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Rare atypical feature of type II lepra reaction with ulcerative skin lesion in a lepromatous leprosy patient.

Korean Leprosy Bulletin.2016;49(1):49-54.

Lepra reaction is an acute exacervational status occurring in the chronic course of leprosy. Type 2 lepra reaction occur from multibacillus leprosy (such as BL or LL), which mediated by antigen-antibody immune complex deposited vasculitis, involving multiple organs, and usually associated with constitutional symptoms such as fever, malaise, joint pains. The skin lesions is characterized by painful and tender red papules or nodules on the skin, which also refers to erythema nodosum leprosum (ENL). Different rare atypical skin lesions of ENL have been reported such as bullous, ulcerative, necrotic, pustular, sweet syndrome like lesions in literature. The 74 years old male patient with lepromatous leprosy presented as multiple crusted ulcers on the trunk and red edematous nodule on extremities and face. The histopathologic feature was typical for type 2 lepra lesion. Fite stain revealed large histiocytes containing well defined dense granular bacillus. This case was very rare and interesting because of unusual crusted ulcerative skin lesions combined with conventional ENL lesions and leprosy itself is rare in Korea these days.
Antigen-Antibody Complex ; Arthralgia ; Bacillus ; Erythema Nodosum ; Extremities ; Fever ; Histiocytes ; Humans ; Korea ; Leprosy ; Leprosy, Lepromatous* ; Male ; Skin* ; Sweet Syndrome ; Ulcer* ; Vasculitis

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Leprosy on Korea, 2001-2015: Situation, International Migration and Perspectives.

Jong Pill KIM

Korean Leprosy Bulletin.2016;49(1):37-48.

BACKGROUND: Although incidence of leprosy in Korea has declined steadily over the years, the 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 Korea-and foreign-born population groups METHODS: Observational, retrospective study of suspected leprosy cases in Korea, as reviewed leprosy records from the Korea Centers for Disease Control & Prevention from 2001 to 2015, with results disaggregated by country of birth. Author collected statistical data on leprosy burden for other countries from WHO(World Health Organization) to estimate the expected number of imported cases. RESULTS: Of the 198 leprosy cases registered during the study period, 172(86.9%) were in Korea patients, while 26(13.1%) were detected in resident immigrants. Author identified a significantly higher number of imported leprosy cases during the 2004~2006, 2007~2009, 2010~2012 and 2013~2015 trienniums compared to the reference triennium 2001~2003 (OR 2.66, 95% CI 0.607–11.65; OR 8.33, 95% CI 2.05–33.94; OR 10.00, 95% CI 2.25–44.49; and OR 10.00, 95% CI 1.99–1.34; respectively). Most imported cases were diagnosed in Indonesia(23%) and Sri Lanka(23.8%). However, registered incidence was lower than expected for each year from 2007 to 2015. For example, in 2007, the expected new cases in immigrants were 8, compared to only one case that were actually detected (a 87.3% difference). Likewise, the author expected to find 24 incident cases among immigrants in 2014 and 2015, but only one new case were reported (95.7% fewer than expected). CONCLUSION: Imported cases of leprosy are low than expected cases in Korea, and the author 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.
Centers for Disease Control and Prevention (U.S.) ; Emigrants and Immigrants ; Emigration and Immigration* ; Humans ; Incidence ; Korea* ; Leprosy* ; Parturition ; Population Groups ; Retrospective Studies ; Spain

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The effect of xerostomia on perceived oral health among Hansen's people wearing dentures.

Dong Chan OH

Korean Leprosy Bulletin.2016;49(1):23-35.

OBJECTIVE: This study examined xerostomia of Hansen's people wearing dentures, their perceived oral health as well as how their general characteristics and xerostomia affected their perceived oral health. METHODS: total of 100 subjects, who were 65 years or older and used in the sorokdo national hospital, were enrolled in this study. A survey and oral examination were carried out through a separate interview from July 1 through to July 30, 2015. A x2-test, t-test, one-way ANOVA, and linear regression analysis were used to analyze the data using the SPSS program. RESULTS: The number of natural teeth in the group of people under and over 74 was 9.92 and 7.01, respectively. The percentage of elderly people who were complete and partial dentures was 45,9% and 39.4% respectively. 48.2% and 31.1% of the elderly adults perceived their oral health to be moderate and poor, respectively. Regarding xerostomia, the subjects achieved a mean of 7.87 out of a maximum 12 points. Moreoverthose who were older and had fewer natural teeth felt that their xerostomia was more severe. The subjects xerostomia and perceived general health had a significant impact on their perceived oral health. CONCLUSIONS: These results highlight the need for oral health programs to help hansen's people retain more of their natural teeth.
Adult ; Aged ; Denture, Partial ; Dentures* ; Diagnosis, Oral ; Humans ; Linear Models ; Oral Health* ; Tooth ; Xerostomia*

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Evaluation of Propidium Monoazide Real-Time PCR for Viablity of Mycobacterium leprae.

Jong Pill KIM ; Yeon Sil KIM ; Chan Woo KIM

Korean Leprosy Bulletin.2016;49(1):13-22.

BACKGROUND: Conventional acid-fast bacilli (AFB) staining cannot differentiate viable from dead cells. Propidium monoazide (PMA) is a photoreactive DNA-binding dye that inhibits PCR amplification by DNA modification. OBJECT: The author evaluated whether PMA real-time PCR is suitable for the viablity of Mycobacterium leprae (M. leprae) in specimens of cultivation in mouse foot pads. METHODS: A total of 55 diluted suspensions from mouse foot pads were quadruplicated and subjected to PMA treatment and/or heat inactivation, and were also tested to compare the ΔCT values (CT value in PMA-treated samples-CT value in non-PMA-treated samples). Real-time PCR was performed using QuantiTect SYBR® Green PCR Kits(Qiagen, USA), and the CT value changes after PMA treatment were compared between PMA treatment and/or heat inactivation groups. RESULTS: The increase in the CT value after PMA treatment was significant in heat inactivated group(4.26) and non-heat inactivated group(1.12)(both P = 0.000). In the ROC curve analysis, the cutoff ΔCT value for maximum sensitivity (100%) and specificity (97.1%) for differentiating dead from live cells was 2.41 CONCLUSIONS: PMA real-time PCR is a useful approach for evaluating viablity of M. leprae.
Animals ; DNA ; Foot ; Hot Temperature ; Mice ; Mycobacterium leprae* ; Mycobacterium* ; Polymerase Chain Reaction ; Propidium* ; Real-Time Polymerase Chain Reaction* ; ROC Curve ; Sensitivity and Specificity ; Suspensions

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An effect of Masseter muscle transfer in recurred cases following temporalis transfer for lower lip paralysis.

Sung Yul AHN ; Jong Pill KIM ; Hyang Joon PARK

Korean Leprosy Bulletin.2016;49(1):3-12.

BACKGROUND: Facial nerve palsy in patients with leprosy brings a variety of discomfort functionally and cosmetically. Although the distortion of the lips is less frequent than that of the eyes, when it occurs, it happens either unilaterally or bilaterally and shows a different dynamic from that in eyes. The lower lip droop causes saliva to flow out of the mouth when eating and exposes the gum and teeth. MATERIALS AND METHODS: All patients were previously treated using the TMT procedure yet symptoms recurred within an unacceptable timeframe. Therefore, we retreated patients using the masseter muscle plication. We performed the masseter muscle plication to the lateral portion of the lower lip muscle to give it power without dividing the anterior segment of masster muscle from mandibular border. RESULTS: Complete closure of the mouth was observed in 6 patients with a moderate degree of lower lip droop. One patient that presented with severe lower lip droop bilaterally showed only partial closure. CONCLUSIONS: Without dividing anterior half segment of masseter muscle from mandibular border, the direct plication of the anterior border of masseter muscle and lower lip muscles was very effective method to correct the lower lip droop and to close the mouth in recurrent patients after temporal muscle transfer.
Eating ; Facial Nerve ; Gingiva ; Humans ; Leprosy ; Lip* ; Masseter Muscle* ; Methods ; Mouth ; Muscles ; Paralysis* ; Saliva ; Temporal Muscle ; Tooth

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The Prospectives on The Association between Disability Resulted from Hansen's Disease and Orthosis Prescribed to Patients with Hansen's Disease.

Rae Hwan LEE

Korean Leprosy Bulletin.2008;41(2):37-54.

BACKGROUND: Hansen's disease is chronic disease, often resulting in musculoskeletal complication such as chronic ulcer, deformity, disability. The aim of this article is to know the present status of prescription of orthosis and to assess the usefulness of orthosis. METHODS: Analysis was done on subjects who had were prescribed orthosis from December, 2007 to November, 2008 at the Clinic of Reserch Center. We have asked the patients questionnaire such as frequency of use of the prescribed orhtosis, the degree of pain reduction and comfortability with orthosis,the cause of disuse of orthosis ,the degree of preventing relapse of ulcer with orthosis, request about prescribed orthosis. RESULTS: The total number who were prescribed orthosis was 173. About 69.4% patients have used orthosis very frequently or nearly at all times. About 83.2% patients said that orthosis had done them good in pain reduction, preventing relapse of ulcer. The major reason of disuse of orthosis was inconvenience of management, not no-helfulness. The major request about orthosis were improvement of quality, imprvement of strength of orthosis, shortening of limitation term of prescription. CONCLUSINON: The prescription of orthosis to Hansen patients with musculoskeletal sequale improve quality of life and is available in preventing relapse of ulcer.
Chronic Disease ; Congenital Abnormalities ; Humans ; Leprosy ; Orthotic Devices ; Prescriptions ; Quality of Life ; Surveys and Questionnaires ; Recurrence ; Ulcer

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The possible predicting factor of the plantar ulcer in patients with leprosy.

Jong Pill KIM ; Yeon Sil KIM

Korean Leprosy Bulletin.2008;41(2):23-35.

TOBJECTS: Leprosy is a chronic infection principally affecting the skin and peripheral nerves caused by the obligate intracellular organism Mycobacterium leprae. Complications secondary to the neuropathy can result in deformity and disability. The plantar ulcer is the commonest complication in leprosy. And the plantar pressure is important factors developing plantar ulcer. So the author is studied about the possible predicting factor of the plantar ulcer in patients with leprosy. SUBJECTS AND METHOD: Subjects included 100 leprosy patients, divided two groups according to the recent plantar ulcer history. The author analyzed the relations between that significant factors and various factors (PGL-I titer, sensory level). RESULTS: The correlations between the PGL-I antibody titer(Spearman's rho=0.215, p=0.048) and PGL-I antibody group(Spearman's rho=0.215, p=0.045) and the recent plantar ulcer history were found. CONCLUSION: The author ascertained that the PGL-I antibody titer and PGL-I antibody group PGL-I antibody titer would be the possible tool for predicting the plantar ulcer of the Hansen disease program.
Congenital Abnormalities ; Foot Ulcer ; Humans ; Leprosy ; Mycobacterium leprae ; Peripheral Nerves ; Skin

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Hydoroxocobalamin (Vitamin B12) Effects on Nerve Function Impairments in Leprosy.

Kyung Duk LEE

Korean Leprosy Bulletin.2008;41(2):17-22.

95 patients in Sorokdo national hospital injected 1-5mg Hydroxocobalamin (5mg/2ml/1ample) in 5-7 days/week, duration 6.4 months, average age 71.6 years old. Effects are 1) softening of hand movement(22/95), early effect, 2) improving of motor function (8/95) 3) sensory function(8/95) 4) sweating (3/95) 5) neuropathic pain and headache(neuralgia-like) (7/95) 6) jaw and hand tremor (7/95) 7) no response (41/95) 8) side effect (1/95) Leprosy is demyelinating peripheral neuropathy, Vitamin B12 effects on myelin, but unkown it's mechnism. Vitamin B12 improve nerve function impairments in leprosy, especially neuropathic pain and tremor, which lead to deformities and disabilities.
Congenital Abnormalities ; Hand ; Humans ; Hydroxocobalamin ; Jaw ; Leprosy ; Myelin Sheath ; Neuralgia ; Peripheral Nervous System Diseases ; Sweat ; Sweating ; Tremor ; Vitamin B 12

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Eyelash Ptosis in Hansen's Disease.

Sung Yul AHN ; Hyang Joon PARK ; Jong Pill KIM

Korean Leprosy Bulletin.2008;41(2):11-15.

BACKGROUND: Eyelash ptosis(ELP) is a common finding in patients with long-standing leprosy. However, it has rarely been reported in the literature previously, because it has been diagnosed as trichiasis or entropion. OBJECTIVE: To determine the prevalence of ELP in Hansen's disease. METHODS: We took both frontal and lateral photographs of eyes in 20 patients and evaluated the degree of ptosis using a 4-point rating scale, in which 0 indicates no ptosis; 1, minimal; 2, moderate; and 3, severe. The evaluation was also performed in 20 normal persons as control group. RESULTS: All patients demonstrated ELP. In general, severity of ptosis in patient group is greater than that in control group. While the mean eyelash ptosis rating was 2.0+/-0.6 in the latter, it was 0.6+/-0.4 in the former, which is statistically significant (p<0.01). CONCLUSIONS: ELP is common in the patients with Hansen's disease and moderate to severe forms occurred more commonly in disease group compared with control group. ELP must be considered as a characteristic ocular finding in long-standing leprosy.
Eye ; Humans ; Leprosy ; Prevalence ; Trichiasis

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A report on thirteen new cases of Hansen's disease in Busan, Ulsan, and Kyungnam district during last 6 years (2002-2007).

Hyun Ho CHO ; Sang Hee SEO ; Do Sang JUNG ; Hyun Chang KO ; Moon Bum KIM ; Kyung Sool KWON

Korean Leprosy Bulletin.2008;41(2):3-10.

INTRODUCTION: Along with the remarkable decrease in incidence of Hansen's disease, many physicians have little experience and are unfamiliar with the disease entity. Consequently physicians may make an error in or delay the correct diagnosis more frequently in these days. We feel that the physicians should constantly be interested in Hansen's disease, and be aware of the updated aspects as compared with the past. MATERIAL AND METHODS: We have analysed 13 new patients of Hansen's disease in Busan, Ulsan, and Kyungnam district during last 6 years (2002-2007). The clinical features of 13 new patients were compared with 370 cases reported 30 years ago, in our clinic. RESULTS: Among 13 patients, male was 4 and female was 9. Mean age was 63 years, and the mean duration until diagnosis was 15.6 months. Two patients had familial history of Hansen's disease. In the classification, lepromatous leprosy was 6, borderline lepromatous leproys was 4, mid-borderline leprosy was 1, borderline tuberculoid leprosy was 1, and tuberculoid leprosy was 1. Eight patients of 13 have experienced lepra reaction. Level of BI and PGL-I antibody corresponded with type of the disease. Among 13 patients, 9 patients (69.2%) were resident in Busan. CONCLUSION: There was an increase in female population, and mutibacillary forms of Hansen's disease were more common as compared with the past. Since majority of patients were resident in Busan and the duration until diagnosis was too long, the dermatologist, especially in Busan should be interested in and carry on clinical studies of Hansen's disease constantly.
Female ; Humans ; Incidence ; Leprosy ; Leprosy, Lepromatous ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Leprosy, Tuberculoid ; Male

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