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Leprosy (Hansen's Disease)
Published in Scott M. Jackson, Skin Disease and the History of Dermatology, 2023
On the other end of the spectrum is the lepromatous form of the disease, characterized by widespread nodules and plaques, nasal congestion and nosebleeds, loss of eyebrow hair, progressive infiltration of the face with the eventual development of leonine facies, lymph node and internal organ involvement, and nerve damage and resultant neuropathy so severe that ulceration, infection, and amputation of digits—or even limbs—might ensue. Neurological symptomatology is very frequently the first sign of the disease since the organism shows a tendency to thrive in the Schwann cells of peripheral nerves. Ample organisms are seen on the biopsy of these patients' skin lesions because the host response is poor and the organism thrives; another term for this form is multibacillary disease. The most common form of the disease is actually somewhere in the middle of the spectrum between tuberculoid and lepromatous, which has been termed borderline leprosy, as it presents with features of both. Today, HD is an illness that can be treated successfully with antibiotics. Due to the rapid development of antibiotic resistance with single-agent regimens, multi-drug treatment is recommended with rifampin, clofazimine, and dapsone.
Peripheral Neuropathies
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Gareth Llewelyn, Robert Powell
In the lepromatous (or low resistance) form, there is a more widespread loss of sensation, beginning distally in the limbs in an asymmetric manner eventually coalescing to produce a more symmetric pattern. The bacilli proliferate in cool areas, and so the ears are often the first area to be affected by numbness. Haematogenous spread of bacilli in this low-resistance type contributes to the eventual symmetric distribution of the neuropathy, which in the later stages has a prominent motor component. The peripheral nerves become thickened, but reflexes are retained, often until the neuropathy is advanced. Borderline leprosy shows a variable spectrum of clinical features between the tuberculoid and lepromatous types.
NUMBNESS OF THE ARM
Published in Rob Norman, The Woman Who Lost Her Skin, 2004
specimen later in the day. I explained to Patrick how to care for the biopsy site, arranged for a follow-up visit, and sent him home. A couple of days later, the dermatopathologist reported lab results that confirmed my hunch. "First time I've seen this," he said. "Lepromatous leprosy." The next day I reviewed a copy of the slide containing Patrick's biopsy. Among the skin cells were numerous dark spots: the bacilli of Mycobacterium leprae. As required by law, I reported his case to the health department and did the follow-up paperwork. Mycobacterium leprae was first identified as the cause of leprosy by a Norwegian doctor, Dr G. Armauer Hansen, in 1873. Although leprosy is often thought of as a disease of the tropics, leprosy (or Hansen's disease) has been widespread historically in regions as diverse as Iceland, Scandinavia, North Korea, Japan, and India. An even more common misconception is that leprosy is highly contagious. In fact, most people exposed to the bacterium, which is thought to spread through respiratory droplets, can easily fend it off. But in some people, for some reason, the bacterium takes hold. Once an infection is established, it can show up in one of three forms. The most severe is lepromatous leprosy, in which the bacterium spreads widely beneath the skin and throughout the body. Another, milder form is tuberculoid leprosy. Its hallmark is severe nerve damage. In particular, the peripheral nerves of the arms and neck can become permanently damaged. The third type, borderline leprosy, occupies the broad and variable zone between lepromatous and tuberculoid leprosy. The reason for the different forms has to do with how an individual's immune system responds to the bacterium. Immune cells called macrophages normally consume the bacterium, which cannot migrate and releases no toxins. The
Immunology of leprosy
Published in International Reviews of Immunology, 2022
Luis Alberto Ribeiro Froes, Maria Angela Bianconcini Trindade, Mirian Nacagami Sotto
Leprosy reactions are episodes of acute hypersensitivity presenting as aggravation of the previous lesions or the appearance of new ones, occurring before, during or after treatment [91,92]. Most commonly, leprosy reactions happen in disseminated presentations during the first three months of treatment and currently represent the main complication of the disease, requiring immediate treatment to prevent permanent neural damage [93]. They can be of two types: reverse reaction (RR) or erythema nodosum leprosum (ENL). RR occurs in approximately one-third of patients with the borderline presentation, whereas ENL occurs in around 50% of patients with lepromatous and 10% of patients with borderline leprosy [51], especially in those with a skin bacilloscopy index equal to, or greater than, 4 + [94].
Genotyping comparison of Mycobacterium leprae isolates by VNTR analysis from nasal samples in a Brazilian endemic region
Published in Pathogens and Global Health, 2018
Luana Nepomueceno Costa Lima, Cristiane Cunha Frota, Phillip Noel Suffys, Amanda Nogueira Brum Fontes, Rosa Maria Salani Mota, Rosa Livia Freitas Almeida, Maria Araci de Andrade Pontes, Heitor de Sá Gonçalves, Carl Kendall, Ligia Regina Sansigolo Kerr
In all four clusters, the 12 leprosy cases reported to have a previous contact with at least one leprosy case. Group 1 was composed of two individuals with lepromatous leprosy, BCG scar, aged 51 and 62, born in the same countryside of Ceará, and living there for 12 years. They were diagnosed in a difference of 17 months (Table 2). Group 2 was composed of two individuals with borderline leprosy, BCG scar, aged 59–60 years, diagnosed in 2010 with a difference in date of diagnosis of 4 months. Despite they were born in different cities of Ceará, they had moved to Fortaleza in 1995 and 1970, respectively. Group 3 was composed of two individuals aged 34 and 32 years and diagnosed within ten months of each other. The first was born and lived in Fortaleza, was diagnosed with borderline leprosy, and presented with a BCG scar. The second, a lepromatous leprosy without a BCG scar, was born in São Paulo, and living in Fortaleza since 1997, and had. Group 4 was composed of six participants with ages ranging from 12 to 71 years, all six cases were diagnosed from February to August 2009. Four cases had borderline leprosy and the two had lepromatous leprosy (Table 4).
Chronic Unilateral Uveitis as a Manifestation of Leprosy: A Case Report and Literature Review
Published in Ocular Immunology and Inflammation, 2021
Claudia Eugenia Duran Merino, María Camila Ortiz Úsuga, María Jaramillo Jaramillo, Ana María Rodríguez
In leprosy, inflammation episodes may be of two types: Type I, also known as reversal reaction, and Type II, or erythema nodosum. In type I there is a delayed hypersensitivity reaction that is associated with tuberculoid and borderline leprosy, in which the most frequent ocular is lagophthalmos. On the other hand, in the erythema nodosum reaction, there is a strong immune response that is associated with lepromatous leprosy, the ocular involvement is mostly uveitic and corneal.19