of time. Mycobacterium indicus pranii (MIP), a taxonomically unknown ‘generalist’ mycobacterium, acts as an immunotherapeutic against leprosy and is approved for use as a vaccine against it. The large-scale field trials of this MIP based leprosy vaccine coupled with its demonstrated immunomodulatory and adjuvant property has led to human clinical evaluations of MIP in interventions against HIV-AIDS, psoriasis and bladder cancer. MIP, commercially available as ‘Immuvac’, is currently the focus of advanced phase III clinical trials for its antituberculosis efficacy. Thus a comprehensive analysis of MIP vis-à-vis evolutionary path, underpinning its immanent immunomodulating properties is of the highest desiderata. Principal Findings Genome wide comparisons together with molecular phylogenetic analyses by fluorescent amplified fragment length polymorphism (FAFLP), enterobacterial repetitive intergenic consensus (ERIC) based genotyping and candidate orthologues sequencing revealed that MIP has been the predecessor of highly pathogenic Mycobacterium avium intracellulare complex (MAIC) that did not resort to parasitic adaptation by reductional gene evolution and therefore, preferred a free living life-style. Further analysis suggested a shared aquatic phase of MAIC bacilli with the early pathogenic forms of Mycobacterium, well before the latter diverged as ‘specialists’. Conclusions/Significance This evolutionary paradigm possibly affirms to marshal our understanding about the acquisition and optimization of virulence in mycobacteria and determinants of boundaries therein. PMID:17912347

  3. BCG vaccination of children against leprosy: seven-year findings of the controlled WHO trial in Burma*

    PubMed Central

    Bechelli, L. M.; Garbajosa, P. Gallego; Gyi, Mg Mg; Uemura, K.; Sundaresan, T.; Domínguez, V. Martínez; Matejka, M.; Tamondong, C.; Quagliato, R.; Engler, V.; Altmann, M.

    1973-01-01

    A controlled study of the efficacy of BCG vaccination for the prevention of leprosy began in Burma at the end of August 1964. This paper presents the findings after 7 years—i.e., the results of 6 annual follow-up examinations up to the end of June 1971. The incidence rate in BCG-vaccinated children 0-4 years of age at intake was lower than that in children in the control group. The protection conferred by BCG was relatively low (44%) and applied only to early cases of leprosy, the great majority tuberculoid cases. BCG vaccination did not protect household contacts or children 5-14 years of age who were not exposed in the household. This reduction must be interpreted in the light of several factors: form of leprosy, bacterial status, lepromin reactivity, evolution of cases, and level of endemicity. Consequently it does not seem probable that the reduction in incidence would substantially affect the pattern or trend of the disease in an area similar to that where the study is being carried out; the probability would be much lower if not nil in regions of relatively low endemicity (1-2 per 1 000 or less). PMID:4270384

  4. Inorganic particles in the skin of inhabitants of volcanic areas of Central America: their possible immunomodulatory influence in leishmaniasis and leprosy.

    PubMed

    Convit, J; Ulrich, M; Castillo, J; De Lima, H; Pérez, M; Caballero, N; Hung, J; Arana, B; Pérez, P

    2006-08-01

    We have evaluated biopsies from patients with atypical nodular and typical ulcerated lesions of cutaneous leishmaniasis, from leishmanin reactions and skin from normal individuals from Nicaragua, Honduras and Guatemala for the presence of inorganic particles using confocal microscopy with a polarised light source and conventional histopathological techniques. Analysis by semiquantitative confocal microscopy permitted the demonstration of significantly larger numbers of particles in atypical lesions. Silica and aluminium, important components of these particles, were less abundant in particles from normal skin. The histology of these atypical lesions, characterised by 'naked' sarcoidal granulomas with epithelioid differentiation but very few lymphocytes, was very similar to the histological reaction observed after 14 days in persisting inflammation at leishmanin skin test sites. The presence of these unusual lesions in areas of Central American countries characterised by the presence of large amounts of volcanic ash, as well the unexpectedly low prevalence of leprosy in Central America, suggest that environmental factors may contribute significantly to the frequency and clinical manifestations of these infections. Among possible environmental features, the presence of inorganic particles with immunomodulatory properties in the skin may be a significant factor.

  5. IL-10 and NOS2 Modulate Antigen-Specific Reactivity and Nerve Infiltration by T Cells in Experimental Leprosy

    PubMed Central

    Hagge, Deanna A.; Scollard, David M.; Ray, Nashone A.; Marks, Vilma T.; Deming, Angelina T.; Spencer, John S.; Adams, Linda B.

    2014-01-01

    Background Although immunopathology dictates clinical outcome in leprosy, the dynamics of early and chronic infection are poorly defined. In the tuberculoid region of the spectrum, Mycobacterium leprae growth is restricted yet a severe granulomatous lesion can occur. The evolution and maintenance of chronic inflammatory processes like those observed in the leprosy granuloma involve an ongoing network of communications via cytokines. IL-10 has immunosuppressive properties and IL-10 genetic variants have been associated with leprosy development and reactions. Methodology/Principal Findings The role of IL-10 in resistance and inflammation in leprosy was investigated using Mycobacterium leprae infection of mice deficient in IL-10 (IL-10−/−), as well as mice deficient in both inducible nitric oxide synthase (NOS2−/−) and IL-10 (10NOS2−/−). Although a lack of IL-10 did not affect M. leprae multiplication in the footpads (FP), inflammation increased from C57Bl/6 (B6)leprosy and presents a new model for investigating the

  6. The prevention of leprosy related disability as an integral component of the government health delivery programme in Indonesia: perspectives on implementation.

    PubMed

    Cross, Hugh

    2013-09-01

    This paper presents a record of three interviews with groups of Ministry of Health personnel and consultants that took place in Jakarta, Indonesia in May 2012. Those contributing to the first interview were provincial and district supervisors with responsibility for leprosy. Those contributing to the second interview were consultants, three of whom were seconded to the Ministry of Health and one was a WHO consultant. A third interview was conducted with the Head and a technical staff member of the Sub Directorate of Leprosy and Yaws Control Programme, Ministry of Health, Indonesia. Leprosy control in Indonesia had been targeted for further enquiry after it became apparent, through an earlier survey of national programme managers and consultants, that the programme had been relatively successful in integrating POD into the government health delivery programme. The perspectives of significant representatives and actors in the national programme were recorded through the interviews undertaken in Jakarta. Limitations This report does not purport to be a study of integration of leprosy services in Indonesia. The perspectives of representatives and significant actors are offered here to enhance understanding of factors that contributed to POD becoming a routine component of general health care in Indonesia. It is also declared here that no independent verification of statements was undertaken and that the effectiveness of measures taken to integrate leprosy related POD has not been independently evaluated.

  7. New Players in the Same Old Game: Disturbance of Group 2 Innate Lymphoid Cells in HIV-1 and Mycobacterium leprae Co-infected Patients

    PubMed Central

    Papotto, Pedro Henrique; Maeda, Solange; Tomimori, Jane; Xavier, Marília Brasil; Rizzo, Luiz Vicente; Kallas, Esper Georges; Carvalho, Karina Inácio

    2015-01-01

    Abstract Leprosy control is achieved through a fine-tuning of TH1 and TH2 immune response pattern balance. Given the increasing epidemiological overlay of HIV and M. leprae infections, immune response in co-infected patients consists in an important contemporary issue. Here we describe for the first time the innate lymphoid cells compartment in peripheral blood of leprosy and HIV/M. leprae co-infected patients, and show that co-infection increases group 2 innate lymphoid whilst decreasing group 1 innate lymphoid cells frequencies and function. PMID:26335023

  8. The Cultural Validation of Two Scales to Assess Social Stigma in Leprosy

    PubMed Central

    Peters, Ruth M. H.; Dadun; Van Brakel, Wim H.; Zweekhorst, Marjolein B. M.; Damayanti, Rita; Bunders, Joske F. G.; Irwanto

    2014-01-01

    Background Stigma plays in an important role in the lives of persons affected by neglected tropical diseases, and assessment of stigma is important to document this. The aim of this study is to test the cross-cultural validity of the Community Stigma Scale (EMIC-CSS) and the Social Distance Scale (SDS) in the field of leprosy in Cirebon District, Indonesia. Methodology/principle findings Cultural equivalence was tested by assessing the conceptual, item, semantic, operational and measurement equivalence of these instruments. A qualitative exploratory study was conducted to increase our understanding of the concept of stigma in Cirebon District. A process of translation, discussions, trainings and a pilot study followed. A sample of 259 community members was selected through convenience sampling and 67 repeated measures were obtained to assess the psychometric measurement properties. The aspects and items in the SDS and EMIC-CSS seem equally relevant and important in the target culture. The response scales were adapted to ensure that meaning is transferred accurately and no changes to the scale format (e.g. lay out, statements or questions) of both scales were made. A positive correlation was found between the EMIC-CSS and the SDS total scores (r = 0.41). Cronbach's alphas of 0.83 and 0.87 were found for the EMIC-CSS and SDS. The exploratory factor analysis indicated for both scales an adequate fit as unidimensional scale. A standard error of measurement of 2.38 was found in the EMIC-CSS and of 1.78 in the SDS. The test-retest reliability coefficient was respectively, 0.84 and 0.75. No floor or ceiling effects were found. Conclusions/significance According to current international standards, our findings indicate that the EMIC-CSS and the SDS have adequate cultural validity to assess social stigma in leprosy in the Bahasa Indonesia-speaking population of Cirebon District. We believe the scales can be further improved, for instance, by adding, changing and

  9. Detection and Strain Typing of Ancient Mycobacterium leprae from a Medieval Leprosy Hospital

    PubMed Central

    Taylor, G. Michael; Tucker, Katie; Butler, Rachel; Pike, Alistair W. G.; Lewis, Jamie; Roffey, Simon; Marter, Philip; Lee, Oona Y-C; Wu, Houdini H. T.; Minnikin, David E.; Besra, Gurdyal S.; Singh, Pushpendra; Cole, Stewart T.; Stewart, Graham R.

    2013-01-01

    Nine burials excavated from the Magdalen Hill Archaeological Research Project (MHARP) in Winchester, UK, showing skeletal signs of lepromatous leprosy (LL) have been studied using a multidisciplinary approach including osteological, geochemical and biomolecular techniques. DNA from Mycobacterium leprae was amplified from all nine skeletons but not from control skeletons devoid of indicative pathology. In several specimens we corroborated the identification of M. leprae with detection of mycolic acids specific to the cell wall of M. leprae and persistent in the skeletal samples. In five cases, the preservation of the material allowed detailed genotyping using single-nucleotide polymorphism (SNP) and multiple locus variable number tandem repeat analysis (MLVA). Three of the five cases proved to be infected with SNP type 3I-1, ancestral to contemporary M. leprae isolates found in southern states of America and likely carried by European migrants. From the remaining two burials we identified, for the first time in the British Isles, the occurrence of SNP type 2F. Stable isotope analysis conducted on tooth enamel taken from two of the type 3I-1 and one of the type 2F remains revealed that all three individuals had probably spent their formative years in the Winchester area. Previously, type 2F has been implicated as the precursor strain that migrated from the Middle East to India and South-East Asia, subsequently evolving to type 1 strains. Thus we show that type 2F had also spread westwards to Britain by the early medieval period. PMID:23638071

  10. Phylogenetic and Molecular Variability Studies Reveal a New Genetic Clade of Citrus leprosis virus C.

    PubMed

    Ramos-González, Pedro Luis; Chabi-Jesus, Camila; Guerra-Peraza, Orlene; Breton, Michèle Claire; Arena, Gabriella Dias; Nunes, Maria Andreia; Kitajima, Elliot Watanabe; Machado, Marcos Antonio; Freitas-Astúa, Juliana

    2016-01-01

    Citrus leprosis virus C (CiLV-C) causes a severe disease affecting citrus orchards in the Western hemisphere. This study reveals the molecular variability of the virus by analyzing four genomic regions (p29, p15, MP and RNA2-intergenic region) distributed over its two RNAs. Nucleotide diversity (π) values were relatively low but statistically different over the analyzed genes and subpopulations, indicating their distinct evolutionary history. Values of πp29 and πMP were higher than those of πp15 and πRNA2-IR, whereas πMP was increased due to novel discovered isolates phylogenetically clustered in a divergent clade that we called SJP. Isolate BR_SP_SJP_01 RNA1 and RNA2 sequences, clade SJP, showed an identity of 85.6% and 88.4%, respectively, with those corresponding to CiLV-C, the type member of the genus Cilevirus, and its RNA2 5'-proximal region was revealed as a minor donor in a putative inter-clade recombination event. In addition to citrus, BR_SP_SJP_01 naturally infects the weed Commelina benghalensis and is efficiently transmitted by Brevipalpus yothersi mites. Our data demonstrated that negative selection was the major force operating in the evaluated viral coding regions and defined amino acids putatively relevant for the biological function of cilevirus proteins. This work provides molecular tools and sets up a framework for further epidemiological studies. PMID:27275832

  11. E-selectin and P-selectin expression in endothelium of leprosy skin lesions.

    PubMed

    Souza, Juarez de; Sousa, Jorge Rodrigues de; Hirai, Kelly Emi; Silva, Luciana Mota; Fuzii, Hellen Thais; Dias, Leonidas Braga; Carneiro, Francisca Regina Oliveira; Aarão, Tinara Leila de Souza; Quaresma, Juarez Antonio Simões

    2015-09-01

    Leprosy is an infectious-contagious disease whose clinical evolution depends on the immune response pattern of the host. Adhesion molecules and leukocyte migration from blood to tissue are of the utmost importance for the recognition and elimination of infectious pathogens. Selectins are transmembrane glycoproteins that share a similar structural organization and can be divided into three types according to their site of expression. The biopsies were cut into 5μm thick sections and submitted to immunohistochemistry using antibodies against E-selectin and P-selectin. The number of E-selectin-positive cells was significantly higher in the tuberculoid form than in the lepromatous form. The immunostaining pattern of P-selectin differed from that of E-selectin. Analysis showed a larger number of endothelial cells expressing CD62P in the lepromatous form compared to the tuberculoid form. The presence of these adhesins in the endothelium contributing to or impairing the recruitment of immune cells to inflamed tissue and consequently influences the pattern of immune response and the clinical presentation of the disease.

  12. Phylogenetic and Molecular Variability Studies Reveal a New Genetic Clade of Citrus leprosis virus C

    PubMed Central

    Ramos-González, Pedro Luis; Chabi-Jesus, Camila; Guerra-Peraza, Orlene; Breton, Michèle Claire; Arena, Gabriella Dias; Nunes, Maria Andreia; Kitajima, Elliot Watanabe; Machado, Marcos Antonio; Freitas-Astúa, Juliana

    2016-01-01

    Citrus leprosis virus C (CiLV-C) causes a severe disease affecting citrus orchards in the Western hemisphere. This study reveals the molecular variability of the virus by analyzing four genomic regions (p29, p15, MP and RNA2-intergenic region) distributed over its two RNAs. Nucleotide diversity (π) values were relatively low but statistically different over the analyzed genes and subpopulations, indicating their distinct evolutionary history. Values of πp29 and πMP were higher than those of πp15 and πRNA2–IR, whereas πMP was increased due to novel discovered isolates phylogenetically clustered in a divergent clade that we called SJP. Isolate BR_SP_SJP_01 RNA1 and RNA2 sequences, clade SJP, showed an identity of 85.6% and 88.4%, respectively, with those corresponding to CiLV-C, the type member of the genus Cilevirus, and its RNA2 5′-proximal region was revealed as a minor donor in a putative inter-clade recombination event. In addition to citrus, BR_SP_SJP_01 naturally infects the weed Commelina benghalensis and is efficiently transmitted by Brevipalpus yothersi mites. Our data demonstrated that negative selection was the major force operating in the evaluated viral coding regions and defined amino acids putatively relevant for the biological function of cilevirus proteins. This work provides molecular tools and sets up a framework for further epidemiological studies. PMID:27275832

  13. Histopathological Diagnosis of Leprosy Type 1 Reaction with Emphasis on Interobserver Variation.

    PubMed

    Sharma, I; Kaur, M; Mishra, A K; Sood, N; Ramesh, V; Kubba, A; Singh, A

    2015-01-01

    Upgrading typel lepra reaction or reversal reaction (RR) is an acute inflammatory complication of leprosy and a disparity exists between clinicians and pathologists for diagnosing a RR. Inter-observer variations among pathologists also compound this problem as no universally agreed diagnostic criteria exist. 120 biopsies and H&E stained slides were assessed by 3 pathologists. The pathologists were blinded to the clinical diagnosis and to each other's observations. Each pathologist assigned a likelihood of reaction by their histopathological observations as definitely reaction, probable reaction and no reaction. Clinicopathological correlation and interobserver agreement was analyzed statistically. Discordance between clinical and histopathological diagnosis was seen in 30.8% by pathologist 1 (P1), 23.7% by pathologist 2 (P2) and 34.5% bythe pathologist 3 (P3). Dermal edema, intragranuloma edema and epidermal erosion were consistent findings by all observers. Definite reaction was seen in 54.2% of cases by P1, 53.3% by P2 and 34.5% by P3. Kappa statistics for strength of agreement showed good agreement between 3 pathologists with P1 (κ = 0.83), P2 (κ = 0.61), P3 (κ = 0.62). RR are underdiagnosed on histopathological examination but this study shows that dermal edema, edema within the granuloma and partial obliteration of grenz zone by granuloma are reliable clues to diagnose a RR on histopathology. PMID:27506008

  14. S-100 immunostaining in the Distinction of Borderline Tuberculoid Leprosy from other Cutaneous Granulomas

    PubMed Central

    Tirumalae, Rajalakshmi; Stany, Anto Ignat; Shanubhogue, Sharan; Yeliur, Inchara K

    2014-01-01

    Background: Histopathologic diagnosis of borderline tuberculoid leprosy (BTL) is fraught with hurdles. It overlaps with other granulomas and documenting nerve involvement is the key to correct diagnosis. This is difficult on H and E sections alone. S-100 immunostaining may help in this regard. Objectives: To study the patterns of nerve involvement in BTL and other cutaneous granulomas using S-100 immunostain and compare its sensitivity with that of H and E staining, in both adequate and inadequate biopsies. Materials and Methods: A total of 20 cases of BTL were reviewed. And, 19 biopsies from other cutaneous granulomas were taken as controls. S-100 immunostaining was done on paraffin sections. The pattern of nerve involvement was graded as intact, infiltrated and/or fragmented, intact with perineural inflammation. Results: Of the 20 cases of BTL, S-100 demonstrated infiltrated and/or fragmented nerves in 15 and absent nerves in 5 cases. H and E stain identified neuritis in eight cases. The sensitivity of S-100 and H and E is 0.78 and 0.41. In the 19 controls, S-100 identified normal nerves in 16 with 7 showing perineural inflammation only and their absence in 2 cases. H and E identified normal nerves in nine cases. The sensitivity of S-100 and H and E is 0.83 and 0.41. In biopsies where subcutis was absent, the sensitivity of S-100 in identifying nerve involvement is 0.66 compared with H and E 0.33. Conclusion: S-100 staining is an efficient ancillary aid in distinguishing BTL from other granulomas and is superior to H and E in identifying nerve involvement, even where subcutis is absent. Infiltration and/or fragmentation of nerves by S-100 is the only reliable marker of BTL. PMID:25071276

  15. Expression of cyclooxygenase-2, alpha 1-acid-glycoprotein and inducible nitric oxide synthase in the developing lesions of murine leprosy

    PubMed Central

    Silva Miranda, Mayra; Rodríguez, Kendy Wek; Martínez Cordero, Erasmo; Rojas-Espinosa, Oscar

    2006-01-01

    Murine leprosy is a chronic disease of the mouse, the most popular animal model used in biomedical investigation, which is caused by Mycobacterium lepraemurium (MLM) whose characteristic lesion is the macrophage-made granuloma. From onset to the end of the disease, the granuloma undergoes changes that gradually transform the environment into a more appropriate milieu for the growth of M. lepraemurium. The mechanisms that participate in the formation and maturation of the murine leprosy granulomas are not completely understood; however, microbial and host-factors are believed to participate in their formation. In this study, we analysed the role of various pro-inflammatory and anti-inflammatory proteins in granulomas of murine leprosy after 21 weeks of infection. We assessed the expression of cyclooxygenase-2 (COX-2), alpha acid-glycoprotein (AGP), and inducible nitric oxide synthase (iNOS) at sequential stages of infection. We also looked for the nitric-oxide nitrosylation product, nitrotyrosine (NT) in the granulomatous lesions of murine leprosy. We found that a pro-inflammatory environment predominates in the early granulomas while an anti-inflammatory environment predominates in late granulomas. No obvious signs of bacillary destruction were observed during the entire period of infection, but nitrosylation products and cell alterations were observed in granulomas in the advanced stages of disease. The change from a pro-inflammatory to an anti-inflammatory environment, which is probably driven by the bacillus itself, results in a more conducive environment for both bacillus replication and the disease progression. PMID:17222216

  16. Fine-mapping analysis revealed complex pleiotropic effect and tissue-specific regulatory mechanism of TNFSF15 in primary biliary cholangitis, Crohn's disease and leprosy.

    PubMed

    Sun, Yonghu; Irwanto, Astrid; Toyo-Oka, Licht; Hong, Myunghee; Liu, Hong; Andiappan, Anand Kumar; Choi, Hyunchul; Hitomi, Yuki; Yu, Gongqi; Yu, Yongxiang; Bao, Fangfang; Wang, Chuan; Fu, Xian; Yue, Zhenhua; Wang, Honglei; Zhang, Huimin; Kawashima, Minae; Kojima, Kaname; Nagasaki, Masao; Nakamura, Minoru; Yang, Suk-Kyun; Ye, Byong Duk; Denise, Yosua; Rotzschke, Olaf; Song, Kyuyoung; Tokunaga, Katsushi; Zhang, Furen; Liu, Jianjun

    2016-01-01

    Genetic polymorphism within the 9q32 locus is linked with increased risk of several diseases, including Crohn's disease (CD), primary biliary cholangitis (PBC) and leprosy. The most likely disease-causing gene within 9q32 is TNFSF15, which encodes the pro-inflammatory cytokine TNF super-family member 15, but it was unknown whether these disparate diseases were associated with the same genetic variance in 9q32, and how variance within this locus might contribute to pathology. Using genetic data from published studies on CD, PBC and leprosy we revealed that bearing a T allele at rs6478108/rs6478109 (r(2) = 1) or rs4979462 was significantly associated with increased risk of CD and decreased risk of leprosy, while the T allele at rs4979462 was associated with significantly increased risk of PBC. In vitro analyses showed that the rs6478109 genotype significantly affected TNFSF15 expression in cells from whole blood of controls, while functional annotation using publicly-available data revealed the broad cell type/tissue-specific regulatory potential of variance at rs6478109 or rs4979462. In summary, we provide evidence that variance within TNFSF15 has the potential to affect cytokine expression across a range of tissues and thereby contribute to protection from infectious diseases such as leprosy, while increasing the risk of immune-mediated diseases including CD and PBC. PMID:27507062

  17. Citrus Leprosis Symptoms Can be Associated with the Presence of Two Different Viruses: Cytoplasmic and Nuclear, the Former Having a Multipartite RNA Genome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Citrus leprosis has been present in several South American countries for many decades. Its recently reported emergence in Central American countries presents a serious threat to citrus in the Caribbean Basin, Central and North America. Cyto- and nucleo-rhabdovirus-like particles have been associate...

  18. Fine-mapping analysis revealed complex pleiotropic effect and tissue-specific regulatory mechanism of TNFSF15 in primary biliary cholangitis, Crohn’s disease and leprosy

    PubMed Central

    Sun, Yonghu; Irwanto, Astrid; Toyo-oka, Licht; Hong, Myunghee; Liu, Hong; Andiappan, Anand Kumar; Choi, Hyunchul; Hitomi, Yuki; Yu, Gongqi; Yu, Yongxiang; Bao, Fangfang; Wang, Chuan; Fu, Xian; Yue, Zhenhua; Wang, Honglei; Zhang, Huimin; Kawashima, Minae; Kojima, Kaname; Nagasaki, Masao; Nakamura, Minoru; Yang, Suk-Kyun; Ye, Byong Duk; Denise, Yosua; Rotzschke, Olaf; Song, Kyuyoung; Tokunaga, Katsushi; Zhang, Furen; Liu, Jianjun

    2016-01-01

    Genetic polymorphism within the 9q32 locus is linked with increased risk of several diseases, including Crohn’s disease (CD), primary biliary cholangitis (PBC) and leprosy. The most likely disease-causing gene within 9q32 is TNFSF15, which encodes the pro-inflammatory cytokine TNF super-family member 15, but it was unknown whether these disparate diseases were associated with the same genetic variance in 9q32, and how variance within this locus might contribute to pathology. Using genetic data from published studies on CD, PBC and leprosy we revealed that bearing a T allele at rs6478108/rs6478109 (r2 = 1) or rs4979462 was significantly associated with increased risk of CD and decreased risk of leprosy, while the T allele at rs4979462 was associated with significantly increased risk of PBC. In vitro analyses showed that the rs6478109 genotype significantly affected TNFSF15 expression in cells from whole blood of controls, while functional annotation using publicly-available data revealed the broad cell type/tissue-specific regulatory potential of variance at rs6478109 or rs4979462. In summary, we provide evidence that variance within TNFSF15 has the potential to affect cytokine expression across a range of tissues and thereby contribute to protection from infectious diseases such as leprosy, while increasing the risk of immune-mediated diseases including CD and PBC. PMID:27507062

  19. Genetics and human rights. Two histories: Restoring genetic identity after forced disappearance and identity suppression in Argentina and after compulsory isolation for leprosy in Brazil.

    PubMed

    Penchaszadeh, Victor B; Schuler-Faccini, Lavinia

    2014-03-01

    Over the past three decades, there has been an accelerated development of genetic technology, leading to its use in human genetic identification for many purposes. Additionally, it has been made explicit that identity is a fundamental human right. A number of historical circumstances have connected these developments. Personal identity is increasingly associated with the preservation and defense of human rights and is a tool to repair the violation of these rights, particularly the right to identity. In this article, we report the use of genetics to support the right to identity in two historical circumstances. First, we report the search, localization, DNA testing and genetic identification of 110 individuals who were appropriated as babies by the Argentine military dictatorship of 1976-1983 in the context of savage repression and egregious violations of human rights, including forced disappearance and suppression of identity. Second, we report on the repair of right-to-identity violations of hundreds of individuals that occurred during the process of compulsory isolation of patients with leprosy in Brazil through the Program "Reencontro", which has led to the genetic identification of 158 pairs of individuals who previously did not have proof that they were siblings. The high value placed on genetic identification by victims of identity suppression did not counter the prevailing view that genetic factors were not more important than other factors (social, emotional, educational, cultural, spiritual) in determining the complex phenomenon of personal identity. The use of genetic identification as a tool to redress and repair human rights violations is a novel application of human genetics for the benefit of mankind.

  20. Genetics and human rights. Two histories: Restoring genetic identity after forced disappearance and identity suppression in Argentina and after compulsory isolation for leprosy in Brazil

    PubMed Central

    Penchaszadeh, Victor B.; Schuler-Faccini, Lavinia

    2014-01-01

    Over the past three decades, there has been an accelerated development of genetic technology, leading to its use in human genetic identification for many purposes. Additionally, it has been made explicit that identity is a fundamental human right. A number of historical circumstances have connected these developments. Personal identity is increasingly associated with the preservation and defense of human rights and is a tool to repair the violation of these rights, particularly the right to identity. In this article, we report the use of genetics to support the right to identity in two historical circumstances. First, we report the search, localization, DNA testing and genetic identification of 110 individuals who were appropriated as babies by the Argentine military dictatorship of 1976–1983 in the context of savage repression and egregious violations of human rights, including forced disappearance and suppression of identity. Second, we report on the repair of right-to-identity violations of hundreds of individuals that occurred during the process of compulsory isolation of patients with leprosy in Brazil through the Program “Reencontro”, which has led to the genetic identification of 158 pairs of individuals who previously did not have proof that they were siblings. The high value placed on genetic identification by victims of identity suppression did not counter the prevailing view that genetic factors were not more important than other factors (social, emotional, educational, cultural, spiritual) in determining the complex phenomenon of personal identity. The use of genetic identification as a tool to redress and repair human rights violations is a novel application of human genetics for the benefit of mankind. PMID:24764764

  1. Identification and Molecular Characterization of Nuclear Citrus leprosis virus, a Member of the Proposed Dichorhavirus Genus Infecting Multiple Citrus Species in Mexico.

    PubMed

    Roy, Avijit; Stone, Andrew L; Shao, Jonathan; Otero-Colina, Gabriel; Wei, Gang; Choudhary, Nandlal; Achor, Diann; Levy, Laurene; Nakhla, Mark K; Hartung, John S; Schneider, William L; Brlansky, Ronald H

    2015-04-01

    Citrus leprosis is one of the most destructive diseases of Citrus spp. and is associated with two unrelated virus groups that produce particles primarily in either the cytoplasm or nucleus of infected plant cells. Symptoms of leprosis, including chlorotic spots surrounded by yellow haloes on leaves and necrotic spots on twigs and fruit, were observed on leprosis-affected mandarin and navel sweet orange trees in the state of Querétaro, Mexico. Serological and molecular assays showed that the cytoplasmic types of Citrus leprosis virus (CiLV-C) often associated with leprosis symptomatic tissues were absent. However, using transmission electron microscopy, bullet-shaped rhabdovirus-like virions were observed in the nuclei and cytoplasm of the citrus leprosis-infected leaf tissues. An analysis of small RNA populations from symptomatic tissue was carried out to determine the genome sequence of the rhabdovirus-like particles observed in the citrus leprosis samples. The complete genome sequence showed that the nuclear type of CiLV (CiLV-N) present in the samples consisted of two negative-sense RNAs: 6,268-nucleotide (nt)-long RNA1 and 5,847-nt-long RNA2, excluding the poly(A) tails. CiLV-N had a genome organization identical to that of Orchid fleck virus (OFV), with the exception of shorter 5' untranslated regions in RNA1 (53 versus 205 nt) and RNA2 (34 versus 182 nt). Phylogenetic trees constructed with the amino acid sequences of the nucleocapsid (N) and glycoproteins (G) and the RNA polymerase (L protein) showed that CiLV-N clusters with OFV. Furthermore, phylogenetic analyses of N protein established CiLV-N as a member of the proposed genus Dichorhavirus. Reverse-transcription polymerase chain reaction primers for the detection of CiLV-N were designed based on the sequence of the N gene and the assay was optimized and tested to detect the presence of CiLV-N in both diseased and symptom-free plants.

  2. Detection of Citrus leprosis virus C using specific primers and TaqMan probe in one-step real-time reverse-transcription polymerase chain reaction assays.

    PubMed

    Choudhary, Nandlal; Wei, G; Govindarajulu, A; Roy, Avijit; Li, Wenbin; Picton, Deric D; Nakhla, M K; Levy, L; Brlansky, R H

    2015-11-01

    Citrus leprosis virus C (CiLV-C), a causal agent of the leprosis disease in citrus, is mostly present in the South and Central America and spreading toward the North America. To enable better diagnosis and inhibit the further spread of this re-emerging virus a quantitative (q) real-time reverse transcription polymerase chain reaction (qRT-PCR) assay is needed for early detection of CiLV-C when the virus is present in low titer in citrus leprosis samples. Using the genomic sequence of CiLV-C, specific primers and probe were designed and synthesized to amplify a 73 nt amplicon from the movement protein (MP) gene. A standard curve of the 73 nt amplicon MP gene was developed using known 10(10)-10(1) copies of in vitro synthesized RNA transcript to estimate the copy number of RNA transcript in the citrus leprosis samples. The one-step qRT-PCR detection assays for CiLV-C were determined to be 1000 times more sensitive when compared to the one-step conventional reverse transcription polymerase chain reaction (RT-PCR) CiLV-C detection method. To evaluate the quality of the total RNA extracts, NADH dehydrogenase gene specific primers (nad5) and probe were included in reactions as an internal control. The one-step qRT-PCR specificity was successfully validated by testing for the presence of CiLV-C in the total RNA extracts of the citrus leprosis samples collected from Belize, Costa Rica, Mexico and Panama. Implementation of the one-step qRT-PCR assays for CiLV-C diagnosis should assist regulatory agencies in surveillance activities to monitor the distribution pattern of CiLV-C in countries where it is present and to prevent further dissemination into citrus growing countries where there is no report of CiLV-C presence. PMID:26341059

  3. Leprosy New Case Detection Trends and the Future Effect of Preventive Interventions in Pará State, Brazil: A Modelling Study

    PubMed Central

    de Matos, Haroldo José; Blok, David J.; de Vlas, Sake J.; Richardus, Jan Hendrik

    2016-01-01

    Background Leprosy remains a public health problem in Brazil. Although the overall number of new cases is declining, there are still areas with a high disease burden, such as Pará State in the north of the country. We aim to predict future trends in new case detection rate (NCDR) and explore the potential impact of contact tracing and chemoprophylaxis on NCDR in Pará State. Methods We used SIMCOLEP, an existing individual-based model for the transmission and control of M. leprae, in a population structured by households. The model was quantified to simulate the population and observed NCDR of leprosy in Pará State for the period 1990 to 2014. The baseline scenario was the current control program, consisting of multidrug therapy, passive case detection, and active case detection from 2003 onwards. Future projections of the NCDR were made until 2050 given the continuation of the current control program (i.e. baseline). We further investigated the potential impact of two scenarios for future control of leprosy: 1) discontinuation of contact tracing; and 2) continuation of current control in combination with chemoprophylaxis. Both scenarios started in 2015 and were projected until 2050. Results The modelled NCDR in Pará State after 2014 shows a continuous downward trend, reaching the official elimination target of 10 cases per 100,000 population by 2030. The cessation of systematic contact tracing would not result in a higher NCDR in the long run. Systematic contact tracing in combination with chemoprophylaxis for contacts would reduce the NCDR by 40% and bring attainment of the elimination target two years forward to 2028. Conclusion The NCDR of leprosy continues to decrease in Pará State. Elimination of leprosy as a public health problem could possibly be achieved around 2030, if the current control program is maintained. Providing chemoprophylaxis would decrease the NCDR further and would bring elimination forward by two years. PMID:26938738

  4. Detection of Citrus leprosis virus C using specific primers and TaqMan probe in one-step real-time reverse-transcription polymerase chain reaction assays.

    PubMed

    Choudhary, Nandlal; Wei, G; Govindarajulu, A; Roy, Avijit; Li, Wenbin; Picton, Deric D; Nakhla, M K; Levy, L; Brlansky, R H

    2015-11-01

    Citrus leprosis virus C (CiLV-C), a causal agent of the leprosis disease in citrus, is mostly present in the South and Central America and spreading toward the North America. To enable better diagnosis and inhibit the further spread of this re-emerging virus a quantitative (q) real-time reverse transcription polymerase chain reaction (qRT-PCR) assay is needed for early detection of CiLV-C when the virus is present in low titer in citrus leprosis samples. Using the genomic sequence of CiLV-C, specific primers and probe were designed and synthesized to amplify a 73 nt amplicon from the movement protein (MP) gene. A standard curve of the 73 nt amplicon MP gene was developed using known 10(10)-10(1) copies of in vitro synthesized RNA transcript to estimate the copy number of RNA transcript in the citrus leprosis samples. The one-step qRT-PCR detection assays for CiLV-C were determined to be 1000 times more sensitive when compared to the one-step conventional reverse transcription polymerase chain reaction (RT-PCR) CiLV-C detection method. To evaluate the quality of the total RNA extracts, NADH dehydrogenase gene specific primers (nad5) and probe were included in reactions as an internal control. The one-step qRT-PCR specificity was successfully validated by testing for the presence of CiLV-C in the total RNA extracts of the citrus leprosis samples collected from Belize, Costa Rica, Mexico and Panama. Implementation of the one-step qRT-PCR assays for CiLV-C diagnosis should assist regulatory agencies in surveillance activities to monitor the distribution pattern of CiLV-C in countries where it is present and to prevent further dissemination into citrus growing countries where there is no report of CiLV-C presence.

  5. A Cluster-Randomized Controlled Intervention Study to Assess the Effect of a Contact Intervention in Reducing Leprosy-Related Stigma in Indonesia

    PubMed Central

    Peters, Ruth M. H.; Dadun; Zweekhorst, Marjolein B. M.; Bunders, Joske F. G.; Irwanto; van Brakel, Wim H.

    2015-01-01

    Background Can deliberate interaction between the public and persons affected by leprosy reduce stigmatization? The study described in this paper hypothesises that it can and assesses the effectiveness of a ‘contact intervention’. Methods/Principal Findings This cluster-randomized controlled intervention study is part of the Stigma Assessment and Reduction of Impact (SARI) project conducted in Cirebon District, Indonesia. Testimonies, participatory videos and comics given or made by people affected by leprosy were used as methods to facilitate a dialogue during so-called ‘contact events’. A mix of seven quantitative and qualitative methods, including two scales to assess aspects of stigma named the SDS and EMIC-CSS, were used to establish a baseline regarding stigma and knowledge of leprosy, monitor the implementation and assess the impact of the contact events. The study sample were community members selected using different sampling methods. The baseline shows a lack of knowledge about leprosy, a high level of stigma and contrasting examples of support. In total, 91 contact events were organised in 62 villages, directly reaching 4,443 community members (mean 49 per event). The interview data showed that knowledge about leprosy increased and that negative attitudes reduced. The adjusted mean total score of the EMIC-CSS reduced by 4.95 points among respondents who had attended a contact event (n = 58; p <0.001, effect size = 0.75) compared to the score at baseline (n = 213); for the SDS this was 3.56 (p <0.001, effect size = 0.81). About 75% of those attending a contact event said they shared the information with others (median 10 persons). Conclusions/Significance The contact intervention was effective in increasing knowledge and improving public attitudes regarding leprosy. It is relatively easy to replicate elsewhere and does not require expensive technology. More research is needed to improve scalability. The effectiveness of a contact intervention to

  6. Mapping of PARK2 and PACRG overlapping regulatory region reveals LD structure and functional variants in association with leprosy in unrelated indian population groups.

    PubMed

    Chopra, Rupali; Ali, Shafat; Srivastava, Amit K; Aggarwal, Shweta; Kumar, Bhupender; Manvati, Siddharth; Kalaiarasan, Ponnusamy; Jena, Mamta; Garg, Vijay K; Bhattacharya, Sambit N; Bamezai, Rameshwar N K

    2013-01-01

    Leprosy is a chronic infectious disease caused by Mycobacterium Leprae, where the host genetic background plays an important role toward the disease pathogenesis. Various studies have identified a number of human genes in association with leprosy or its clinical forms. However, non-replication of results has hinted at the heterogeneity among associations between different population groups, which could be due to differently evolved LD structures and differential frequencies of SNPs within the studied regions of the genome. A need for systematic and saturated mapping of the associated regions with the disease is warranted to unravel the observed heterogeneity in different populations. Mapping of the PARK2 and PACRG gene regulatory region with 96 SNPs, with a resolution of 1 SNP per 1 Kb for PARK2 gene regulatory region in a North Indian population, showed an involvement of 11 SNPs in determining the susceptibility towards leprosy. The association was replicated in a geographically distinct and unrelated population from Orissa in eastern India. In vitro reporter assays revealed that the two significantly associated SNPs, located 63.8 kb upstream of PARK2 gene and represented in a single BIN of 8 SNPs, influenced the gene expression. A comparison of BINs between Indian and Vietnamese populations revealed differences in the BIN structures, explaining the heterogeneity and also the reason for non-replication of the associated genomic region in different populations.

  7. Pre-miR-146a (rs2910164 G>C) Single Nucleotide Polymorphism Is Genetically and Functionally Associated with Leprosy

    PubMed Central

    Cezar-de-Mello, Paula F. T.; Toledo-Pinto, Thiago G.; Marques, Carolinne S.; Arnez, Lucia E. A.; Cardoso, Cynthia C.; Guerreiro, Luana T. A.; Antunes, Sérgio L. G.; Jardim, Márcia M.; Covas, Claudia de J. F.; Illaramendi, Ximena; Dias-Baptista, Ida M.; Rosa, Patrícia S.; Durães, Sandra M. B.; Pacheco, Antonio G.; Ribeiro-Alves, Marcelo; Sarno, Euzenir N.; Moraes, Milton O.

    2014-01-01

    Mycobacterium leprae infects macrophages and Schwann cells inducing a gene expression program to facilitate its replication and progression to disease. MicroRNAs (miRNAs) are key regulators of gene expression and could be involved during the infection. To address the genetic influence of miRNAs in leprosy, we enrolled 1,098 individuals and conducted a case-control analysis in order to study four miRNAs genes containing single nucleotide polymorphism (miRSNP). We tested miRSNP-125a (rs12975333 G>T), miRSNP-223 (rs34952329 *>T), miRSNP-196a-2 (rs11614913 C>T) and miRSNP-146a (rs2910164 G>C). Amongst them, miRSNP-146a was the unique gene associated with risk to leprosy per se (GC OR = 1.44, p = 0.04; CC OR = 2.18, p = 0.0091). We replicated this finding showing that the C-allele was over-transmitted (p = 0.003) using a transmission-disequilibrium test. A functional analysis revealed that live M. leprae (MOI 100∶1) was able to induce miR-146a expression in THP-1 (p<0.05). Furthermore, pure neural leprosy biopsies expressed augmented levels of that miRNA as compared to biopsy samples from neuropathies not related with leprosy (p = 0.001). Interestingly, carriers of the risk variant (C-allele) produce higher levels of mature miR-146a in nerves (p = 0.04). From skin biopsies, although we observed augmented levels of miR-146a, we were not able to correlate it with a particular clinical form or neither host genotype. MiR-146a is known to modulate TNF levels, thus we assessed TNF expression (nerve biopsies) and released by peripheral blood mononuclear cells infected with BCG Moreau. In both cases lower TNF levels correlates with subjects carrying the risk C-allele, (p = 0.0453 and p = 0.0352; respectively), which is consistent with an immunomodulatory role of this miRNA in leprosy. PMID:25187983

  8. [Psoriasis, biblical afflictions and patients' dignity].

    PubMed

    Shai, Avi; Vardy, Daniel; Zvulunov, Alex

    2002-05-01

    The currently accepted Hebrew word for psoriasis is 'sapachat'. The word 'sapachat' is biblical and its original meaning is unknown. Similar uncertainty applies also to the biblical word 'tzaraat', the currently accepted Hebrew term for leprosy. This article discusses possible explanations of the biblical terms 'sapachat' and 'tzaraat'. The link between 'sapachat' and psoriasis was made only several decades ago. The word 'sapachat' conveys a definite negative connotation, and imposes an emotional burden on psoriatic patients. We therefore recommend preferable use of the word 'psoriasis' and avoid using the offending term 'sapachat'.

  9. The complete nucleotide sequence and genomic organization of Citrus Leprosis associated Virus, Cytoplasmatic type (CiLV-C).

    PubMed

    Pascon, Renata C; Kitajima, João Paulo; Breton, Michèle C; Assumpção, Laura; Greggio, Christian; Zanca, Almir S; Okura, Vagner Katsumi; Alegria, Marcos C; Camargo, Maria E; Silva, Giovana G C; Cardozo, Jussara C; Vallim, Marcelo A; Franco, Sulamita F; Silva, Vitor H; Jordão, Hamilton; Oliveira, Fernanda; Giachetto, Poliana F; Ferrari, Fernanda; Aguilar-Vildoso, Carlos I; Franchiscini, Fabrício J B; Silva, José M F; Arruda, Paulo; Ferro, Jesus A; Reinach, Fernando; da Silva, Ana Cláudia Rasera

    2006-06-01

    The Citrus leprosis disease (CiL) is associated to a virus (CiLV) transmitted by Brevipalpus spp. mites (Acari: Tenuipalpidae). CiL is endemic in Brazil and its recently spreading to Central America represents a threat to citrus industry in the USA. Electron microscopy images show two forms of CiLV: a rare nuclear form, characterized by rod-shaped naked particle (CiLV-N) and a common cytoplasmic form (CiLV-C) associated with bacilliform-enveloped particle and cytoplasmic viroplasm. Due to this morphological feature, CiLV-C has been treated as Rhabdovirus-like. In this paper we present the complete nucleotide sequence and genomic organization of CiLV-C. It is a bipartite virus with sequence similarity to ssRNA positive plant virus. RNA1 encodes a putative replicase polyprotein and an ORF with no known function. RNA2 encodes 4 ORFs. pl5, p24 and p61 have no significant similarity to any known proteins and p32 encodes a protein with similarity to a viral movement protein. The CiLV-C sequences are associated with typical symptoms of CiL by RT-PCR. Phylogenetic analysis suggests that CiLV-C is probably a member of a new family of plant virus evolutionarily related to Tobamovirus. PMID:16732481

  10. CHEMOPROPHYLAXIS TO CONTROL LEPROSY AND THE PERSPECTIVE OF ITS IMPLEMENTATION IN BRAZIL: A PRIMER FOR NON-EPIDEMIOLOGISTS

    PubMed Central

    da CUNHA, Sergio Souza; BIERRENBACH, Ana Luiza; BARRETO, Vitor Hugo Lima

    2015-01-01

    The occurrence of leprosy has decreased in the world but the perspective of its elimination has been questioned. A proposed control measure is the use of post-exposure chemoprophylaxis (PEP) among contacts, but there are still questions about its operational aspects. In this text we discuss the evidence available in literature, explain some concepts in epidemiology commonly used in the research on this topic, analyze the appropriateness of implementing PEP in the context of Brazil, and answer a set of key questions. We argue some points: (1) the number of contacts that need to receive PEP in order to prevent one additional case of disease is not easy to be generalized from the studies; (2) areas covered by the family health program are the priority settings where PEP could be implemented; (3) there is no need for a second dose; (4) risk for drug resistance seems to be very small; (5) the usefulness of a serological test to identify a higher risk group of individuals among contacts is questionable. Given that, we recommend that, if it is decided to start PEP in Brazil, it should start on a small scale and, as new evidence can be generated in terms of feasibility, sustainability and impact, it could move up a scale, or not, for a wider intervention. PMID:27049701

  11. What would make your life better? A needs analysis of leprosy settlements in the middle belt region of Nigeria.

    PubMed

    Ogbeiwi, O; Nash, J

    1999-09-01

    A needs analysis using rural appraisal and matrix ranking techniques was done in six leprosy communities in the middle belt region of Nigeria. Asked 'what would make their life better?' whole village groups were made to list, prioritize and rank their expressed needs by voting in a matrix table drawn on the ground. Out of a total of 504 votes, 31% was for health care or drugs for their general ailments, 23.6% for money and less than 10% for other needs that ranged from water, trade and housing to love and, least, mobility aids. Health care was prioritized in all communities but got the highest votes in three communities, money got the highest in the only two communities where it was prioritized and water in one. The need ranked the highest in each settlement seemed to be a reflection of its peculiar socio-economic situation. Apart from the similar priorities of health care and money, men's differing priorities were water, housing, clothes and assistance with farming, and women's, school fees for children, family, trade and food. These reflect their different traditional roles. Considering the variety of needs we think that there is no one solution to rehabilitation in the Nigerian context, but the situation and context of individual settlements should be considered, looking at general health care, income generation or loans schemes, schooling and water supply.

  12. Primary Neuritic Hansen's Disease presenting as Ulnar Nerve Abscess in a Human Immunodeficiency Virus Positive Patient.

    PubMed

    Karjigi, S; Herakal, K; Murthy, S C; Bathina, A; Kusuma, M R; Nikhil, K R Y

    2015-01-01

    Leprosy has been increasingly known to have an enigmatic relationship with human immunodeficiency virus infection. Co-infection may result in atypical manifestations of leprosy. A 45-year old human immunodeficiency virus-positive male; agricultural laborer presented with a swelling over right elbow, right hand deformity, generalized itching and recurrent vesicles overthe perinasal area. Clinical and investigational findings were consistent with mononeuritic type of Hansen's disease with right sided silent ulnar nerve abscess, partial claw hand. CD4+ count of the patientwas 430 cells/cmm. This patient also hadherpes simplex labialis, with HIV-associated pruritus. To the best of our knowledge such an atypical presentation has not been reported earlier. PMID:26999990

  13. Anticardiolipin, anti-ß2-glycoprotein I and antiprothrombin antibodies in black South African patients with infectious disease

    PubMed Central

    Loizou, S; Singh, S; Wypkema, E; Asherson, R

    2003-01-01

    Objectives: To investigate IgG, IgM, and IgA, antiphospholipid antibodies (aPL), against cardiolipin (aCL), ß2-glycoprotein I (anti-ß2GPI), and prothrombin (anti-PT), in black South African patients with infectious disease. Unlike patients with systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS), raised levels of aPL in infectious diseases are not usually associated with thrombotic complications. Patients and methods: Serum samples from 272 patients with a variety of infectious diseases (100 HIV positive, 112 leprosy, 25 syphilis, 25 malaria, and 10 HCV patients) were studied and compared with autoantibody levels in 100 normal controls. All three aPL were measured using commercial enzyme linked immunosorbent assay (ELISA) kits. Results: Raised levels of all thee aPL were found in all patient groups studied: aCL in 7%, anti-ß2GPI in 6%, and aPT in 43% of 100 HIV patients, in 29%, 89%, and 21% of 112 patients with leprosy, in 8%, 8%, and 28% of 25 patients with syphilis, in 12%, 8%, and 28% of 25 patients with malaria, and in 20%, 30%, and 30% of 10 HCV patients studied, respectively. Conclusions: The prevalence of aCL and anti-ß2GPI in black South African HIV positive patients, or those with syphilis, malaria, or hepatitis C virus is lower than reported for mixed race or white populations. aPT were the most prevalent aPL detected in these patient groups, except in patients with leprosy, for whom anti-ß2GPI was the most prevalent, and where the spectrum of aPL was similar to that seen in patients with SLE and APS. PMID:14583576

  14. Interaction of Mycobacterium leprae with the HaCaT human keratinocyte cell line: new frontiers in the cellular immunology of leprosy.

    PubMed

    Lyrio, Eloah C D; Campos-Souza, Ivy C; Corrêa, Luiz C D; Lechuga, Guilherme C; Verícimo, Maurício; Castro, Helena C; Bourguignon, Saulo C; Côrte-Real, Suzana; Ratcliffe, Norman; Declercq, Wim; Santos, Dilvani O

    2015-07-01

    Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae affecting the skin and peripheral nerves. Despite M. leprae invasion of the skin and keratinocytes importance in innate immunity, the interaction of these cells in vitro during M. leprae infection is poorly understood. Conventional and fluorescence optical microscopy, transmission electronic microscopy, flow cytometry and ELISA were used to study the in vitro interaction of M. leprae with the HaCaT human keratinocyte cell line. Keratinocytes uptake of M. leprae is described, and modulation of the surface expression of CD80 and CD209, cathelicidin expression and TNF-α and IL-1β production of human keratinocytes are compared with dendritic cells and macrophages during M. leprae interaction. This study demonstrated that M. leprae interaction with human keratinocytes enhanced expression of cathelicidin and greatly increased TNF-α production. The highest spontaneous expression of cathelicidin was by dendritic cells which are less susceptible to M. leprae infection. In contrast, keratinocytes displayed low spontaneous cathelicidin expression and were more susceptible to M. leprae infection than dendritic cells. The results show, for the first time, an active role for keratinocytes during infection by irradiated whole cells of M. leprae and the effect of vitamin D on this process. They also suggest that therapies which target cathelicidin modulation may provide novel approaches for treatment of leprosy.

  15. 'People like me don't make things like that': Participatory video as a method for reducing leprosy-related stigma.

    PubMed

    Peters, R M H; Zweekhorst, M B M; van Brakel, W H; Bunders, J F G; Irwanto

    2016-01-01

    The Stigma Assessment and Reduction of Impact project aims to assess the effectiveness of stigma-reduction interventions in the field of leprosy. Participatory video seemed to be a promising approach to reducing stigma among stigmatized individuals (in this study the video makers) and the stigmatisers (video audience). This study focuses on the video makers and seeks to assess the impact on them of making a participatory video and to increase understanding of how to deal with foreseeable difficulties. Participants were selected on the basis of criteria and in collaboration with the community health centre. This study draws on six qualitative methods including interviews with the video makers and participant observation. Triangulation was used to increase the validity of the findings. Two videos were produced. The impact on participants ranged from having a good time to a greater sense of togetherness, increased self-esteem, individual agency and willingness to take action in the community. Concealment of leprosy is a persistent challenge, and physical limitations and group dynamics are also areas that require attention. Provided these three areas are properly taken into account, participatory video has the potential to address stigma at least at three levels - intrapersonal, interpersonal and community - and possibly more. PMID:27219896

  16. Recognition of the phenotype of thalidomide embryopathy in countries endemic for leprosy: new cases and review of the main dysmorphological findings.

    PubMed

    Vianna, Fernanda S L; Schüler-Faccini, Lavínia; Leite, Julio César L; de Sousa, Silvia H C; da Costa, Lea Márcia M; Dias, Murilo F; Morelo, Elaine F; Doriqui, Maria Juliana R; Maximino, Claudia M; Sanseverino, Maria Teresa V

    2013-04-01

    Thalidomide is the best-known teratogen worldwide. It was first marketed as a sedative in the late 1950s, but the birth of ~10 000 children with birth defects resulted in the withdrawal of thalidomide from the market in 1962. Thalidomide embryopathy affects almost all organs but the main defects are concentrated in the limbs, eyes, ears, and heart. Shortly after the withdrawal of thalidomide from the market, its effectiveness in the treatment of erythema nodosum leprosum, an inflammatory condition resulting from leprosy, was reported and since the mid-1990s, the drug has been used widely in the treatment of cancers and autoimmune diseases, among other conditions. 40 000 new cases of leprosy are diagnosed every year in Brazil. Although there is a strict legislation for the prescription and use of thalidomide in Brazil, cases of thalidomide embryopathy have continued to be reported. Here, we present two new cases of thalidomide embryopathy identified in 2011 and review the major clinical findings in the literature that can aid the identification of the embryopathy.

  17. Epidemiological shift in leprosy in a rural district of central India following introduction of multi-drug therapy (April 1986 to March 1992 and April 1992 to March 2002).

    PubMed

    Pandey, A; Uddin, M Jamal; Patel, R

    2005-06-01

    This study compares the epidemiological pattern of leprosy in pre- (April 1986 to March 1992) and post- (April 1992 to March 2002) multi-drug therapy (MDT) periods by retrospective analysis of 3274 registered leprosy cases in the rural field area of Regional Leprosy Training & Research Institute (RLTRI), situated in Raipur district of Chattisgarh province of Central India. The area has high endemicity for leprosy. In the post-MDT period, prevalence rate (PR) came down to less than 1 in 10, while New Case Detection Rate (NCDR) remained almost static during the two periods. Of the total new registered cases, 30.1% were registered during the pre-MDT period and the remaining 69.9% during the post-MDT period. Comparison of key leprosy variables among new registered cases showed a 2-fold rise in the proportion of MB cases (14.8 versus 27.6%), 3.0% increase in proportion of child cases (15.3 versus 18.6%) and cases with deformity grade II (3.1 versus 5.9%) and 4.0% increase in female proportion (41.4 versus 45.7%) during the post-MDT period. A decline was noted in mean age of registration for both MB (6.4 years) and PB (5.7 years) groups in the post-MDT period. While comparing treatment and outcome related variables, a marked fall of 25.8 months was recorded in treatment duration in the post-MDT period. The defaulter rate came down by 45.0% and relapse rate by more than 12.0% during the same period. The study shows that MDT is effective operationally, but continued ongoing transmission of infection and delayed diagnosis needs corrective action.

  18. Lower numbers of natural killer T cells in HIV-1 and Mycobacterium leprae co-infected patients.

    PubMed

    Carvalho, Karina I; Bruno, Fernanda R; Snyder-Cappione, Jennifer E; Maeda, Solange M; Tomimori, Jane; Xavier, Marilia B; Haslett, Patrick A; Nixon, Douglas F; Kallas, Esper G

    2012-05-01

    Natural killer T (NKT) cells are a heterogeneous population of lymphocytes that recognize antigens presented by CD1d and have attracted attention because of their potential role linking innate and adaptive immune responses. Peripheral NKT cells display a memory-activated phenotype and can rapidly secrete large amounts of pro-inflammatory cytokines upon antigenic activation. In this study, we evaluated NKT cells in the context of patients co-infected with HIV-1 and Mycobacterium leprae. The volunteers were enrolled into four groups: 22 healthy controls, 23 HIV-1-infected patients, 20 patients with leprosy and 17 patients with leprosy and HIV-1-infection. Flow cytometry and ELISPOT assays were performed on peripheral blood mononuclear cells. We demonstrated that patients co-infected with HIV-1 and M. leprae have significantly lower NKT cell frequencies [median 0.022%, interquartile range (IQR): 0.007-0.051] in the peripheral blood when compared with healthy subjects (median 0.077%, IQR: 0.032-0.405, P < 0.01) or HIV-1 mono-infected patients (median 0.072%, IQR: 0.030-0.160, P < 0.05). Also, more NKT cells from co-infected patients secreted interferon-γ after stimulation with DimerX, when compared with leprosy mono-infected patients (P = 0.05). These results suggest that NKT cells are decreased in frequency in HIV-1 and M. leprae co-infected patients compared with HIV-1 mono-infected patients alone, but are at a more activated state. Innate immunity in human subjects is strongly influenced by their spectrum of chronic infections, and in HIV-1-infected subjects, a concurrent mycobacterial infection probably hyper-activates and lowers circulating NKT cell numbers.

  19. Dynamics of Mycobacterium leprae transmission in environmental context: deciphering the role of environment as a potential reservoir.

    PubMed

    Turankar, Ravindra P; Lavania, Mallika; Singh, Mradula; Siva Sai, Krovvidi S R; Jadhav, Rupendra S

    2012-01-01

    Leprosy is a disease caused by Mycobacterium leprae. Various modes of transmission have been suggested for this disease. Transmission and risk of the infection is perhaps related to presence of the infectious cases and is controlled by environmental factors. Evidence suggests that humidity may favor survival of M. leprae in the environment. Several reports show that non-human sources like 'naturally' infected armadillos or monkeys could act as reservoir for M. leprae. Inanimate objects or fomites like articles used by infectious patients may theoretically spread infection. However, it is only through detailed knowledge of the biodiversity and ecology that the importance of this mode of transmission can be fully assessed. Our study focuses here to decipher the role of environment in the transmission of the disease. Two hundred and seven soil samples were collected from a village in endemic area where active cases also resided at the time of sample collection. Slit skin smears were collected from 13 multibacillary (MB) leprosy patients and 12 household contacts of the patients suspected to be hidden cases. DNA and RNA of M. leprae were extracted and amplified using M. leprae specific primers. Seventy-one soil samples showed presence of M. leprae DNA whereas 16S rRNA could be detected in twenty-eight of these samples. Samples, both from the environment and the patients, exhibited the same genotype when tested by single nucleotide polymorphism (SNP) typing. Genotype of M. leprae found in the soil and the patients residing in the same area could help in understanding the transmission link in leprosy.

  20. Sequence and immunological characterization of a serine-rich antigen from Mycobacterium leprae.

    PubMed Central

    Vega-López, F; Brooks, L A; Dockrell, H M; De Smet, K A; Thompson, J K; Hussain, R; Stoker, N G

    1993-01-01

    Sera from lepromatous leprosy patients were used to screen a Mycobacterium leprae lambda gt11 library. Three positive plaques were picked, and lysogens were constructed. Immunoblot analysis showed that all of the lysogens expressed an apparently identical beta-galactosidase fusion protein which reacted strongly with the sera. The 1.7-kbp insert from one clone was subcloned into the lacZ gene in pUR290; sequence analysis of the end fused to lacZ revealed an open reading frame with no significant homology to previously published sequences. The insert was used to screen an M. leprae cosmid library, and five clones were isolated. The insert was also found to hybridize to clones expressing the M. leprae antigen which had previously been designated class III and 25L. A 1.8-kbp HindIII fragment was subcloned from one of the cosmids and sequenced. The sequence revealed a 1,227-bp open reading frame, encoding a 408-amino-acid protein with a predicted molecular mass of 42,466 Da. The protein contains amino- and carboxy-terminal hydrophobic domains and a hydrophilic central domain; the amino-terminal domain shows some homology to a 51-kDa hypothetical antigen of Mycobacterium tuberculosis, while the hydrophilic region contains a high proportion of serine residues, and we have therefore designated the protein serine-rich antigen (Sra). Some repeated motifs are present in the protein, but their significance is unknown. Seventy-eight percent of serum samples from multibacillary leprosy patients and 68% of serum samples from paucibacillary leprosy patients recognized the fusion protein, showing that this is a major M. leprae antigen. In contrast, all serum samples from endemic controls were negative, while 26% of serum samples from tuberculosis patients were weakly positive. Images PMID:8478104

  1. [Veganin's Leprosy Via Sacra].

    PubMed

    Boti, Nadja Cristiane Lappann; Aquino, Kiane Aparecida

    2008-01-01

    Historical research was carried out with documentary analysis and oral history aiming at describing the biography and reviewing the painting of Veganin. Luiz Carlos de Souza was born in 1950 in Aimorés (MG) and at age of 16 years he was working in nursing at the Santa Casa de Misericórdia in Belo Horizonte. With 20 years he was hospitalized in Colônia Santa Isabel and is now known as " Veganin" . In Colônia worked in nursing, carpentry and painting. He painted in the style of Pop Art the tables's Via Sacra where shows the Passion of Christ with originality and social criticism. In his paintings he presents his resilience front of the disease and treatment. Died in Colônia Santa Fé (MG) in 1997.

  2. Mycobacterium leprae in Colombia described by SNP7614 in gyrA, two minisatellites and geography

    PubMed Central

    Cardona-Castro, Nora; Beltrán-Alzate, Juan Camilo; Romero-Montoya, Irma Marcela; Li, Wei; Brennan, Patrick J; Vissa, Varalakshmi

    2013-01-01

    New cases of leprosy are still being detected in Colombia after the country declared achievement of the WHO defined ‘elimination’ status. To study the ecology of leprosy in endemic regions, a combination of geographic and molecular tools were applied for a group of 201 multibacillary patients including six multi-case families from eleven departments. The location (latitude and longitude) of patient residences were mapped. Slit skin smears and/or skin biopsies were collected and DNA was extracted. Standard agarose gel electrophoresis following a multiplex PCR-was developed for rapid and inexpensive strain typing of M. leprae based on copy numbers of two VNTR minisatellite loci 27-5 and 12-5. A SNP (C/T) in gyrA (SNP7614) was mapped by introducing a novel PCR-RFLP into an ongoing drug resistance surveillance effort. Multiple genotypes were detected combining the three molecular markers. The two frequent genotypes in Colombia were SNP7614(C)/27-5(5)/12-5(4) [C54] predominantly distributed in the Atlantic departments and SNP7614 (T)/27-5(4)/12-5(5) [T45] associated with the Andean departments. A novel genotype SNP7614 (C)/27-5(6)/12-5(4) [C64] was detected in cities along the Magdalena river which separates the Andean from Atlantic departments; a subset was further characterized showing association with a rare allele of minisatellite 23-3 and the SNP type 1 of M. leprae. The genotypes within intra-family cases were conserved. Overall, this is the first large scale study that utilized simple and rapid assay formats for identification of major strain types and their distribution in Colombia. It provides the framework for further strain type discrimination and geographic information systems as tools for tracing transmission of leprosy. PMID:23291420

  3. Mycobacterium leprae in Colombia described by SNP7614 in gyrA, two minisatellites and geography.

    PubMed

    Cardona-Castro, Nora; Beltrán-Alzate, Juan Camilo; Romero-Montoya, Irma Marcela; Li, Wei; Brennan, Patrick J; Vissa, Varalakshmi

    2013-03-01

    New cases of leprosy are still being detected in Colombia after the country declared achievement of the WHO defined 'elimination' status. To study the ecology of leprosy in endemic regions, a combination of geographic and molecular tools were applied for a group of 201 multibacillary patients including six multi-case families from eleven departments. The location (latitude and longitude) of patient residences were mapped. Slit skin smears and/or skin biopsies were collected and DNA was extracted. Standard agarose gel electrophoresis following a multiplex PCR-was developed for rapid and inexpensive strain typing of Mycobacterium leprae based on copy numbers of two VNTR minisatellite loci 27-5 and 12-5. A SNP (C/T) in gyrA (SNP7614) was mapped by introducing a novel PCR-RFLP into an ongoing drug resistance surveillance effort. Multiple genotypes were detected combining the three molecular markers. The two frequent genotypes in Colombia were SNP7614(C)/27-5(5)/12-5(4) [C54] predominantly distributed in the Atlantic departments and SNP7614 (T)/27-5(4)/12-5(5) [T45] associated with the Andean departments. A novel genotype SNP7614 (C)/27-5(6)/12-5(4) [C64] was detected in cities along the Magdalena river which separates the Andean from Atlantic departments; a subset was further characterized showing association with a rare allele of minisatellite 23-3 and the SNP type 1 of M. leprae. The genotypes within intra-family cases were conserved. Overall, this is the first large scale study that utilized simple and rapid assay formats for identification of major strain types and their distribution in Colombia. It provides the framework for further strain type discrimination and geographic information systems as tools for tracing transmission of leprosy. PMID:23291420

  4. Research ethics review practices: experiences of the Armauer Hansen Research Institute/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center Ethics Review Committee, Ethiopia.

    PubMed

    Wassie, Liya; Woldeamanuel, Yimtubezinash; Gebre-Mariam, Senkenesh; Feleke, Yeweyenhareg; Temam, Fuad; Hailu, Abebe; Abay, Hiwot; Zerihun, Zeyin; Bussa, Solomon; Aberra, Lensa; Tarekegne, Geremew; Gebre-Yohannes, Asfawessen; Aseffa, Abraham

    2015-01-01

    The need for ethics review committees (ERCs) is imperative in the conduct of research to ensure the protection of the rights, safety and well-being of research participants. However, the capacities of most ERCs in Africa are limited in terms of trained experts, competence, resources as well as standard operating procedures. The aim of this report is to share experiences of one of the local institutional ERCs, the Armauer Hansen Research Institute (AHRI)/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) Ethics Review Committee (AAERC), to other ERCs found in academic and research institutions in the Country. In this report, we used an empirical approach to review archived documents of the AAERC Secretariat to assess the Committee's strengths and weaknesses. The experiences of the AAERC in terms of its composition, routine work activities, learning practices and pitfalls that require general attention are summarized. In spite of this summary, the Committee strongly acknowledges the functions and roles of other ERCs in the Country. In addition, an independent assessment of the Committee's activity in general is warranted to evaluate its performance and further assess the level of awareness or oversights among researchers about the roles of ERCs. PMID:25816497

  5. Ileofemoral Deep Vein Thrombosis (DVT) in Steroid Treated Lepra Type 2 Reaction Patient.

    PubMed

    Thangaraju, P; Giri, V C; Aravindan, U; Sajitha, V; Showkath Ali, M K

    2015-01-01

    In 1998 a 57-year-old man having skin leisons of 6 months duration reported to Central Leprosy Teaching and Research Institute (CLTRI), Chengalpattu. It was diagnosed as a case of borderline lepromatous leprosy with a type 2 lepra reaction, was treated with multi bacillary-multi drug therapy (MBMDT) for a period of 12 months and the patient was released from treatment (RFT) in September 1999. For reactions the patient was treated with prednisolone for more than 10 months. After 14 years in April 2013 the same patient presented to CLTRI with complaints of weakness of both hands with loss of sensation for 4 months, so making a diagnosis suggestive of MB relapse with neuritis the patient was started with MB-MDT for period of 12 months with initial prednisolone 25 mg OD dose then increased to 40 mg for painful swollen leg and to follow the neuritis associated pain and swelling. Increased dose is not beneficial and the patient was investigated for other pathology. Doppler ultra-sound revealed a left ileofemoral deep vein thrombosis (DVT) in that patient with levels. Prednisolone was withdrawn and the patient was started with anticoagulant heparin followed by warfarin. During this period rifampicin was also withdrawn. After patient was in good condition he was put on MB-MDT regimen. Till the 6th pulse the patient continues to show improvement in functions without steroids and any tenderness, he is taking multivitamins; regular physiotherapy. This DVT appears to be due to prednisolone and such causative relationship though rare should be kept in mind when patient on long term treatment with steroids/and or immobilized or on prolonged bed rest report with such symptomatology. PMID:26999989

  6. Production of monoclonal antibodies for detection of Citrus leprosis virus C in enzyme-linked immuno-assays and immunocapture reverse transcription-polymerase chain reaction.

    PubMed

    Choudhary, Nandlal; Roy, Avijit; Govindarajulu, A; Nakhla, M K; Levy, L; Brlansky, R H

    2014-09-01

    Citrus leprosis virus C (CiLV-C) causes damage in citrus production in the South and Central America. Since closely related types of citrus viruses have recently been described monoclonal antibodies (MAbs) are needed for accurate and sensitive diagnosis of CiLV-C. In this study, MAbs to the expressed coat protein of CiLV-C were produced for serological detection of CiLV-C in crude extracts of infected tissues in double antibody sandwich enzyme-linked immunosorbent assays (DAS-ELISA), dot blot immunosorbent assays (DBIA) and immuonocapture-reverse transcription-polymerase chain reaction (IC-RT-PCR) procedures. Monoclonal antibodies were developed in mice to the purified expressed coat protein of CiLV-C. The published standard protocols of DAS-ELISA, DBIA and IC-RT-PCR were followed for the detection of coat protein p29 of CiLV-C in the crude extracts of CiLV-C infected tissues. Two monoclonal antibodies, designated G10 and C11, were identified from four potential candidates for the specific and sensitive detection of coat protein p29 of CiLV-C in the crude citrus extracts of CiLV-C infected tissues in DAS-ELISA, whereas G10 was also selected based on performance for use in the DBIA and IC-RT-PCR diagnostic assays. Sensitivity analysis comparing the three methods for detection of coat protein p29 of CiLV-C determined that IC-RT-PCR was more sensitive than DAS-ELISA and DBIA. The creation of MAbs to CiLV-C allows for the sensitive and accurate detection of the virus from CiLV-C infected citrus leaf tissues. Successful detection of the virus in three diagnostic assays formats provides flexibility to diagnosticians who can use either ELISA or DBIA for screening large numbers of samples, and IC-RT-PCR for rapid, sensitive confirmation testing.

  7. An interesting case of Lucio phenomenon triggered by activation of hepatitis C infection

    PubMed Central

    Mareen, Jacob; Madhukara, Jithendriya

    2016-01-01

    Lucio phenomenon (LP) or erythema necroticans is a rare type of reaction pattern found in untreated patients with diffuse non-nodular leprosy. It is important to distinguish this from vasculonecrotic erythema nodosum because thalidomide with high-dose steroids is the mainstay of treatment for the latter, whereas LP shows no response to thalidomide. We report a case of a 60-year-old man who presented with purpuric patches, hemorrhagic blisters, and ulcers over extremities of 15 days duration. On cutaneous examination, there were multiple stellate purpuric patches, hemorrhagic bullae, and deep necrotic ulcers, mainly over extremities. Slit-skin smear examination from six sites revealed bacteriological index 6+ with globi, and morphological index 5%. Histopathology revealed diffuse infiltration of bacilli in epidermis, dermis, and endothelial cells along with neutrophilic and lymphocytic infiltrate. Fibrinoid necrosis and thrombosis of blood vessels was also noted. The above clinicohistopathological features helped in making the diagnosis of LP. Concomitantly he was found to be infected with hepatitis C virus. Many triggering factors have been described in literature; however, activation of hepatitis C as a trigger for Lucio phenomenon has not been reported. In addition, IgM and IgG anticardiolipin antibodies were found to be positive. The patient was started on high-dose steroids along with multibacillary antileprosy therapy and improved within 2 weeks. PMID:27730040

  8. Quality of life in vitiligo patients.

    PubMed

    Teovska Mitrevska, Natasa; Eleftheriadou, Viktoria; Guarneri, Fabrizio

    2012-01-01

    Quality of life is defined by the World Health Organization as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns." Often overlooked in the past, it is nowadays considered, in a more holistic view of medicine, a decisive factor to understand the impact of diseases and improve the quality of medical care. Such evaluation is particularly relevant for dermatological diseases, because visibility of the lesions can significantly affect self-esteem and social relationships. Vitiligo represents an emblematic case: often disfiguring and located in visible areas, confused in the past (and, in many world regions, even in the present) with leprosy, often perceived by physicians as a harmless, purely cosmetic problem, it significantly decreases the quality of life of affected persons. After a brief overview on definition, usefulness and methods for the assessment of quality of life, the authors examine the peculiarities of its relationship with skin diseases, particularly vitiligo. The state of the art of knowledge and research in this field is presented, together with data showing usefulness and positive results of a multidisciplinary approach, which adequately keeps into account perceived quality of life, on patient's satisfaction, adherence to treatment protocols and, ultimately, better outcome of treatments. In this context, an important role can be played by support communities, groups of patients and dedicated associations and societies, connected through modern communication networks like the Internet. PMID:23237035

  9. Quality of life in vitiligo patients.

    PubMed

    Teovska Mitrevska, Natasa; Eleftheriadou, Viktoria; Guarneri, Fabrizio

    2012-01-01

    Quality of life is defined by the World Health Organization as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns." Often overlooked in the past, it is nowadays considered, in a more holistic view of medicine, a decisive factor to understand the impact of diseases and improve the quality of medical care. Such evaluation is particularly relevant for dermatological diseases, because visibility of the lesions can significantly affect self-esteem and social relationships. Vitiligo represents an emblematic case: often disfiguring and located in visible areas, confused in the past (and, in many world regions, even in the present) with leprosy, often perceived by physicians as a harmless, purely cosmetic problem, it significantly decreases the quality of life of affected persons. After a brief overview on definition, usefulness and methods for the assessment of quality of life, the authors examine the peculiarities of its relationship with skin diseases, particularly vitiligo. The state of the art of knowledge and research in this field is presented, together with data showing usefulness and positive results of a multidisciplinary approach, which adequately keeps into account perceived quality of life, on patient's satisfaction, adherence to treatment protocols and, ultimately, better outcome of treatments. In this context, an important role can be played by support communities, groups of patients and dedicated associations and societies, connected through modern communication networks like the Internet.

  10. Variations in IL-23 and IL-25 receptor gene structure, sequence and expression associated with the two disease forms of sheep paratuberculosis.

    PubMed

    Nicol, Louise; Gossner, Anton; Watkins, Craig; Chianini, Francesca; Dalziel, Robert; Hopkins, John

    2016-02-09

    The immunopathology of paucibacillary and multibacillary sheep paratuberculosis is characterized by inflammatory T cell and macrophage responses respectively. IL-23 and IL-25 are key to the development of these responses by interaction with their complex receptors, IL-23R/IL-12RB1 and IL-17RA/IL-17RB. In humans, variations in structure, sequence and/or expression of these genes have been implicated in the different pathological forms of tuberculosis and leprosy, and in gastrointestinal inflammatory disorders such as Crohn's disease. Sequencing has identified multiple transcript variants of sheep IL23R, IL12RB1 and IL17RB and a single IL17RA transcript. RT-qPCR assays were developed for all the identified variants and used to compare expression in the ileo-caecal lymph node of sheep with paucibacillary or multibacillary paratuberculosis and uninfected animals. With IL-23 receptor, only the IL12RB1v3 variant, which lacks the receptor activation motif was differentially expressed and was significantly increased in multibacillary disease; this may contribute to high Th2 responses. Of the IL17RB variants only full length IL17RB was differentially expressed and was significantly increased in multibacillary pathology; which may also contribute to Th2 polarization. IL17RA expression was significantly increased in paucibacillary disease. The contrast between the IL17RA and IL17RB results may indicate that, in addition to Th1 cells, Th17 T cells are also involved in paucibacillary pathology.

  11. National Hansen's Disease (Leprosy) Program

    MedlinePlus

    ... its facility at the Ochsner Medical Center in Baton Rouge. Oversees an ambulatory care network with clinics throughout ... National Hansen's Disease Programs 1770 Physicians Park Drive Baton Rouge, Louisiana 70816 1-800-642-2477 Online Courses ...

  12. An evaluation of the contribution of the Swedish International Development Authority (SIDA) to leprosy control in India based on the implementation of multiple drug therapy (MDT) 1981-1993.

    PubMed

    Peat, M; Brolin, L; Ganapati, R; McDougall, A C; Revankar, C R; Watson, J W

    1995-01-01

    The Swedish International Development Authority (SIDA) first supported the National Leprosy Control Programme in India in 1978. In 1981/82 priority was given to the implementation of multiple drug therapy (MDT), starting in two high-endemic districts, and gradually extending to a total of 19 districts in the years by 1993. SIDA then decided to undertake a detailed evaluation of its 12-year contribution and this was carried out by an international team between November 1993 and April 1994. In terms of epidemiological and public health impact, the main results were impressive and clear-cut; 837,519 cases (old and newly arising) were successfully treated, with few complications and a low rate of relapse. The voluntary reporting rate had improved significantly. Data relating to new case detection, child and disability rates were, however, less clear and difficult to interpret. Deficiencies were also identified in the areas of health education, community participation, gender issues, disability prevention and management, rehabilitation, operational research and assessment of cost-effectiveness. These problems should not, however, detract from the contribution of SIDA, from 1981 onwards, in establishing the implementation of MDT in two 'pilot' districts at an early and important stage in the history of the MDT programme in India. SIDA also made significant contributions in other areas, namely pre-MDT 'screening' of registers in 45 endemic districts in 1990-1993, appointment of consultant leprologists at district level, group education activities, annual meetings of voluntary agencies and the development of a monitoring and information system, with computer facilities, at national level. This paper describes the design and methodology, main findings and conclusions of the evaluation, based on the final report and the appendices submitted to SIDA in Stockholm in April 1994.

  13. WHO co-ordinated short-term double-blind trial with thalidomide in the treatment of acute lepra reactions in male lepromatous patients*

    PubMed Central

    Iyer, C. G. S.; Languillon, J.; Ramanujam, K.; Tarabini-Castellani, G.; de las Aguas, J. Terencio; Bechelli, L. M.; Uemura, K.; Dominguez, V. Martinez; Sundaresan, T.

    1971-01-01

    The treatment of lepra reactions constitutes one of the most serious problems in leprosy. For this reason, the first reports in 1965 of the favourable results obtained with thalidomide aroused considerable interest and led WHO, in 1967, to carry out a trial with the co-operation of four centres. A short-term double-blind trial was designed to study the effect of thalidomide, in comparison with acetylsalicylic acid, in the treatment of acute lepra reactions in male lepromatous patients. Acetylsalicylic acid was used instead of a placebo because of its antipyretic and analgesic activity. Because of the severe adverse reactions that may be caused by thalidomide, mainly the teratogenic effects, only males were included in the trial. The results of this short-term study seem to confirm previous reports of the efficacy of thalidomide and indicate that acetylsalicylic acid also seems to be helpful in the management of certain symptoms of lepra reactions. PMID:4947831

  14. Sensory cutaneous nerve fine-needle aspiration in Hansen's disease: A retrospective analysis of our experience

    PubMed Central

    Prasoon, Dev; Mandal, Swapan Kumar; Agrawal, Parimal

    2015-01-01

    Background: Leprosy affects peripheral nerves. As Mycobacterium leprae has unique tropism for Schwann cells, thickened sensory cutaneous nerves provide an easy target for the detection of lepra bacilli and other changes associated with the disease. Materials and Methods: The data of patients with sensory cutaneous nerve involvement were retrieved from our record for the period January 2006 to December 2014. The hematoxylin and eosin (H and E)- and May-Grünwald-Giemsa (MGG)-stained slides were screened for Schwann cells, granuloma, and necrosis. Modified Ziehl-Neelsen (ZN)-stained smears were searched for lepra bacilli and globi. Morphological index was calculated in multibacillary lesions. Result: Twenty-nine sensory cutaneous nerves were aspirated in 23 patients. While 15 cases showed skin and nerve involvement, 8 cases showed only nerve involvement. Terminal cutaneous branch of the radial nerve was most often aspirated. No motor loss was observed after aspiration. Five cytologic pictures were seen — Epithelioid cell granuloma only in 6 cases, epithelioid cell granuloma with necrosis in 1 case, epithelioid cell granuloma with lepra bacilli in 3 cases, necrosis with lepra bacilli in 1 case, and only lepra bacilli in 12 cases. Morphological index ranged from 20% to 80%. Conclusion: Sensory cutaneous nerve fine-needle aspiration (FNA) is a feasible, viable, effective, and safe procedure. It adds to diagnostic FNA yield in patients with concomitant skin involvement and offers a way to evaluate patients with only nerve involvement. Calculation of morphological index allows prognostication and may have a role in assessing response to therapy and/or relapse. PMID:26729977

  15. Renal disease in adult Indians: a clinicopathological study of 2,827 patients.

    PubMed

    Date, A; Raghavan, R; John, T J; Richard, J; Kirubakaran, M G; Shastry, J C

    1987-09-01

    Nephrotic syndrome was the commonest clinical presentation among 2827 consecutive adult Indian patients from whom adequate kidney biopsies were obtained for suspected renal disease. In 83 per cent of cases the nephrotic syndrome was due to minimal change disease, focal segmental glomerulosclerosis, mesangiocapillary glomerulonephritis, membranous usually secondary to tuberculosis or leprosy, was present in only 34 patients. Acute nephritis, the next most frequent clinical presentation, was due to diffuse endocapillary proliferative, crescentic or mesangial proliferative glomerulonephritis in 88 per cent of cases, almost half of whom had elevated serum streptococcal antibody titres. Eosinophilia showed a highly significant association with diffuse endocapillary proliferative and mesangiocapillary glomerulonephritis. Idiopathic IgA nephropathy was present in only 10, and antiglomerular basement membrane antibody disease in only one, of the 238 patients whose biopsies were studied by immunofluorescence. Complications of pregnancy accounted for 70 per cent of cases of cortical necrosis. Acute gastroenteritis, septicaemia, abortions, snake bite and allopathic and indigenous medicines were important causes of acute tubular necrosis. PMID:3449884

  16. Widespread nasal carriage of Mycobacterium lepraeamong a healthy population in a hyperendemic region of northeastern Brazil.

    PubMed

    Lima, Luana Nepomuceno Gondim Costa; Frota, Cristiane Cunha; Mota, Rosa Maria Salani; Almeida, Rosa Livia Freitas; Pontes, Maria Araci de Andrade; Gonçalves, Heitor de Sá; Rodrigues, Laura Cunha; Kendall, Carl; Kerr, Ligia

    2015-11-01

    A case-control study was conducted to determine the presence ofMycobacterium lepraeDNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented.

  17. Widespread nasal carriage of Mycobacterium leprae among a healthy population in a hyperendemic region of northeastern Brazil

    PubMed Central

    Lima, Luana Nepomuceno Gondim Costa; Frota, Cristiane Cunha; Mota, Rosa Maria Salani; Almeida, Rosa Livia Freitas; Pontes, Maria Araci de Andrade; Gonçalves, Heitor de Sá; Rodrigues, Laura Cunha; Kendall, Carl; Kerr, Ligia

    2015-01-01

    A case-control study was conducted to determine the presence of Mycobacterium leprae DNA in nasal secretions of leprosy cases and nonleprosy individuals in Fortaleza, Brazil. It included 185 cases identified by physicians at the Dona Libânia National Reference Centre for Sanitary Dermatology (CDERM). A control group (Co) (n = 136) was identified among individuals from CDERM not diagnosed as leprosy cases. To augment the spatial analysis of M. leprae specific repetitive element (RLEP) positive prevalence, an external group (EG) (n = 121), a convenience sample of healthy students, were included. Polymerase chain reaction for the RLEP sequence was conducted for all participants. Prevalence of RLEP positivity for cases and Co were 69.2% and 66.9%, respectively, significantly higher than for EG (28.1%), and reported elsewhere. Male sex, belonging to a lower socioeconomic status (D/E), history of a previous contact with a case and being older, were associated with being a leprosy case. Our geographical analysis demonstrated that the bacillus is widespread among the healthy population, with clusters of RLEP positive multibacillary cases concentrated in distinct areas of the city. Our results suggest that in endemic areas, as in Fortaleza, surveillance for both nonhousehold leprosy contacts and members of the general population living in cluster areas should be implemented. PMID:26560980

  18. [Guidelines for the treatment of Hansen's disease in Japan (third edition)].

    PubMed

    Goto, Masamichi; Nogam, Reiko; Okano, Yoshiko; Gidoh, Masaichi; Yotsu, Rie; Ishida, Yutaka; Kitajima, Shinichi; Kai, Masanori; Ishii, Norihisa; Ozaki, Motoaki; Hatano, Kentaro

    2013-12-01

    ad hoc committee of Japanese Leprosy Association recommends revised standard treatment protocol of leprosy in Japan, which is a modification of World Health Organization's multidrug therapy (WHO/MDT, 2010). For paucibacillary (PB) leprosy, 6 months treatment by rifampicin and dapsone (MDT/PB) is enough. However, for high bacterial load multibacillary (MB) leprosy, 12 months treatment seems insufficient. Thus, (A) For MB with bacterial index (BI) > 3 before treatment, 2 years treatment by rifampicin, dapsone and clofazimine (MDT/MB) is necessary. When BI becomes negative and active lesion is lost within 2 years, no maintenance therapy is necessary. When BI is still positive, one year of MDT/MB is added (3 years in total), followed by maintenance therapy by dapsone and clofazimine until BI negativity and loss of active lesions. (B) For MB with BI < 3 or fresh MB (less than 6 months after the onset of the disease) with BI > 3, 1 year treatment by MDT/MB is necessary. When BI becomes negative and active lesion is lost within one year, no maintenance therapy is necessary. When BI is still positive or active lesion is remaining, additional therapy with MDT/MB for one more year is recommended. Brief summary of diagnosis, purpose of therapy, character of drugs, and prevention of deformity is also described.

  19. Fighting leprosy and other endemic diseases.

    PubMed

    Convit, Jacinto

    2002-07-01

    As part of its 100th-anniversary celebration, the Pan American Health Organization has named 12 persons as "Public Health Heroes of the Americas" in recognition of their noteworthy contributions to public health in the Region of the Americas. Over the course of this year, the Revista Panamericana de Salud Pública/Pan American Journal of Public Health will be carrying pieces written by or about these heroes. Como parte de la celebración de su Centenario, la Organización Panamericana de la Salud (OPS) ha distinguido con el título de Héroes de la Salud Pública a 12 personalidades que se han destacado por su valiosa contribución a la salud en el continente americano. A lo largo de este año, la Revista Panamericana de Salud Pública/Pan American Journal of Public Health publicará una serie de escritos de los mismos galardonados o acerca de ellos.

  20. Fighting leprosy and other endemic diseases.

    PubMed

    Convit, Jacinto

    2002-07-01

    As part of its 100th-anniversary celebration, the Pan American Health Organization has named 12 persons as "Public Health Heroes of the Americas" in recognition of their noteworthy contributions to public health in the Region of the Americas. Over the course of this year, the Revista Panamericana de Salud Pública/Pan American Journal of Public Health will be carrying pieces written by or about these heroes. Como parte de la celebración de su Centenario, la Organización Panamericana de la Salud (OPS) ha distinguido con el título de Héroes de la Salud Pública a 12 personalidades que se han destacado por su valiosa contribución a la salud en el continente americano. A lo largo de este año, la Revista Panamericana de Salud Pública/Pan American Journal of Public Health publicará una serie de escritos de los mismos galardonados o acerca de ellos. PMID:12202018

  1. The value of histopathological diagnosis in the elderly patients with granulomatous dermatoses. Case series.

    PubMed

    Badea, Mihail Alexandru; Buicu, Corneliu Florin; Sin, Anca Ileana; Cotoi, Ovidiu Simion; Badea, Iudita Maria; Chiotoroiu, Andreea Luciana; Morariu, Silviu Horia

    2016-01-01

    Granulomatous inflammations are a particular type of chronic septic or aseptic inflammation, in which infectious or non-infectious agents are difficult to eliminate by the immune system. These are type IV hypersensitivity reactions mediated by pre-sensitized T-lymphocytes cells CD4+ and CD8+ lymphocytes. Disorders included in this category are: tuberculosis, leprosy, syphilis, sarcoidosis, type I diabetes, multiple sclerosis, Crohn's disease and rheumatoid arthritis. At cutaneous level, this pattern of granulomatous reaction is characterized by a chronic inflammation with formation of granulomas consisting of a variable number of histiocytes, multinucleated giant cells and lymphocytes. Granulomatous dermatoses should be differentiated from other primary or secondary lesions affecting the skin such as inflammation or tumors. Often granulomatous dermatoses can be confused with other skin disorders, both clinically and histological. Histopathology examination can add important information and clarify the diagnosis. This paper presents a series of three clinical cases of granulomatous skin occurring in the elderly patients confirmed at histology examination. Clinical and histology criteria were analyzed, along with specific differential diagnosis, based on data from the literature. PMID:27516029

  2. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

    Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice. PMID:21430827

  3. Patient satisfaction.

    PubMed

    Prakash, Bhanu

    2010-09-01

    Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice.

  4. Type 2 lepra reaction as a cause of pyrexia of unknown origin.

    PubMed

    Vinod, K V; Chandramohan, R; Dutta, T K; Rajesh, N G; Basu, Debdatta

    2012-04-01

    Leprosy, a commonly encountered disease, can rarely present as a reactional state de novo with fever as the main presenting feature. Here we describe an uncommon presentation of leprosy [with type 2 lepra reaction] as pyrexia of unknown origin with prominent rheumatologic manifestations [acute polyarthritis], renal involvement and generalized lymphadenopathy with rare presentation of type 2 lepra reaction without the classic skin lesions of erythema nodosum leprosum, occurring in a treatment naive patient without prior history of leprosy. PMID:23029751

  5. Livedo reticularis in type 2 lepra reaction: A rare presentation.

    PubMed

    Naveen, Kikkeri Narayanasetty; Athanikar, Sharatchandra Bhimrao; Hegde, Spandana Prakash; Athanikar, Vidisha Sharatchandra

    2014-04-01

    Type 2 lepra reaction or erythema nodosum leprosum (ENL) is an immune complex syndrome that occurs mostly in lepromatous leprosy and sometimes in borderline lepromatous leprosy patients. We present an untreated case of lepromatous leprosy, who presented with type 2 lepra reaction and livedo reticularis. Livedo reticularis, though seen in lucio phenomenon, is not a part of type 2 lepra reaction. The case is being reported for its rarity. PMID:24860758

  6. Mycobacterium leprae-induced Insulin-like Growth Factor I attenuates antimicrobial mechanisms, promoting bacterial survival in macrophages

    PubMed Central

    Batista-Silva, L. R.; Rodrigues, Luciana Silva; Vivarini, Aislan de Carvalho; Costa, Fabrício da Mota Ramalho; Mattos, Katherine Antunes de; Costa, Maria Renata Sales Nogueira; Rosa, Patricia Sammarco; Toledo-Pinto, T. G.; Dias, André Alves; Moura, Danielle Fonseca; Sarno, Euzenir Nunes; Lopes, Ulisses Gazos; Pessolani, Maria Cristina Vidal

    2016-01-01

    Mycobacterium leprae (ML), the etiologic agent of leprosy, can subvert macrophage antimicrobial activity by mechanisms that remain only partially understood. In the present study, the participation of hormone insulin-like growth factor I (IGF-I) in this phenomenum was investigated. Macrophages from the dermal lesions of the disseminated multibacillary lepromatous form (LL) of leprosy expressed higher levels of IGF-I than those from the self-limited paucibacillary tuberculoid form (BT). Higher levels of IGF-I secretion by ML-infected macrophages were confirmed in ex vivo and in vitro studies. Of note, the dampening of IGF-I signaling reverted the capacity of ML-infected human and murine macrophages to produce antimicrobial molecules and promoted bacterial killing. Moreover, IGF-I was shown to inhibit the JAK/STAT1-dependent signaling pathways triggered by both mycobacteria and IFN-γ most probably through its capacity to induce the suppressor of cytokine signaling-3 (SOCS3). Finally, these in vitro findings were corroborated by in vivo observations in which higher SOCS3 expression and lower phosphorylation of STAT1 levels were found in LL versus BT dermal lesions. Altogether, our data strongly suggest that IGF-I contributes to the maintenance of a functional program in infected macrophages that suits ML persistence in the host, reinforcing a key role for IGF-I in leprosy pathogenesis. PMID:27282338

  7. Lepra reaction with lucio phenomenon mimicking cutaneous vasculitis.

    PubMed

    Misra, Durga Prasanna; Parida, Jyoti Ranjan; Chowdhury, Abhra Chandra; Pani, Krushna Chandra; Kumari, Niraj; Krishnani, Narendra; Agarwal, Vikas

    2014-01-01

    Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis. PMID:25580317

  8. Lepra Reaction with Lucio Phenomenon Mimicking Cutaneous Vasculitis

    PubMed Central

    Misra, Durga Prasanna; Parida, Jyoti Ranjan; Chowdhury, Abhra Chandra; Pani, Krushna Chandra; Kumari, Niraj; Krishnani, Narendra

    2014-01-01

    Leprosy is a disease typically found in the tropics. Patients with leprosy can have varying presentation with constitutional symptoms, joint pains, skin nodules, and rarely a vasculitis-like picture with skin ulcers and neuropathy. We present a young lady who presented with the rare manifestation of skin infarcts mimicking cutaneous vasculitis, diagnosed on histopathology to have Lucio phenomenon on a background of lepromatous leprosy. With increasing migration and widespread use of biologic response modifiers, clinicians all over the world need to be aware of various presentations of leprosy as well as needing to keep an open mind while considering the differential diagnoses of vasculitis. PMID:25580317

  9. Innovative use of dapsone.

    PubMed

    Wozel, V E Gottfried

    2010-07-01

    After synthesis of dapsone (4,4' diaminodiphenylsulfone) in 1908, the compound was known exclusively in chemistry. Following the epoch-making discovery of the antimicrobial potential for sulfonamides emerged, the sulfone class was included in the medical armamentarium. The therapeutic role of sulfones related to both pathogen-caused diseases and chronic inflammatory dermatoses has led to extensive use in dermatology. At present dapsone is the only sulfone congener available for clinical practice. The sulfone is used in rifampin-based multiple-drug regiments to treat multibacillary and paucibacillary leprosy and to treat Pneumocystis jiroveci pneumonia and prevent toxoplasmosis in individuals with AIDS. In dermatology, dapsone is the preferred drug for treating dermatitis herpetiformis (Duhring's disease) and is useful in the management of a broad range of chronic inflammatory entities, especially autoimmune bullous disorders. With proper administration and monitoring, the sulfone should be considered a useful and safe agent. PMID:20510768

  10. Erythema nodosum leprosum mimicking Sweet's syndrome: an uncommon presentation.

    PubMed

    Mahajan, Vikram K; Abhinav, C; Mehta, Karaninder S; Chauhan, Pushpinder S

    2014-12-01

    Erythema nodosum leprosum (ENL) lesions may uncommonly develop ulceration, necrosis, pustulation or bullae. This 60 year-old female was hospitalised with previously undiagnosed multibacillary (BL) leprosy and Sweet's syndrome-like ENL, a presentation that is rarely reported. In addition to skin lesions simulating Sweet's syndrome, she had anaemia, elevated ESR, and a peripheral leucocytosis with neutrophilia, the laboratory features of Sweet's syndrome. The final diagnosis was made from chronic iridocyclitis, presence of lepra bacilli in slit-skin smears, and histology. The pathogenesis of Sweet's-like ENL remains conjectural. In Sweet's syndrome a complex interplay of various cytokines leading to an abundance of pro- inflammatory cytokines in the target tissues has been postulated to initiate an abnormal tissue response to certain antigens; such findings may eventually explain these uncommon lepra reactions as well. PMID:25675656

  11. “Home is where the patient is”: a qualitative analysis of a patient-centred model of care for multi-drug resistant tuberculosis

    PubMed Central

    2014-01-01

    Background Ambulatory, community-based care for multi-drug resistant tuberculosis (MDR-TB) has been found to be effective in multiple settings with high cure rates. However, little is known about patient preferences around models of MDR-TB care. Médecins Sans Frontières (MSF) has delivered home-based MDR-TB treatment in the rural Kitgum and Lamwo districts of northern Uganda since 2009 in collaboration with the Ministry of Health and the National TB and Leprosy Programme. We conducted a qualitative study examining the experience of patients and key stakeholders of home-based MDR-TB treatment. Methods We used semi-structured interviews and focus-group discussions to examine patients’ perceptions, views and experiences of home-based treatment and care for MDR-TB versus their perceptions of care in hospital. We identified how these perceptions interacted with those of their families and other stakeholders involved with TB. Participants were selected purposively following a stakeholder analysis. Sample size was determined by data saturation being reached within each identified homogenous category of respondents: health-care receiving, health-care providing and key informant. Iterative data collection and analysis enabled adaptation of topic guides and testing of emerging themes. The grounded theory method of analysis was applied, with data, codes and categories being continually compared and refined. Results Several key themes emerged: the perceived preference and acceptability of home-based treatment and care as a model of MDR-TB treatment by patients, family, community members and health-care workers; the fear of transmission of other infections within hospital settings; and the identification of MDR-TB developing through poor adherence to and inadequate treatment regimens for DS-TB. Conclusions Home-based treatment and care was acceptable to patients, families, communities and health-care workers and was seen as preferable to hospital-based care by most

  12. Type II lepra reaction--an unusual presentation.

    PubMed

    Ray, Avas Chandra; Sen, Sumit; Banerjee, Sabyasachi; Mukhopadhyay, Jotideb

    2012-06-01

    Type II lepra reaction usually present with skin lesions. We report a 23 years old male patient presented with fever for two weeks with no visible skin lesion suggestive of leprosy and with no history of either completion or concurrent anti leprosy drug treatment was eventually turned out to be a case of Hansen's presenting with type II lepra reaction. PMID:23409423

  13. Patient Injuries?

    PubMed

    2015-01-01

    An injured patient may be the last thing dentists want to think about. However, in reality, patients can be injured during dental treatment or as the result of an incident such as a slip and fall in the office. Treatment-related injuries can run the gamut and include burns, lacerations, swallowed objects and allergic reactions, according to The Dentists Insurance Company.

  14. [Hansen disease in Mercosur].

    PubMed

    Vazquez, F A; Varela, N N; Antola, M C; Wand-Del-Rey, M L; Leguizamón, O R

    1996-01-01

    In the context of the important changes of a political economic, social and health order upon which the Argentina, Brazil, Paraguay and Uruguay have now embarked in the framework of the commitment undertaken to create instruments for the Common Market of the South America (MERCOSUR), the importance of leprosy for public health in this new region is analysed. In this connection a description is given of the background and reasons which led to the creation of the MERCOSUR Committee for technical cooperation on leprosy, composed of the heads of the national leprosy control programmes of the countries in question, for the purpose of implementing the Protocol of Intention signed by the representatives of the Ministers of member countries, with the object of establishing policies of technical cooperation in activities to control this disease, with a view to attaining the goal proposed by WHO of eliminating leprosy as a public health problem by the year 2000. Using the data contributed by the different programmes, the epidemiological situation existing in this region in December 1995 is outlined, with analysis of certain epidemiological, demographic and operational variables, showing that MERCOSUR has a prevalence of 6.03 per 10,000 population, one of the highest rates in comparison with other WHO regions; a high percentage of cases lost to view (abandons); and a low rate of coverage with multidrug therapy. In this region a total of 33,654 new cases were detected during 1995, of which more than 50% were multibacillary forms, while nearly 10% of them were youngsters of less of 15 years of age. The action carried out jointly among the four countries, the successes achieved and the results to be achieved in the short term are also described.

  15. Patient Empowerment

    MedlinePlus

    ... cancer patient organization. Ask for this help. Your Responsibilities Keep Good Records Get in the habit of ... responsible for your follow-up. You should take responsibility for getting a follow-up scheduled and for ...

  16. Patient Monitoring

    NASA Technical Reports Server (NTRS)

    1978-01-01

    In photo above, the electrocardiogram of a hospitalized patient is being transmitted by telemetry. Widely employed in space operations, telemetry is a process wherein instrument data is converted to electrical signals and sent to a receiver where the signals are reconverted to usable information. In this instance, heart readings are picked up by the electrode attached to the patient's body and delivered by wire to the small box shown, which is a telemetry transmitter. The signals are relayed wirelessly to the console in the background, which converts them to EKG data. The data is displayed visually and recorded on a printout; at the same time, it is transmitted to a central control station (upper photo) where a nurse can monitor the condition of several patients simultaneously. The Patient Monitoring System was developed by SCI Systems, Inc., Huntsville, Alabama, in conjunction with Abbott Medical Electronics, Houston, Texas. In developing the system, SCI drew upon its extensive experience as a NASA contractor. The company applied telemetry technology developed for the Saturn launch vehicle and the Apollo spacecraft; instrumentation technology developed for heart, blood pressure and sleep monitoring of astronauts aboard NASA's Skylab long duration space station; and communications technology developed for the Space Shuttle.

  17. Patient Safety

    MedlinePlus

    You can help prevent medical errors by being an active member of your health care team. Research shows that patients who are more involved with their ... get better results. To reduce the risk of medical errors, you can Ask questions if you have doubts ...

  18. Refugee patients.

    PubMed

    Valeras, Aimee Burke

    2016-06-01

    This short story focuses on refugee patients. Family members talk about the horrific struggles of civil war, refugee camps, and promises of US resettlement. Their harsh reception into a brutal world includes unemployment, food scarcity, and isolation. (PsycINFO Database Record PMID:27270253

  19. Refugee patients.

    PubMed

    Valeras, Aimee Burke

    2016-06-01

    This short story focuses on refugee patients. Family members talk about the horrific struggles of civil war, refugee camps, and promises of US resettlement. Their harsh reception into a brutal world includes unemployment, food scarcity, and isolation. (PsycINFO Database Record

  20. Patient's perspective.

    PubMed

    Raffa, Robert B; Martin, Kathleen J

    2010-01-01

    An unknown, but significant subgroup (perhaps the majority), of patients who have undergone chemotherapy treatment for their cancer report a subsequent decline in cognitive performance (e.g., difficulty in balancing a checkbook; forgetting or mixing up names of friends or relatives, etc.). The condition has been termed chemo fog, chemo brain, or some similar term to reflect the fact that the symptoms are usually difficult to describe and involve domains of cognition such as attention, concentration, memory, speed of information processing, multitasking, or ability to organize information. The deficits are reported to persist. The magnitude of the negative impact on quality of life depends, as does the condition itself, on multiple and varied factors. This chapter relates the experience of one patient.

  1. Overwhelmed Patients

    PubMed Central

    Bohlen, Krista; Scoville, Elizabeth; Shippee, Nathan D.; May, Carl R.; Montori, Victor M.

    2012-01-01

    OBJECTIVE Patients with diabetes may experience high burden of treatment (BOT), including treatment-related effects and self-care demands. We examined whether patients with type 2 diabetes and their clinicians discuss BOT, the characteristics of their discussions, and their attempts to address BOT during visits. RESEARCH DESIGN AND METHODS Two coders independently reviewed videos of 46 primary care visits obtained during a practice-based trial and identified utterances concerning BOT, classifying them by topic and by whether BOT was addressed (i.e., whether statements emerged aimed at alleviating BOT). RESULTS Of the 46 visits, 43 (93.5%) contained BOT discussions. Both coders identified 83 discussions: 12 involving monitoring, 28 treatment administration, 19 access, and 24 treatment effects. BOT was unambiguously addressed only 30% of the time. CONCLUSIONS BOT discussions usually arise during visits but rarely beget problem-solving efforts. These discussions represent missed opportunities for reducing treatment-related disruptions in the lives of patients with diabetes, which may affect adherence and well-being. PMID:22100962

  2. Characterization of Mycobacterium leprae Genotypes in China--Identification of a New Polymorphism C251T in the 16S rRNA Gene.

    PubMed

    Yuan, Youhua; Wen, Yan; You, Yuangang; Xing, Yan; Li, Huanying; Weng, Xiaoman; Wu, Nan; Liu, Shuang; Zhang, Shanshan; Zhang, Wenhong; Zhang, Ying

    2015-01-01

    Leprosy continues to be prevalent in some mountainous regions of China, and genotypes of leprosy strains endemic to the country are not known. Mycobacterium lepromatosis is a new species that was discovered in Mexico in 2008, and it remains unclear whether this species exists in China. Here, we conducted PCR- restriction fragment length polymorphism (RFLP) analysis to classify genotypes of 85 DNA samples collected from patients from 18 different provinces. All 171 DNA samples from skin biopsies of leprosy patients were tested for the presence of Mycobacterium leprae and Mycobacterium lepromatosis by amplifying the 16S rRNA gene using nested PCR, followed by DNA sequencing. The new species M. lepromatosis was not found among the 171 specimens from leprosy patients in 22 provinces in China. However, we found three SNP genotypes among 85 leprosy patients. A mutation at C251T in the 16S rRNA gene was found in 76% of the strains. We also found that the strains that showed the 16S rRNA C251T mutation belonged to SNP type 3, whereas strains without the point mutation belonged to SNP type 1. The SNP type 3 leprosy strains were observed in patients from both the inner and coastal regions of China, but the SNP type 1 strains were focused only in the coastal region. This indicated that the SNP type 3 leprosy strains were more prevalent than the SNP type 1 strains in China. In addition, the 16S rRNA gene sequence mutation at C251T also indicated a difference in the geographical distribution of the strains. To our knowledge, this is the first report of a new polymorphism in 16S rRNA gene in M. leprae in China. Our findings shed light on the prevalent genotypes and provide insight about leprosy transmission that are important for leprosy control in China.

  3. Patient Advocate Foundation

    MedlinePlus

    ... Board Members Annual Reports & Financials Annual Patient Data Analysis Report About PAF's Patient Services Job & Volunteer Opportunities ... 06.16.2016 « PAF’s Releases 2015 Patient Data Analysis Report Illuminating Common Patient Issues 05.27.2016 « ...

  4. Resident rounds part III: case report: a papulo- nodular eruption with systemic signs and symptoms.

    PubMed

    Richards, Lindsey E; Horner, Mary E; Menter, Alan

    2015-04-01

    This is a typical presentation of erythema nodosum leprosum in a patient with lepromatous leprosy who recently migrated from Micronesia. The clinical presentation, pathology findings, pathogenesis, and therapeutic options are reviewed here. PMID:26043447

  5. [Patient advice].

    PubMed

    Lucio-Villegas Menéndez, M Eulalia; González, Laura López; Gutiérrez Pérez, M Isabel; Lluch, Natalia Aresté; Morató Agustí, M Luisa; Cachafeiro, Santiago Pérez

    2014-05-01

    In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material.

  6. Informed consent: patient's right or patient's duty?

    PubMed

    Hull, R T

    1985-05-01

    The rule that a patient should give a free, fully-informed consent to any therapeutic intervention is traditionally thought to express merely a right of the patient against the physician, and a duty of the physician towards the patient. On this view, the patient may waive that right with impunity, a fact sometimes expressed in the notion of a right not to know. This paper argues that the rule also expresses a duty of the patient towards the physician and a right of the physician against the patient. The argument turns, first, on the truism that a physician has no obligation to commit a battery, or unauthorized touching, and, second, on the thesis that a patient necessarily cannot consent to something that is unknown to him. The conclusion is drawn that a patient is not free to receive treatment voluntarily without knowledgeably authorizing it.

  7. Patient-centered Radiology.

    PubMed

    Itri, Jason N

    2015-10-01

    Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients' needs and preferences. In this model, providers respect patients' values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as "doctor-to-doctor" consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients' needs and preferences. Expanding radiology's core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction. PMID:26466190

  8. Counseling the Coronary Patient

    ERIC Educational Resources Information Center

    Semmler, Caryl; Semmler, Maynard

    1974-01-01

    The article discusses counseling sessions designed to a) help the coronary patient adjust to cardiovascular disease, b) diminish patient anxieties and fears, and c) educate the patient and family members on controlling risk factors to deter another coronary attack. (JS)

  9. [Patient education, perioperative management, patient support groups].

    PubMed

    Stöckli, M; Müller, B; Wagner, M

    2007-09-01

    In our division, highly qualified enterostomal therapists treat approximately 300 patients each year Patient care consists of extensive preoperative information, localization of the ideal stoma position and providing patient-education in stoma handling. A regular ambulatory consultation allows early recognition of typical stoma related complications and their effective treatment in a timely manner. Another important issue of our consulting service includes patients concerns, such as social integration and physical independence. The creation of a specialized center provides an efficient and continuous care of enterostomy patients and their relatives. Thus, initial fears and emotional crisis can be addressed and minimalized. It is our goal to provide individual and comprehensive service in order to accommodate our patients needs. PMID:18075148

  10. The master patient index: split patient records.

    PubMed

    Wieners, W; Stewart, S P

    1988-11-01

    Systems integrators have overlooked the potential for corrupting the medical-record database through the creation of multiple (split) records for the individual patient. This article introduces a computer software technology that has been used at the University of California, San Francisco (UCSF) Medical Center to identify split patient records.

  11. Peroneus longus transfer for drop foot in Hansen disease.

    PubMed

    Cohen, Jose Carlos; de Freitas Cabral, Elifaz

    2012-09-01

    Leprosy or Hansen's disease is a chronic infectious disease caused by the Mycobacterium leprae. Nerve injury is a central feature of the pathogenesis of leprosy that results in autonomic, sensory and motor neuropathy. One of the most common secondary disabilities caused by Hansen's disease is the drop foot and it is found in 2% to 5% of newly-diagnosed leprosy patients. Unlike the clinical picture of traumatic injury of the common peroneal nerve where both of its branches (the deep peroneal nerve and the superficial peroneal nerve) are involved, in leprosy there is the possibility of isolated involvement of the deep peroneal nerve branch, sparing the superficial peroneal branch. The article discusses the advantages of using the peroneus longus tendon transfer to the dorsum of the foot instead of the posterior tibial tendon for the correction of dropfoot in selected cases where the peroneals tendons are intact. PMID:22938641

  12. Periprocedural Patient Care.

    PubMed

    Kohi, Maureen P; Fidelman, Nicholas; Behr, Spencer; Taylor, Andrew G; Kolli, Kanti; Conrad, Miles; Hwang, Gloria; Weinstein, Stefanie

    2015-10-01

    Periprocedural care of patients who undergo image-guided interventions is a task of monumental importance. As physicians