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Bacterial, Mycobacterial, and Spirochetal (Nonvenereal) Infections
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
In addition, recognized variants of the major types include the following: Borderline tuberculoid leprosy which presents with similar lesions to TT but larger in size, more numerous (5–20), and can be less well defined. Anesthesia over the lesions is less pronounced compared to TT. Peripheral nerves are affected in an asymmetrical pattern and can cause deformity and disability. Borderline lepromatous leprosy is characterized by widespread bilaterally symmetrical lesions of variable size and shape. There is no loss of sensation, but peripheral nerves can be extensively involved with resulting glove and stocking numbness.
Pathophysiology
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
iv – Mycobacterium leprae causes leprosy. Leprosy has two forms: tuberculoid and lepromatous. The tuberculoid form of leprosy presents with a few hypoesthetic skin nodules in patients with an intact T-cell response. However, in patients with a deficient T-cell response, lepromatous leprosy presents diffusely over the skin, infecting superficial nerves. Both types can be treated with long-term oral dapsone.14
New Discoveries of Significance to the Prevention, Control, and Treatment of Leprosy
Published in Max J. Miller, E. J. Love, Parasitic Diseases: Treatment and Control, 2020
In the pathology of leprosy over the last 5 years, a number of interesting observations have been made. Subcutaneous venous involvement or leprous phlebitis has been described in a very high percentage of lepromatous leprosy patients and may be quite advanced, even in early lepromatous cases.8 This may contribute to the continuous bacillemia of untreated lepromatous leprosy.
Immunology of leprosy
Published in International Reviews of Immunology, 2022
Luis Alberto Ribeiro Froes, Maria Angela Bianconcini Trindade, Mirian Nacagami Sotto
It is estimated that more than 95% of infected individuals are naturally resistant to M. leprae, never developing any symptoms of the disease [13]. Among symptomatic individuals, the disease manifests itself along a clinical spectrum with two poles and is classically divided into five different presentations in between these poles. Tuberculoid leprosy lies in one of the poles, presenting as well-defined annular erythematous plaques and sensitivity loss. The anatomopathological examination of these lesions is characterized by well-defined granulomas, formed by epithelioid cells, multinucleated giant cells and macrophages, surrounded by a ring of lymphocytes, with few or no bacilli inside. On the other end of the spectrum, individuals with lepromatous leprosy exhibit intense humoral immune response, abundant production of specific anti-M. leprae antibodies and very weak cellular immune response. Clinically, these individuals present with a higher number of lesions, and no granulomas on histological examination, but abundant foamy macrophages full of bacilli – the so-called Virchow cells [14]. Between the poles lie the borderline presentations, namely: borderline-tuberculoid, borderline-borderline and borderline-lepromatous. As the clinical presentation moves from the tuberculoid to the lepromatous pole, a gradual transition occurs from a Th1 to a Th2 immune response.
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
The type of leprosy that clinically develops in each patient depends on the host immune response, which is taken into account in the Ridley-Jopling classification system, as it is based on the type of skin lesion and bacterial load. Patients with tuberculoid leprosy have a good cellular immune response, in general present fewer lesions and a low bacterial load. On the other hand, patients with lepromatous leprosy have a humoral immune response and multiple skin lesions. The simplified classification of leprosy proposed by the WHO, aiming to facilitate and determine treatment in regions with less access to healthcare, refers to paucibacillary leprosy (PB, five or less skin lesions and negative smears) and multibacillary leprosy (MB, six or more skin lesions with positive smear). Therefore, under this system, our patient was classified as having multibacillary lepromatous leprosy.14,15
Leprosy in skulls from the Paris Catacombs
Published in Annals of Human Biology, 2020
Patrícia D. Deps, Simon M. Collin, Sylvie Robin, Philippe Charlier
The effects of leprosy range from mild symptoms and limited morbidity (tuberculoid leprosy) to severe manifestations with severe morbidity (lepromatous leprosy) including skeletal involvement (Andersen et al. 1994; Brachman and Abrutyn 2009). In the lepromatous form of the disease, massive mycobacterial infection of the nasal passages and the palate leads to collapse of the bridge of the nose, absorption of the central part of the maxilla, inflammation of the floor and sides of the nasal cavity and hard palate and, ultimately, perforation of the palate. Several palaeopathological criteria have been proposed for recognition of leprosy in skulls, including pathognomonic signs proposed by Moller-Christensen (1961) and the concept of rhinomaxillary syndrome (RMS) proposed by Andersen and Manchester (1992). Both sets of criteria are based on changes to the nasal aperture, orbital bones, and alveolar process of maxilla.