No abstract available.
Acupuncture ; Foreign Bodies ; Granuloma, Foreign-Body ; Leprosy ; Leprosy, Lepromatous

We report a 23-year-old male with lepromatous leprosy atypically presenting with 5-year history of asymptomatic, verrucous papules, and nodules. Human Immunodeficiency Virus (HIV) testing was positive with depressed CD4 count. In HIV/leprosy co-infection, most of the documented patients were diagnosed with paucibacillary leprosy as immune reconstitution disease (IRD) from treatment-induced immunological recovery. Rarely, multibacillary lepromatous leprosy is encountered in the setting of untreated, severe immunodeficiency. Atypical clinical presentation warrants investigation for concurrent HIV infection.

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 (leprosy) is a chronic infectious disease caused by Mycobacterium leprae which affect mainly skin and nerve systems. Currently the incidence of leprosy reached the goals set by WHO in the year 2000. In recent 10 years, only 47 new patients were found in Koreans and their average age was over 70. A 21 year-old young man showed multiple erythematous papules, macules and plaque at face, extremities and trunk. In family history, his grandfather was diagnosed with leprosy at young age and leprosy was recurred when the patient was 7 years old. The patient lived with grandfather from birth to 7 years old. Clinico-pathologically he was diagnosed with a lepromatous leprosy. We performed VNTR both at the skin tissue of grandfather and patient to find out the infection pathway of the patient and found some consistent. Herein, we report a new case of young Korean male transmitted from grandfather.
Communicable Diseases ; Extremities ; Grandparents ; Humans ; Incidence ; Leprosy* ; Leprosy, Lepromatous ; Male ; Minisatellite Repeats ; Mycobacterium leprae ; Parturition ; Skin

Introduction: Hansen’s disease (HD) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system caused by Mycobacterium leprae. The incubation period varies from months to more than 30 years. The tuberculoid form of HD usually presents with a single hypoesthetic patch and skin biopsy shows epithelioid granulomas with absence of bacilli on Fite-Faraco stain. In contradistinction, lepromatous leprosy usually presents with numerous papules, plaques and nodules with induration of the ears and nose. Biopsy shows foamy granulomas with presence of acid-fast bacilli on Fite-Faraco stain. Case summary: We present a case of a 13-year old female who presented with a 3-year history of a single hypoesthetic patch on the left knee. The initial clinical diagnosis was tuberculoid leprosy. However, histopathology revealed a Grenz zone, and a nodular granulomatous infiltrate consisting of epitheloid and foamy histiocytes with scattered lymphocytes. Fite-Faraco stain showed a bacillary index (BI) of 3+. Slit-skin smear revealed a BI of 4+. She was then started on multidrug therapy. Conclusion This case highlights the importance of slit-skin smear and biopsy as routine procedures in all new cases of suspected HD. These procedures will help differentiate multibacillary from paucibacillary forms of the disease which will influence decisions for treatment and prognostication. This case emphasizes that lepromatous leprosy may present with single lesions and may be misdiagnosed as paucibacillary leprosy if skin-slit smear and biopsy have not been done. This case further suggests that there are factors yet undetermined which play significant roles in determining the host response to M. leprae which are believed to influence morphology, configuration, number and distribution of skin lesions.
Leprosy ; Leprosy, Multibacillary

INTRODUCTION: This paper documents the variations in the diagnosis and management of multibacillary leprosy patients in three of the biggest case-holding hospitals in Metro Manila. Furthermore, we aimed to discuss the implications of these variations on the country's leprosy control and elimination program.

METHODS: Focus group discussions (FGD) were conducted with 23 health professionals composed of doctors and nurses with at least a year of experience in managing leprosy patients. The topics included procedures on patient diagnosis and management such as treatment duration, patient follow-up and definitions of treatment completion and default. The FGD participants provided suggestions to improve treatment compliance of patients. Their responses were compared with the World Health Organization (WHO) standards and/or the 2002 DOH Manual of Operating Procedures (MOP) for leprosy. Transcripts of the recordings of the FGDs were prepared and thematic analysis was then performed.

RESULTS: There were variations in the hospitals' procedures to diagnose leprosy, in treatment duration, and in patient follow-up. Definitions for treatment completion and default differed not just between hospitals but also with the WHO guidelines and the 2002 MOP. Hospitals extended treatment up to 24 or even 36 months, despite the 12 months stipulated in the MOP. Two hospitals required a slit skin smear and skin biopsy in diagnosis, despite the MOP and WHO provisions that these were not mandatory. One hospital defined default as three consecutive months without treatment, which was different from the MOP and WHO standards and from the other hospitals.

CONCLUSION: Given the variations in patient management, we recommended that the effectiveness of the standard treatment relative to other regimens being practiced by specialists be evaluated.

No abstract available.
Granuloma* ; Leprosy, Lepromatous*

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

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

Leprosy is a chronic granulomatous disease affecting the skin and peripheral nervous system. Because of its variable manifestations, leprosy can be misdiagnosed as syphilis, sarcoidosis, psoriasis and eczema. A 73 year-old man showed erythematous papules on his arms and legs. He had been erroneously treated as eczema before the correct clinicopathological diagnosis of borderline lepromatous leprosy was made. We report this case to suggest that dermatologists should pay careful attention while diagnosing new cases of leprosy.
Arm ; Diagnosis ; Eczema* ; Granulomatous Disease, Chronic ; Leg ; Leprosy* ; Leprosy, Multibacillary* ; Peripheral Nervous System ; Psoriasis ; Sarcoidosis ; Skin ; Syphilis