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Background: Mast cells are found at all levels of dermis, grouped around blood vessels, nerves and appendages. An increase in the mast cell number has been reported in various cutaneous diseases. Mast cells respond to diverse range of stimuli like neuronal impulses, allergens, antigens, hormones, cytokines from T cells and keratinocytes and thus play a role in manifestation of dermatological disorders. The objective was to study mast cell density in various subsets of Hansen’s disease and analyse whether the distribution and density vary amongst the subsets. Methods: A total of 60 skin biopsies diagnosed as leprosy were included in this study. 10 control slides were also studied for mast cell density and distribution. Histopathological diagnosis was made on the biopsy and mast cell density and distribution was assessed on toluidine blue stained sections and compared with those of controls. Results: All the subsets of Hansen’s disease studied showed an increase in the number of mast cells. The highest mean mast cell count was noted in lepromatous leprosy (66/mm2), followed by erythema nodosum leprosum (42.6/mm2) and borderline lepromatous leprosy (40.8/mm2). The mean mast cell count showed progressive increase over the immunological spectrum of tuberculoid leprosy to lepromatous leprosy. The mast cells showed spindle and ovoid morphology in all the lesions (active) while round morphology was seen in controls. Conclusion: Tissue mast cell number, distribution and morphology vary depending on the degree of activation in different leprosy lesions. This may have a bearing on the diagnosis and management.

Background: Cardinal criteria proposed by the World Health Organisation (WHO) lack sensitivity to diagnose indeterminate leprosy. Aims: To estimate the frequency of hypopigmented skin lesions with doubtful/minimal sensory impairment showing histopathology features of indeterminate leprosy. To compare between the histopathology findings noted in specimens showing features suggestive of indeterminate leprosy and those showing a non-specific dermatitis pattern. Materials and Methods: Data on patients who attended our department with hypopigmented patches with doubtful/minimal sensory impairment from January 2018 to December 2019 and who underwent a skin biopsy were collected. A pathologist blinded to the clinical findings reviewed the histopathology specimens using a pre-set questionnaire. Results: We studied sixteen biopsy specimens from 14 patients. Eight specimens (50%) showed histopathology suggestive of indeterminate leprosy and the remaining eight showed a non-specific dermatitis pattern. A higher percentage of patients with indeterminate pattern showed mast cells (87.5% vs 25%) and fibrosis around nerve twig or sweat duct (75% vs 12.5%) when compared to those who showed a non-specific dermatitis pattern. Limitations: Small sample size and retrospective study design were the limitations. Conclusions: We found histopathology features of indeterminate leprosy in 50% of the skin biopsy specimens from hypopigmented lesions with doubtful/minimal sensory impairment. The present study highlights the need to improve the diagnostic definition of indeterminate leprosy. [ABSTRACT FROM AUTHOR]

Objective/Background: Clinical diagnosis of indeterminate and tuberculoid leprosy is often difficult due to limited and confounding signs and symptoms. In the current study, we evaluated the utility of new multiplex polymerase chain reaction (PCR) using Mycobacterium leprae-specific DNA sequences in the pseudogene regions of ML1545, ML2180, and ML2179 for PCR-based diagnosis of indeterminate leprosy (IND) and leprosy cases across the immunological spectrum. The sensitivity was compared with that of RLEP PCR. Methods: DNA was extracted from paraffin-embedded skin biopsy specimens of 220 leprosy cases, which were divided into IND (41), tuberculoid form (3), borderline tuberculoid (42), midborderline (3), borderline lepromatous (n=59), and lepromatous leprosy (72) cases. PCR positivity of both multiplex and RLEP PCR were compared in all the samples. A decision tree was constructed using the classification and regression trees algorithm to predict the probability of PCR positivity with the new multiplex PCR scheme in various clinical groups of leprosy. Sensitivity of each pseudogene target was determined using real-time PCR assays, and specificity was confirmed by PCR amplification of DNA extracted from three other mycobacterial species and skin biopsies of 44 non-leprosy cases. Results: A multiplex PCR positivity of 75.61% was noted in IND cases when compared to that of 58.54% using RLEP PCR (P < 0.05). Enhanced multiplex PCR positivity was noted across various clinical groups in comparison to RLEP PCR. The decision tree classifier has predicted statistically significant probability for multiplex PCR positivity among RLEP-PCR negative group and clinical groups with a low bacillary load. Conclusion: This new multiplex PCR scheme can support the diagnosis of indeterminate and tuberculoid forms of leprosy with limited clinical manifestations and can be implemented in basic clinical/diagnostic setting that possess conventional PCR facilities.

A borderline lepromatous leprosy patient was treated with anti-leprosy treatment. During the period of treatment Type 1 reaction developed. The patient was treated with multi drug for second time along with steroid. On completion of MDT the patient was released from treatment though the patient was found to suffer from skin lesion and plantar ulcer with osteomyelitis. The patients was treated with Mercurious solubilis, a homoeopathic medicine for a period of four years three months. At the end of the treatment the skin biopsy revealed the picture of indeterminate leprosy.

Early detection and treatment can be beneficial for the check and progress of the disease in the community so we planned to tackle the disease in very early stage. Indeterminate stage is the earliest stage so it is very easier to treat this disease at this stage. The study was carried out at the skin outpatients department (OPD) and immunology unit of Department of Pathology, K.G.'s Medical College, Lucknow from October 1998 to Dec. 2001. Early response was measured after 48 hours of intradermal injection only 28 of 75 (37.3%) indeterminate leprosy cases gave positive response in which 20 of 75 (26.7%) cases gave 1+ response, 5 of 75 (6.7%) cases gave 2+ response and only 1 of 75 (1.3%) indeterminate cases gave 4+ DTH response. In diseases control groups 19 of 20 (95%) TT, 17 of 20 (85%) BT, 18 of 20 (90%) BB and 5 of 20 (25%) BL cases gave positive DTH response but DTH response is negative in all cases of lepromatous leprosy. Late reaction (Mitsuda response) was measured after 3 weeks of intradermal injection only 23 of 75 (30%) indeterminate leprosy cases gave positive response. Eight of 20 (40%) TT, 6 of 20 (30%) BT, 3 of 20 (15%) BB and 1 of 20 (5%) BL, disease control group gave positive response. Mitsuda response is negative in LL case. Most interesting observation was the detection of DTH of lepromin in 28 of 75 indeterminate cases, suggesting the usefulness of delayed reaction (in duration diameter measured after 48 hrs) in early diagnosis of in determinate leprosy. [ABSTRACT FROM AUTHOR]

Abstract: A normalized procedure for medical infrared imaging is suggested, and illustrated by a leprosy and hepatitis C treatment follow-up, in order to investigate the effect of concurrent treatment which has not been reported before. A 50-year-old man with indeterminate leprosy and a 20-year history of hepatitis C was monitored for 587 days, starting from the day the patient received treatment for leprosy. Standard therapy for hepatitis C started 30 days later. Both visual observations and normalized infrared imaging were conducted periodically to assess the response to leprosy treatment. The primary end points were effectiveness of the method under different boundary conditions over the period, and rapid assessment of the response to leprosy treatment. The patient achieved sustained hepatitis C virological response 6 months after the end of the treatment. The normalized infrared results demonstrate the leprosy treatment success in spite of the concurrent hepatitis C treatment, since day 87, whereas repigmentation was visually assessed only after day 182, and corroborated with a skin biopsy on day 390. The method detected the effectiveness of the leprosy treatment in 87 days, whereas repigmentation started only in 182 days. Hepatitis C and leprosy treatment did not affect each other. [Copyright &y& Elsevier]

Leprosy is a chronic inflammatory disease caused by Mycobacterium Leprae, which affects not only the peripheral nerves and skin but also various internal viscera through the hematogenous spread, especially in lepromatous cases. Low socioeconomic status people are affected more. In this study the total numbers of patients included were 60 from Meerut and nearby area. The pattern of leprosy among the patients were indeterminate, 25 cases (41.6%); tuberculoid, 6 cases (10.0%): borderline leprosy, 4 cases (6.6%); borderline lepromatous, 4 cases (6.6%) and lepromatous leprosy, 7 cases (11.6%). The aim of the study is to show the presence of bacilli in the hair follicle of normal appearing skin sites from leprosy cases and to correlate the transmission of disease from intact skin. The methods used for the study are (1) Hematoxylin and Eosin staining (2) modified Harada's allochrome method for demonstrating AFB. Definitive histopathological changes along with presence of bacilli in the hair follicle of normal appearing skin are noticed. Presence of AFB is significant as far as dissemination and transmission of disease is concerned. It may be due to phagocytic activity of keratinocytes which engulf bacilli, hence, possibility of discharge of lepra bacilli from intact skin, even without ulceration, should be seriously considered. [ABSTRACT FROM AUTHOR]

Abstract: Background: Leprosy is a chronic inflammatory disease caused by Mycobacterium leprae, which affects not only the peripheral nerves and skin, but also various internal viscera through hematogenous spread, especially in lepromatous cases. Histology in its own way plays a vital role, not only in classifying the established lesion, but also in confirming the clinical diagnosis. During the latent period of subclinical involvement, the apparently normal looking skin might also be undergoing some pathological changes. Methods: We investigated skin biopsy material taken from 60 patients with clinically diagnosed leprosy at Subharti Hospital, Subharti Medical College, Meerut, India. Hematoxylin and eosin staining and Harada''s modified allochrome method for acid-fast bacilli were applied for histological investigations. Results: The pattern of leprosy among the patients was indeterminate in 25 cases (41.7%), tuberculoid in 14 (23.3%), borderline tuberculoid in six (10%), borderline leprosy in four (6.7%), borderline lepromatous in four (6.7%), and lepromatous leprosy in seven (11.7%). Changes were seen in the arrector pili muscle of normal appearing skin in all types of leprosy, but involvement was greater at the lepromatous end of the spectrum compared to the tuberculoid end. Conclusions: Results of this study revealed definitive histological changes in the arrector pili muscle in normal appearing skin. The presence of AFB is significant as far as dissemination and transmission of the disease is concerned. [Copyright &y& Elsevier]