The leprosy mission(TLM) as an organization moving toward together as a global partnership between supporting countries whose primary role is to raise financial, people and prayer support for the work of TLM and implementing countries where they work with leprosy-affected people and communities has been working since 1874.TLM developed continuously by changing shape globally for increasingly more effective in leprosy work worldwide since then.The never changing TLM’s vision and goal is A world without Leprosy by eradicating the causes and consequences of leprosy.TLM’s values are striving to be like Jesus, holistic, professional and appropriate, open.By believing God who will listen and respond, TLM’s members are praying all together and hold on to God’s faithful promise for good. TLM was initiated, has been sustained and will be continued by God through Godly man as I convince till leprosy is defeated and lives transformed.

Background: Sensory impairment in leprosy patients does not progress further even after the disease is completely cured but remains as a after effect.Even in a state where the bacteria are negative and the bacteria have been eliminated from the body and there is no infection, bony muscular disorders can progress and recur, leading to severe foot deformity and ulcers, deep tissue infection, chronic Osteomyelitis, and eventually amputation. Objective: and MethodsWounds occur where sensation is lost, and the appearance is diverse, including calluses, burn, and frostbite.In particular, wounds occur most often on the soles of the feet, but patients do not feel them until the wounds become severe due to numbness.When discovered, Cellulitis often worsen or progresses to Osteomyelitis.Loprost, which requires physical and mental treatment, must be considered from various perspectives.Scars with wound often stay with patients of Leprosy disease therest of their lives. It causes deep pain to patients. Conclusion In this regards, regular visits, Callus removal, and wound treatment are very important.Continuous, long-term care of Leprosy patients is the basis of leprosy treatment.

Background: Importance of the histopathological findings for diagnosis of leprosy cannot be overstated. Understanding the histopathological characteristics of leprosy is eventual and the most hopeful way to diagnose leprosy in non-endemic area like Korea for we do not include leprosy as the differential diagnosis. Objective: Dermatologists in non-endemic area reach to diagnose leprosy histopathologically through discriminating the degree of significance from many important and characteristic findings of leprosy Methods: We have collected histopathological findings calling for diagnosis of leprosy from review articles, textbooks, booklets to classify them according to significance. Degree of significance was divided into four scales using three factors of nerve changes, granulomas, and infiltrates. Scales are as follows: suspicious, moderately concerned findings were called S1, highly concerned S2, strong, seriously concerned S3, and highly significant, conclusive S4 Results: 1) Nerve(n.) changes were as follow: S1 was fragmented nervearound the center of epithelioid granuloma, no normal n. bundles outside the lesions. S2 was selective involvement of dermal n., perineurial changes. S3 was undergoing destruction and swelling of deep dermal n. by granuloma and no detectable n. S4 was AFBs, onion skin appearance of perineurial fibroblast proliferation, n. destruction by granulomas with anesthetic skin lesion2) Characteristic granulomas for diagnosis of leprosy were as follow: S1 was epithelioid granulomas on the sweat glands and arrector pili muscle. S2 was epithelioid granulomas situated on the deep dermal n. bundles, epidermal erosion by granuloma associated with tubercles in entire dermis, linear or angulated tubercles. S3 was elongated tubercles along the n. in the deep dermis and also granulomas on the sweat glands and arrector pili muscles. S4 was AFBs. 3) Dermal infiltrates had following characteristics: S1 was lymphohistiocytic infiltrate that is more prominent around the adnexa than the vessels.S2 was selective lymphocytic infiltration and cuffing of deep dermal n. S3 was foamy macrophages of gray and granular cytoplasm. S4 was foamy macrophages with AFBs. Conclusion We propose a scale for discriminating the degree of significance to diagnose leprosy histopathologically when dermatologist in non-endemic area meet the leprosy-related findings.

World Health Organization recently recommended new drug regimens including bedaquiline, pretomanid, and linezolid for the treatment of quinolone-resistant multidrug tuberculosis (pre-XDR-TB). Considering a continuous increase in rifampin- and ofloxacin-resistant Mycobacterium leprae, of interest would be antibacterial activities of the new TB drugs against M. leprae. Of the three new TB drugs above, bedaquiline showed the most potent bactericidal effects even after a single dose of 25 mg/km in the mouse footpad infection model of M. leprae. Bedaquiline level could be lowered to as low as 0.1 mg/kg when given with rifampin and/or clofazimine in a combination treatment in mouse models. Despite very potent anti-M. tuberculosis activity, however, pretomanid showed a moderate inhibitory activity against M. leprae in mouse model because of natural resistance due to lack of niroreductase enzyme in the organism, which is essential in releasing nitric oxide. Although linezolid showed an antibacterial activity at 100 mg/kg concentration against M. leprae in a mouse model, it may not be feasible to use for treatment of Hansen’s Disease due to the high frequency of severe adverse events that appeared during treatment of TB patients. While waiting for more new TB drugs with anti-M. leprae activity, bedaquiline seems to be promising for use in the treatment of Hansen’s Disease in the near future.

Background: It has been essential that leprosy is included as differential diagnosis for diagnosing leprosy. But in non-endemic area like Korea, this is not enough for leprosy does not dwell in differential diagnosis. Objective: To reach out diagnosis of leprosy as differentiating many diseases that are familiar or are considered by application of algorithm Methods: We have collected review articles, textbooks, booklets, case reports of differential diagnosis of leprosy to classify them according to primary lesions, symptoms, and clinical characteristics. The major and important clues to diagnosis of leprosy were checked using algorithmic trees. Results: 1) It is important that leprosy is characterized by no itching sensation, no predilection of immune sites, and usually not monomorphic lesions except LL. 2) Additionally, leprosy does not usually proceed to tumor, generalized erythroderma, or alopecia of the scalp.3) Scales give no differentiating points in TT, BT, and BB lesions. 4) Annular papules and plaques are the most concerning lesions for diagnosing leprosy. 5) Nodules and diffuse infiltration of the eyebrows, ear auricles, and nose are not specific, but peculiar to MB. 6) When we consider diagnosing the skin diseases with myriads of clinical manifestation, such as mycosis fungoides, sarcoidosis, lupus erythematosus, Sweet syndrome, leprosy should be included for differential diagnosis. Conclusion We have made the decision trees for diagnosing leprosy. But on the other hand, we cannot reach the diagnosis of leprosy without knowledge of major characteristic clues of leprosy. Therefore, as the result highlights the necessity of education of clinical leprosy would increase.

CD11b+Gr-1low cells that are increased in the lungs of a Mycobacterium (M) tuberculosisinfection mouse model have the characteristics of monocytic (M) - myeloid - derived suppressor cells (MDSCs) and harbor M.tuberculosis. Interestingly, a high number of M-MDSCs have also been observed in skin lesions of patients with lepromatous leprosy.We hypothesized that CD11b+Gr-1low cells might be involved in the pathogenesis of leprosy, as they are in tuberculosis. In the current study, we investigated the issue of whether CD11b+Gr-1low cells accumulate in Mycobacterium (M) leprae-induced granulomas of the footpad skin of nude mice. Our results show that CD11b+Gr-1low cells began to accumulate in the 7-month-old M.leprae-induced granulomas and were replaced by other leukocytes, including CD11b + Gr-1 high over time during M.leprae infections. CD11b+Gr-1low cells expressed the surface markers of M-MDSC, Ly6C high and Ly6G low . In addition, CD11b+Gr-1low cells have the nuclei of a mononuclear cell type and expressed higher levels of arginase 1 (Arg1) and inducible NO synthetase (iNOS).Furthermore, they showed a higher infection rate by M.leprae. Taken together, our results indicate that the inoculation with M.leprae induced an accumulation of CD11b+Gr-1low at a relatively early stage, 7-month-old M.leprae-induced granulomas, and that CD11b+Gr-1low have the characteristics of M-MDSC and may act as a reservoir for M.leprae.

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae), an obligate intracellular organism residing within host macrophages and Schwann cells.Currently, there is no artificial medium capable of culturing M. leprae, so it is mainly grown by inoculating animals such as nude mice and armadillos. In a laboratory environment, it is convenient to maintain and cultureM. lepraeusing athymic nude mice. Objective: The maintenance and growth ofM. lepraestrains in nude mice is important for studying leprosy. In this study, we developed an efficient purification method to collect M. lepraestrain grown in nude mice. Methods: Purification ofM. lepraestrain from nude mouse footpads was used of gentleMACS™ C Tube and DT-20 Dispersing tube without a tissue homogenizer. The isolated tissues were dissociated with gentleMACS™ C Tubes and gentleMACS Dissociators. In order to increase the bacterial recovery rate, bacilli from the remaining tissues (dermis, tendons, nerves and bones of the foot) were purified using a DT-20 Dispersing tube and IKA Tube Disperser. After the tissue dissociation, cells were separated by trypsin treatment and the contaminated bacteria were removed by sodium hydroxide (NaOH). The isolated bacteria were stained with methylene blue solution in the usual Ziehl-Neelsen method and the chromosomal DNA extracted by cracking of cell wall with bead beating was analyzed by DNA amplification by polymerase chain reaction (PCR). Results: Using gentleMACS™ C Tube and DT-20 Dispersing tube instead of a tissue homogenizer, M. lepraestrain was efficiently obtained from tissues. Trypsin was suitable for tissue dissociation, resulting in an effective cell suspension and did not affect the survival of M. lepraestrain. The procedures showed high viability and high recovery rate and allowed simultaneous purification of different bacillary strains from each nude mice without contamination by NaOH treatment. Conclusion It is a useful method for high viability rate and high recovery rate of M. lepraestrain harvested from nude mouse. The procedures were possible method for extracting several strains at the same time.

Background: From May 1992 to the present, I(Ahn)have been in charge of reconstructive & restoration treatment for facial deformities and hand deformities once a week at a clinic affiliated with the Korea.Hansen Welfare Association for 30 years. The most common patients among these are those with lagophthalmos and ectropion.According to Kim Doil’s report 1 , the frequency of lagophthalmos is approximataly 20% in Korean leprosy patients.It occurs when eyes can’t close due to paralyis of the zygomatic branch of the facial nerve.Ectropion also appears as facial paralysis and due to senile change, which show relaxation of medial and lateral canthal tendons and sagging of the lower eye-lid itself.In 1988, there were about 25,000 registered patients with leprosy, but as of 2023, 8,100 people have been registered and the average age is 79 years old.There is a natural decline of approximately 500 people per year.It is calculated that there are still about 1,600 patients remaining with lagophthalmos.By reviewing 18 papers pubblished by the authors on our experience with plastic surgery treatment for lagophthalmos and ectropion over past 30 years, we hope th find better treatment methods in the future. Objective: and MethodsWhen I first started treating lagophthalmos in the early 1990s Temporalis transfer surgery(hereinafter called as TMT) was known to be the most effective method in the literature, so I started using this method for 2-3 years.But starting in 1980s, leperosy settlements on the outskirts gradually developed into cities, and leprosy patients who healed, came to live with the general pullic.As a result, the TMT surgery method, which shows the drawback of the phenomenon of eyelids closing at the same time on eating, was no longer preferred by patients.The author also looked for other surgical methods such as gold plate insertion, and levator and Muller muscle severing on the upper eyelid and lateral canthoplasty, horizontal shortening and canthal sling using deep fascia on the lower eyelid.However, as people age, this static method had a drawback in terms of sustainability of effect.The average age of papers published in 1995 was 50.7 years old, but in 2004 it was 61 years old and in 2014 the average was 70.1 years old and in 2022 the average age was 74.3 years old. Results: Patients in there 50s and 60s who are socially active sought a cosmetically effective procedure with a shorter recovery period than TMT surgery, but patients over 70 years of age returned to TMT method which priorities functional aspects.The author also looked for a simple & effective modified TMT method using the deep fascia with less elevation of temporal muscle, but has now returned to the original Gillies-Anderson method, which modifying above method such as inserting temporal muscle obliquely into lateral canthal area about 15 degrees appropriate for the elderly and considering ways to fix fascia slip transplanted to the medial canthal area and prevent ptosis caused by fascia slip transplanted to the upper eyelid. Conclusion To reduce the recurrence of ectropion after TMT surgery, it is thought to be effective to perform lateral tarsal strip and sever the capsulo-palpebral fascia along with modified TMT as an auxiliary surgical method.To prevent of eye closing simultaneously with mastication, regular and steady chewing of gum or training to increase contact between the upper and lower teeth is recommended starting 3 weeks after TMT surgery.

Background: One of the Sequelae of facial nerve paralysis in leprosy patients is severe eye and lip deformity. Eye deformities are most common, followed by unilateral lip deviation. When there is bilateral failal nerve paralysis, the lower lip drooping may occur. The lower lip drooping makes mouth closure incomplete, so the fluid or saliva may flow out when eating. And the teeth may be exposed or even the gum may be visible, which causes serious cosmetic and functional impairments. Objective: It is to evaluate the masseter muscle sling (MMS) method in the treatment of the recurrent lower lip drooping in patients with Hansen's disease. Methods: In the case of masseter muscle sling, there is a traditional method of detaching, separating and raising anterior masseter muscle in half from the mandibular jaw line and fixing it to the lip muscle. However, the authors observed a 3cm gap between the anterior border of masseter muscle and the lateral edge of orbicularis oris muscle. Under the local anesthesia the nasolabial line was incised and 3-4 places were pulled up between both musle edges and plicated with a 2/0 PDS??threads the gap-space. Results: During 5 years (2016-2020), there were 17 recurrent lower lip palsy patients. The mean age was 71.3 years and the ratio of male and female was 9:8. Of 17 patents, 12 received temporal muscle transfer (TMT) attached with tensor fascia lata (TFL), 2 received temporal muscle transfer attached with Alloderm, and 3 received masseter muscle sling alone. The postoperative results of corrective masseter muscle sling were satisfactory in all 17 patients and there were no serious complication and recurrence during follow-up. Conclusion Masseter muscle sling is effective method in correction of recurrent lower lip drooping in patient with leprosy who treated previously with temporal muscle transfer attached with tensor fascia lata or temporal muscle transfer attached with Alloderm. In addition, masseter muscle sling may be considered as the first-line treatment in the lower lip paralysis.

Background: The prevalence of leprosy has almost reached the goal of World Health Organization. Accordingly, attention to leprosy and the number of skilled doctors who can diagnosis the leprosy upon clinical manifestations were decreased which caused the delayed diagnosis of leprosy. Objective: Serum C-reactive protein, interferon gamma-induced protein 10, anti-phenolic-glycolipid-1 IgM are biomarkers associated with multi-bacillary leprosy. Therefore, we investigated whether the use of multiple biomarkers has diagnostic value. Methods: The samples were collected from August 2012 to December 2019 at our institute. Through various statistic methods, multiple biomarkers and equation were compared in multi-bacillary patients, pauci-bacillary patients, contacts and different skin disease. Results: Samples were collected from 21patients (17 multi-bacillary, 4 pauci-bacillary) and 17 from non-patients (7 from contacts, 10 from other skin disease). Serum level of C-reactive protein, interferon gamma-induced protein 10, anti-phenolic-glycolipid-1 IgM and equation showed statistical significance compared from patients to non-patients. Comparing multi-bacillary patients to pauci-bacillary patients, only anti-phenolic-glycolipid-1 IgM showed statistical significance. Each area under receiver operating characteristic curve of those biomarkers and equation was ≥0.70 and p≤0.05. The results of Equation using 3 indicators showed higher area under receiver operating characteristic curve and lower P value compared when each indicator was used. Also sensitivity and specificity of them presented meaningful data. Conclusion We confirmed that using integrated analysis of three biomarkers is more significant than the single indicator in the diagnosis of leprosy. In addition, the use of multiple biomarkers is thought to contribute to the management of leprosy in the community.