BACKGROUND

Efforts to control Hansen's d isease have progressed through multidrug therapy implementation. However, documented cases of relapse present challenges to its effective management and eradication. Understanding the contributing factors to relapse is crucial for optimizing treatment strategies and achieving better outcomes against Hansen's Disease.

OBJECTIVE

To determine the epidemiological profile and clinical patterns of patients diagnosed with Hansen's Disease Relapse in selected Tertiary Government Hospitals in the Philippines from November 2016 to October 2021.

METHODOLOGY

This was a multi-center, retrospective study involving a five-year chart review method. Charts of all Hansen's Disease Relapse patients were obtained from participating institutions with necessary approvals. Data collection followed approved forms, and patient profiles were analyzed using descriptive statistics. Pre- and post- relapse profiles were compared using T-tests, Wilcoxon tests, and Fisher's Exact Test. Relapse time across subgroups were assessed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

A total of 60 relapse cases were included in the study. Majority were single, unemployed males aged 26-35, with low household screening. The Bacillary Index significantly decreased post- relapse. Documented comorbidities included G6PD deficiency before treatment and lepra reactions during MDT. Patients on 12-month MDT regimens had higher relapse time than those on 24-month regimens.

CONCLUSION

This study underscores the influence of socioeconomic, gender, and age-related factors on relapse. It emphasizes the imperative for enhanced public health measures in accordance with the WHO Global Leprosy Strategy and the importance of considering clinical factors while advocating for continuous improvements in leprosy management protocols.

Human ; Multiple Chronic Conditions

Cutaneous tuberculosis is a rare form of extrapulmonary tuberculosis seen in 1% of all cases. Lupus vulgaris is one of the most common types of cutaneous tuberculosis. Its cutaneous patterns may mimic other dermatologic conditions such as pyoderma gangrenosum. Clinical, diagnostics and histopathologic correlation is important in diagnosing lupus vulgaris.

This is a case of a 17-year-old Filipino male with multi-drug resistant Pulmonary Tuberculosis who presented with three-months history of erythematous papule that gradually progressed into plaque on the scalp, abdomen and left popliteal area with associated pruritus 5/10. The initial working diagnosis was cutaneous tuberculosis versus pyoderma gangrenosum. Incision biopsy revealed a granulomatous dermatitis surrounded by a dense mixed cell infiltrate of lymphohistiocytes from superficial to mid dermis suggestive of an infectious process. Chest radiograph confirmed pulmonary tuberculosis, interferon gamma detection by enzyme linked immunosorbent assay (Quantiferon TB Gold Plus) and nucleic acid amplification test (GeneXpert TB) further verified the presence of Mycobacterium tuberculosis (MTB). The patient was managed as lupus vulgaris, plaque type and started on second line anti-Koch’s medications. Excellent clinical response was seen after 3 months of treatment.

Lupus vulgaris is a challenging disease and may mimic a myriad of other cutaneous disorders, in this case pyoderma gangrenosum. This case highlights a high index of suspicion, trained clinical eye and multi-specialty care to diagnose and treat complicated cutaneous tuberculosis cases. In geographic locations where MTB is still endemic and drug resistance burdens pose complications in treatment, second line pharmacologic interventions for MTB treatment is a viable option.

Human ; Male ; Adolescent: 13-18 Yrs Old ; Lupus Vulgaris ; Pyoderma Gangrenosum

Introduction: Histoplasmosis is a granulomatous infection caused by the fungus, Histoplasma capsulatum. The disseminated type can be the initial manifestation of HIV/AIDS. It may affect the lungs, skin, gastrointestinal tract, liver, spleen, genitourinary tract, heart, bone marrow, adrenal glands, lymph nodes, and the central nervous system. Cutaneous findings are diverse and most present with few nodules and ulcerative lesions with involvement of the mucosal surface. Case summary: This article describes the case of a 42-year-old male who presented fever, cough, oral ulcers, and multiple brownish nodular papules and plaques on the lips, face, trunk and extremities. Skin biopsy with tissue culture and sensitivity revealed Histoplasma capsulatum which was resistant to the recommended treatment, Amphotericin-B and Itraconazole. The patient was seropositive for HIV. Conclusion The incidence of HIV in the Philippines is rapidly increasing and we are expected to encounter more cases of opportunistic infections, such as in this case. Having a high index of clinical suspicion is important in establishing a diagnosis. In patients with HIV/AIDS or presumed to have AIDS presenting with multiple cutaneous lesions, skin biopsy for identification, culture, and sensitivity studies are valuable in determining the diagnosis and initiating treatment. Furthermore, the stigma of being diagnosed with HIV/AIDS prevents people from having HIV tests done. This causes delay in the diagnosis and treatment, and results in higher mortality. Public education and patient counseling are therefore vital in addressing the HIV epidemic.
Histoplasma ; Histoplasmosis ; HIV ; Acquired Immunodeficiency Syndrome