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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Disease manifests as a spectrum influenced by the host's cell-mediated immune response. Lepromatous leprosy occurs with poor cellular immunity and high pathogen numbers, resulting in tissue thickening and damage. Tuberculoid leprosy occurs with substantial cellular immunity and is usually localized within an area of hypopigmented anaesthetic skin supplied by a thickened nerve.
Infections
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
In contrast, in tuberculoid leprosy the skin lesions are few and asymmetrical, with a raised margin and hypopigmented centre; they are often anaesthetic (Figure 20.24B). The peripheral nerves are thickened; damage may be acute with relatively sudden anaesthesia or motor damage.
Pharyngitis
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Leprosy usually begins as an anaesthetized area in a hypopigmented skin lesion that can arise anywhere within the body. The spectrum of disease that then develops depends upon the degree of cell-mediated immune response mounted by the host. If there is a vigorous host response, tuberculoid leprosy, which is not infectious and clinically must contain fewer than five skin lesions, results. Borderline leprosy can progress to lepromatous leprosy with numerous skin lesions and this is infectious.
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
Leprosy is an immunological spectrum disease. In people with low levels of cell-mediated immunity (CMI), the bacteria are not killed (hence, “multibacillary” leprosy), and one of the clinical presentations is lepromatous leprosy (Ridley and Jopling 1966; Nath and Chaduvula 2010). The sequelae of this form of leprosy are seen in the bones of the hands, feet and head, and RMS is considered pathognomonic of lepromatous sequelae in the skull. People with high levels of CMI present with tuberculoid leprosy; there are no bacilliferous skin lesions (hence, “paucibacillary” leprosy) and no head bone alterations. Intermediate presentations along the CMI spectrum (between the “polar” forms of tuberculoid and lepromatous leprosy) are termed “indeterminate” and “borderline tuberculoid” (both paucibacillary forms), and “borderline borderline” and “borderline lepromatous” (both multibacillary forms). Subclinical leprosy may exist in individuals at the extreme high end of CMI (Jopling 1982). Recently, Matos and Santos proposed a classification for tuberculoid leprosy based on palaeopathological alterations in hands and feet with no head involvement (Matos 2018). Gradual involvement of bones from hands and feet to the head would reflect the clinical and immunological spectrum of leprosy, from paucibacillary to multibacillary forms (Matos and Santos 2013, 2014). Some theories propose that Europeans became more resistant to M. leprae towards the end of the medieval period, as implied by the decline of leprosy in the 15th century (Rawcliffe 2006). Given that remains in the Paris Catacombs originate from the 15th to 18th centuries, there would be a greater likelihood of finding bones with alterations corresponding to tuberculoid and inter-polar forms of leprosy, rather than signs of RMS in skulls corresponding to lepromatous leprosy.