BACKGROUND: The causative agents of leprosy are the well-known Mycobacterium leprae and the newly discovered Mycobacterium lepromatosis. This agent was found in 2008, and it was found to be the cause of diffuse lepromatous leprosy in two Mexican patients. OBJECTIVE: The objective of this work was to determine if M. leprae and M. lepromatosis were present in formalin-fixed and paraffin-embedded skin samples from cases from different regions in Mexico. METHODS: A total of 41 skin samples were obtained from 11 states of Mexico. All patients' samples were diagnosed by clinical and histopathological analyses. Total DNA was isolated using a Qiagen-DNeasy blood and tissue kit and molecular identification was achieved by two semi-nested polymerase chain reactions. RESULTS: The 41 patient included 33 samples from men and 8 samples from women; 29 samples were polymerase chain reaction (PCR)-positive to Mycobacterium and 12 samples were PCR-negative. From those 29 samples, 13 were PCR-positive to M. leprae, 8 to M. lepromatosis and 8 were positive to both species. The histopathological diagnosis included; Nodular lepromatous leprosy (NLL); Diffuse lepromatous leprosy (DLL); and Borderline leprosy (BL). The 29 PCR-positive samples were classified as follow: 14 NLL, 4 DLL, and 11 BL. In the 12 samples negative to Mycobacterium, 7 showed the NLL, 2 DLL and 3 BL. CONCLUSION: These findings add evidence to the M. leprae and M. lepromatous distribution, clinical forms and participation of dual infections in Mexico.
Diagnosis ; DNA ; Female ; Hospital Distribution Systems ; Humans ; Leprosy ; Leprosy, Borderline ; Leprosy, Lepromatous ; Male ; Mexico* ; Mycobacterium leprae* ; Mycobacterium* ; Polymerase Chain Reaction ; Skin*

Hansen's disease(HD) is a chronic infectious disorder acquired by inoculation of Mycobacterium leprae. With the establishment of complex multidrug therapy, the incidence rate of leprosy patients has continually shown to decline by 90% compared to the incidence rate in the 1990s. However, the prevalence of the disease still remains high in southeast asian countries. Due to the rarity and diverse nature of cutaneous presentation, HD is often misdiagnosed with other dermatoses or infectious conditions. Especially, when a patient presents with unusual presentation with leprosy reaction with no classical feature such as sensory disorders and skin lesion, the diagnosis is further delayed with misguided treatments. Herein we present a 27-year-old Indonesian immigrant who displayed clinical features mimicking that of orbital cellulitis who was later diagnosed with borderline lepromatous leprosy through histologic and PCR confirmation, in light of alerting the probability of leprosy in immigrants with intractable skin presentations.
Adult ; Asian Continental Ancestry Group ; Diagnosis ; Emigrants and Immigrants ; Humans ; Incidence ; Leprosy ; Leprosy, Borderline ; Leprosy, Multibacillary ; Mycobacterium leprae ; Orbit ; Orbital Cellulitis ; Polymerase Chain Reaction ; Prevalence ; Sensation Disorders ; Skin ; Skin Diseases

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. The prevalence and number of new cases have recently markedly decreased in Korea, and the possibility of leprosy can therefore be clinically overlooked. However, leprosy is still endemic in various regions of the world. A 30 year-old male immigrant from Indonesia presented with an erythematous plaque without sensory loss on his face six months after immigration. The skin lesion was diagnosed as tuberculoid leprosy based on clinico-pathology.
Emigrants and Immigrants* ; Emigration and Immigration ; Granulomatous Disease, Chronic ; Humans ; Indonesia ; Korea ; Leprosy ; Leprosy, Tuberculoid* ; Male* ; Mycobacterium leprae ; Prevalence ; Skin

Humans ; Leprosy, Tuberculoid ; diagnosis ; pathology ; Male ; Middle Aged ; Toes ; pathology

The Ziehl-Neelson's AFB staining method was mainly used for the AFB observation of the mycobacteria. However, this method has several issues of false negative results, and hence a comparative experiment of the Ziehl-Neelson's AFB staining and the fluorescence staining method was done to remedy this problem. As the fluorescence staining method brightly highlights the AFB in a dark field, and also as it is observed with the lower power objective, it is a method that can better the observation and shorten the time of observation as well. The fluorescence staining method that was used in this experiment did a comparative analysis of the Auramine O-Rhodamine B and the Acridine Orange. The results showed that although the Auramine O-Rhodamine B allows easier observation of the AFB with a high fluorescence expression rate for the multibacillary leprosy sample, the darkness on the periphery makes it hard to observe anything else, while also making it hard to observe the cell changes and paucibacillary leprosy of the AFB. However, the Acridine Orange staining method highlights the cells in dark green and changes the color of the AFB from bright red to orange making it easier to observe bacilli. The results of the study show that the Acridine Orange method is superior to the Auramine O-Rhodamine B method in detecting acid fast bacilli in specimen.
Acridine Orange ; Benzophenoneidum ; Citrus sinensis ; Darkness ; Fluorescence ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Mycobacterium ; Mycobacterium leprae

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

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.
Aged ; Appetite ; Chronic Disease ; Extremities ; Fatigue ; Female ; Fever ; Granuloma ; Humans ; Hypesthesia ; Leprosy* ; Leprosy, Paucibacillary* ; Neuritis ; Paresthesia ; Skin

BACKGROUND: Leprosy is an infectious disease with two polar forms, tuberculoid leprosy (TT) and lepromatous leprosy (LL), that are characterized by strong cell-mediated immunity (CMI) and CMI anergy, respectively. Transforming growth factor-beta (TGF-beta) is a family of growth factors involved in essential physiological processes, including development, differentiation, tissue repair, cell growth control and inflammation. Cellular signaling by TGF-beta family members is initiated by the assembly of specific cell surface receptors that activate transcription factors of the Smad family. Deregulation of the TGF-beta-Smad signaling pathway has been implicated in developmental disorders and several human diseases. Recently, ELISA & immunohistochemistry revealed high expression of TGF-beta isoforms in LL. OBJECTIVE: The purpose of this study was to investigate TGF-beta-Smad signaling in various forms of leprosy. METHODS: We investigated the involvement of TGF-beta by immunohistochemical staining for Smad 2 and 3 in skin biopsies from six patients of BL and four patients of TT. RESULTS: The inflammatory cells, keratinocytes and fibroblasts in BL showed strong positivity for both Smad 2 and 3, whereas those in TT showed little positivity. CONCLUSION: The high expression of Smad 2/3 in BL could represent high expression of TGF-beta, which possibly contributes to local CMI anergy and other clinical characteristic features of leprosy.
Biopsy ; Communicable Diseases ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Humans ; Immunity, Cellular ; Immunohistochemistry ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Leprosy* ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Physiological Processes ; Protein Isoforms ; Receptors, Cell Surface ; Skin ; Transcription Factors ; Transforming Growth Factor beta

BACKGROUND: On previous reports, the incidence of hepatitis C in Korean leprous patients is too high (55.6~69%). We investigated the percentage of the leprous patients with hepatitis C, genotypes, and risk factors in National Sorokdo Hospital. METHODS: Out of total 714 leprous patients in National Sorokdo Hospital, 147 selected risky patients (with abnormal AST/ALT, plateletleprosy, 29 (5.57% out of 503) were patients with lepromatous leprosy and 16 (11.94% out of 134) were those with tuberculoid leprosy. Genotypic result for 41 patients was 1b in 16 (39.02%), 2a in 20 (48.78%), other type in 3 (7.32%) and mixed in 2 (4.88%). Only 2 of the patients (4.40%) had experienced blood transfusion before 1990, 20 (44.40%) had taken an operation or tattooing, 3 (6.67%) were given intravenous drugs, 2 (4.44%) were family members as married couple, and as much as 20 (44.40%) had no previously known possible risk factors. CONCLUSIONS: Major genotype of hepatitis C in leprous patients was 2a and it is different from that of other Korean population without leprosy (p-value= 0.0027). The percentage of patients with hepatitis C was not related to the subclass of the leprosy. Further studies for the non-blood transmission of hepatitis C virus in them and its controls are needed.
Blood Transfusion ; Female ; Genotype* ; Hepacivirus ; Hepatitis C* ; Hepatitis* ; Humans ; Incidence ; Leprosy ; Leprosy, Lepromatous ; Leprosy, Tuberculoid ; Male ; Risk Factors* ; Tattooing

The rate of the relapse of leprosy differs from researcher to researcher, so it is thought that the exact decision on the termination of a treatment would play an important role in lowering the rate of the relapse of leprosy. This study attempts to lower the rate of the relapse of leprosy by the decision for termination of leprosy treatment by using reticulum stain of skin in leprosy which is one of granulomatous diseases, as granuloma can be easily observed in reticulum stain in sarcoidosis which is one of the common granulomatous diseases. The patients for this study consisted of five cases of lepromatous type leprosy, three cases of tuberculoid type leprosy, and one case of borderline tuberculoid leprosy. They were treated by a multidrug therapy, and its clinical lesions were observed every month. Also skin biopsy was performed every six months, and the changes of granuloma and acid-fast bacilli were observed in accordance with hematoxylin-eosin, Fite-Farraco, and reticulum stain which provides a better observation of granuloma lesion. Skin lesion of paucibacillary leprosy disappeared in 8 to 12 months, but seen from skin biopsy, epitheloid cell granuloma began to disappear after several months and after 12 months, it almost disappeared. But in some lesion, it remained until 21 months, and even after 33 months, perivascular inflammatory cell infiltrations were found. Skin lesions of multibacillary leprosy disappeared within 9 to 33 months, and bacilli checked by skin smear turned negative, but according to a skin biopsy, the number or the size of the foamy histiocytic granuloma became smaller. There was an example that it still remained after 84-month treatment. As a rule, reticulum stain in leprosy made reticulum fibers surround granuloma in various ways, so it helped us to observe distinctively granuloma. In a treatment of leprosy, it could prevent the relapse of leprosy that the already treated lesions should be checked with repeated skin biopsies at certain intervals, though skin lesions disappear and bacilli are not found in a skin smear. It is concluded that reticulum stain could be one of the useful methods in observing granulomatous lesions for determination of healing of leprosy.
Biopsy ; Granuloma ; Humans ; Leprosy* ; Leprosy, Multibacillary ; Leprosy, Paucibacillary ; Recurrence ; Reticulum* ; Sarcoidosis ; Skin*