SummaryLeprosy is a chronic infectious disease caused by Mycobacterium (M.) leprae. Worldwide, 210,758 new cases were diagnosed in 2015. The highest incidence is found in India, Brazil, and ...Indonesia. While the exact route of transmission remains unknown, nasal droplet infection is thought to be most likely.The pathogen primarily affects the skin and peripheral nervous system. The disease course is determined by individual host immunity. Clinically, multibacillary lepromatous variants are distinguished from paucibacillary tuberculoid forms. Apart from the various characteristic skin lesions, the condition is marked by damage to the peripheral nervous system. Advanced disease is characterized by disfiguring mutilations. Current treatment options are based on WHO recommendations. Early treatment frequently results in complete remission without sequelae. While paucibacillary forms are treated with rifampicin and dapsone for at least six months, multibacillary leprosy is treated for at least twelve months, additionally requiring clofazimine. Leprosy reactions during therapy may considerably aggravate the disease course. Besides individual treatment, WHO‐supported preventive measures and strategies play a key role in endemic areas.
A hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae. Pode resultar em incapacidades físicas permanentes se não for diagnosticado precocemente. Um estudo do tipo ...caso-controle foi conduzido para identificar os fatores associados à ocorrência de hanseníase em indivíduos residentes em uma região de alta incidência da doença no estado do Tocantins, no Norte do Brasil. Sessenta casos diagnosticados entre 2016 e 2018 e 120 controles foram incluídos no estudo. O grupo controle foi constituído por moradores da mesma área dos casos, do mesmo sexo e com variação de idade de até 5 anos. Os dados foram coletados por meio de entrevistas com cada participante. As associações foram avaliadas por análise univariada, seguida de análise de regressão logística. Os seguintes fatores foram associados à hanseníase no modelo de regressão logística: domicílios com até quatro cômodos (OR = 4,01), ausência de cicatriz de vacina BCG (OR = 2,16) e caso anterior de hanseníase na família (OR = 4,32). Os dados apontam que o convívio íntimo entre indivíduos em famílias mais numerosas e domicílios pequenos, sem qualquer proteção imunológica e com histórico de casos de hanseníase, aumentou significativamente o risco de infecção por M. leprae e desenvolvimento de hanseníase.
Identification of
DNA by polymerase chain reaction (PCR) is a reliable and an affordable method to confirm leprosy. DNA from 87 nerve samples (61 from paraffin blocks and 26 fresh samples) was ...extracted.
DNA was amplified by PCR from 80/87 (92%) specimens. Patients were seen over a period of 11 years (2007-2019), and leprosy was diagnosed based on clinical and characteristic histopathology findings. The clinical diagnostic possibilities were as follows: leprous neuropathy in 73/80 (91.3%), mononeuritis multiplex of unknown etiology in four (5.0%), vasculitic neuropathy in two (2.5%), and distal symmetric sensory motor neuropathy in one (1.3%). The biopsied nerves were as follows: superficial radial = 34 (42.6%), dorsal cutaneous branch of ulnar = 19 (23.8%), sural = 18 (22.5%), and superficial peroneal = 9 (11.3%), and corresponding neurological deficits were recorded in 77 (96.3%) cases. The histopathological diagnoses in total group were as follows: (borderline tuberculoid (BT) = 52, tuberculoid (TT) = 8, borderline lepromatous (BL) = 8, borderline borderline (BB) = 3, nonspecific inflammation = 3, healed/fibrosed = 4, and axonopathy = 2). Acid fast bacilli (AFB) was demonstrated in 11 (13.7%) samples. For comparison, 31 clinically and histopathologically defined non-leprous disease control nerves (inherited neuropathy = 20, vasculitis = 8, and nutritional neuropathy = 3) subjected to PCR were negative for
DNA. In most instances, there are multiple thickened peripheral nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are not as widespread. The current findings emphasize the importance of selecting the most appropriate nerve for biopsy to obtain a positive PCR result. We infer that clinical, histopathological, and PCR tests complement each other to help achieve a definitive diagnosis of leprosy particularly in pure neuritic leprosy and in leprous neuropathy with negative skin smears/biopsy.
Leprosy: Clinical aspects and diagnostic techniques Maymone, Mayra B.C.; Laughter, Melissa; Venkatesh, Samantha ...
Journal of the American Academy of Dermatology,
July 2020, 2020-Jul, 2020-07-00, 20200701, Letnik:
83, Številka:
1
Journal Article
Recenzirano
Leprosy, also known as Hansen's disease, is a curable infectious disease that remains endemic in >140 countries around the world. Despite being declared “eliminated” as a global public health problem ...by the World Health Organization in the year 2000, approximately 200,000 new cases were reported worldwide in 2017. Widespread migration may bring leprosy to nonendemic areas, such as North America. In addition, there are areas in the United States where autochthonous (person-to-person) transmission of leprosy is being reported among Americans without a history of foreign exposure. In the first article in this continuing medical education series, we review leprosy epidemiology, transmission, classification, clinical features, and diagnostic challenges.
Granulomas are complex cellular structures composed predominantly of macrophages and lymphocytes that function to contain and kill invading pathogens. Here, we investigated the single-cell phenotypes ...associated with antimicrobial responses in human leprosy granulomas by applying single-cell and spatial sequencing to leprosy biopsy specimens. We focused on reversal reactions (RRs), a dynamic process whereby some patients with disseminated lepromatous leprosy (L-lep) transition toward self-limiting tuberculoid leprosy (T-lep), mounting effective antimicrobial responses. We identified a set of genes encoding proteins involved in antimicrobial responses that are differentially expressed in RR versus L-lep lesions and regulated by interferon-γ and interleukin-1β. By integrating the spatial coordinates of the key cell types and antimicrobial gene expression in RR and T-lep lesions, we constructed a map revealing the organized architecture of granulomas depicting compositional and functional layers by which macrophages, T cells, keratinocytes and fibroblasts can each contribute to the antimicrobial response.
Leprosy: Treatment and management of complications Maymone, Mayra B.C.; Venkatesh, Samantha; Laughter, Melissa ...
Journal of the American Academy of Dermatology,
July 2020, 2020-Jul, 2020-07-00, 20200701, Letnik:
83, Številka:
1
Journal Article
Recenzirano
In the second article in this continuing medical education series, we review the treatment of leprosy, its immunologic reactions, and important concepts, including disease relapse and drug ...resistance. A fundamental understanding of the treatment options and management of neuropathic sequelae are essential to reduce disease burden and improve patients’ quality of life.
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