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Hansen’s disease (also known as leprosy) is an infection caused by Mycobacterium leprae which can affect the skin, mucous membranes and nerves. It is known to spread among and infect family members. There are very few published studies pertaining to family leprosy conducted in India and worldwide. : To find the prevalence of familial leprosy and to know the clinicoepidemiological patterns of these cases.: Observational study.: This was a descriptive study conducted for a period of five years from 2013-2018. The study population included all new documented cases of leprosy visiting our out-patient department during the study period. All the patients were diagnosed as leprosy on histopathological confirmation or by the presence of cardinal signs of leprosy according to the world health organization (WHO) definition. The data collected was analysed by simple descriptive statistics. Permission to conduct the study was taken from institutional ethical committee. Consent was taken from index case and family members.: A total of 302 new leprosy cases with 18 index cases (n=18) whose family members were affected, accounting for the prevalence of 5.96 %. Total number of family members with documented leprosy (old or newly detected) was 26. So, the total number of leprosy cases were 44 (index cases + family members). Out of the 18 families, 4 families had more than one person who was affected. 8 cases (18.18%) of Childhood leprosy were noted. Among the index cases 4 cases (22%) of paucibacillary leprosy were seen and 14 cases (78%) of multibacillary leprosy was seen. Among the family members, 18 cases of paucibacillary leprosy were seen and 8 cases of multibacillary leprosy were seen. Conjugal leprosy was seen in 10 families accounting for the prevalence of 3.31%. : Our study intends to emphasize the importance of examining the close contacts of a case of leprosy, especially the family members in whom the incidence of leprosy could be very high. By way of identifying leprosy cases early in its course we may be able to prevent deformities to a great extent.

Background Individuals with relapses of leprosy should be monitored carefully, however, with respect to paucibacillary (PB) leprosy, it is sometimes difficult to make a definitive diagnosis of relapse, because the bacillary index is often negative. To evaluate the usefulness of cytokine profiling in a patient with relapsed PB leprosy who tested negative for anti-phenolic glycolipid-I antibodies, we analyzed the Mycobacterium leprae protein-induced cytokine expression in peripheral blood mononuclear cells of the patient. Case presentation An 89-year-old-male relapsed PB patient, first treated for leprosy over 50 years prior, was examined. In April 2012, he noticed three skin lesions consisting of annular erythema in the thighs. Slit skin smear tests were negative, and skin biopsies revealed a pathology of indeterminate-to-borderline tuberculoid leprosy. He received 600 mg of rifampicin once per month and 75 mg of dapsone daily for 12 months. The annular erythemas disappeared after starting treatment. Before treatment, and 6 and 12 months after starting treatment, the Th1/Th2 cytokine profiles in the supernatant of mononuclear cells from the patient before and after stimulation with Mycobacterium leprae soluble protein (MLS) were examined using a Cytometric Bead Array (CBA) Human Th1/Th2 Cytokine Kit II. The CBA Enhanced Sensitivity Flex Set system was applied to detect small amounts of cytokines in the serum just before treatment and one year before relapse. In the culture supernatant, just before treatment, increases in IFN-γ level and the IFN-γ/IL-10 ratio and a decreased IL-6 level were observed without stimulation. Upon stimulation with MLS, just before treatment, both the IFN-γ and TNF levels increased markedly, and twelve months after starting treatment, the IFN-γ and TNF levels decreased greatly. In the serum, just before treatment, increases in IFN-γ and TNF levels and the IFN-γ/IL-10 ratio were evident compared with those measured one year before relapse. Conclusions Cytokine profiling using culture supernatants and serum samples may be useful for the diagnosis of relapsed PB leprosy.

This article presents a clinical case of a 52-year-old man suffering from oligobacillary border-tuberculoid leprosy in the acute phase associated with an established diagnosis of pulmonary tuberculosis and hepatitis C.Aim: to present a clinical case of leprosy with atypical and complicated manifestations.Materials and methods. A 52-year-old patient had been receiving treatment for allergic dermatitis for a long time.Results. The patient was diagnosed with: A 30.2. Borderline tuberculoid leprosy (Paucibacillary Leprosy, Borderline tuberculoid form. Acute phase). The patient demonstrated atypical complications of the leprosy process in the form of ulcerative necrotic rashes.

Impeded diagnosis in Tuberculosis may be a major cause of morbidity and mortality among particular group of patients, hence better methods are needed for the accurate detection of tuberculosis (TB) among both smear positive and smear negative cases. This study was aimed to compare conventional and molecular methods in detecting Mycobacterium tuberculosis among the clinically suspected cases of TB. A total of 100 clinically diagnosed TB patients were incorporated in this study. All the patients were either admitted or attending JSS Hospital, Mysore during the study period i.e., from January 2018- December 2018. Sputum, Gastric aspirate, Pleural fluid, Ascitic fluid, Pus discharge, CSF and Tissue samples were gathered for smear microscopy, culture (Lowenstein – Jensen medium) and PCR testing. The sensitivity of smear and PCR were compared to that of culture considering as gold standard. 50 of 100 patients were positive on smear microscopy. 51 specimens yielded the growth of Mycobacterium tuberculosis on Lowenstein-Jensen’s medium and PCR detected the presence of MTB specific gene in 77 specimens. In clinical diagnosis of tuberculosis, molecular methods are probably a useful adjunct certainly in smear negative paucibacillary cases. Early diagnosis of TB is cornerstone for proper treatment and control of this deadly disease. Polymerase chain reaction testing is the most rapid and sensitive method for the diagnosis of tuberculosis while culture is specific but it takes 4 to 8 weeks to provide results and smear testing is the cheapest but least sensitive test.

Leprosy may present kidney and endothelial abnormalities, being a risk factor for complications. However, the involvement of renal and vascular endothelia has been poorly investigated. We aimed to investigate if the levels of systemic endothelial biomarkers are associated with kidney abnormalities and the clinical forms of leprosy. This is a cross-sectional study with leprosy patients enrolled in January 2017 to December 2018, before the initiation of the multidrug therapy. Leprosy-associated clinical and epidemiological data were collected. Two groups were investigated: Paucibacillary (PB) and Multibacillary (MB) infections, for the comparisons. Serum and urine samples were obtained for laboratory analysis. In serum samples, were evaluated the endothelial biomarkers VCAM-1 and ICAM-1. In total, 101 leprosy patients were included, the mean age was 48±١٥ years and 71 (70%) were male. The multibacillary form occurred in 81 cases (80%), among which 22 had the Virchowian form. Serum creatinine was more elevated in the MB group than in PB patients. In addition, VCAM-1 was elevated in the MB group and was correlated with the bacteriological index (rho = 0.372, p 15 mg/g of creatinine, VCAM-1 showed a significant correlation with increased albuminuria and improved the correlation with the number of skin lesions (rho= 0.563, p=0.010). In conclusion, higher systemic VCAM-1 levels were associated with the multibacillary clinical form of leprosy and with increased albuminuria. Prospective studies are necessary to establish a cause-effect and evaluate the preventive role of these biomarkers to improve the clinical care.

INTRODUCTION: Erythema Induratum (EI) is a relatively rare dermatologic disorder affecting subcutaneous fat tissue, which is often associated with Mycobacterium tuberculosis. This report details the presentation, diagnosis and management in a 70-year-old female who presented with a painful erythematous annular rash at the clinic. The rash was later diagnosed as EI associated with Mycobacterium leprae, one rarely seen in literature. DISCUSSION: EI is a rare form of panniculitis that typically presents as a recurrent grouping of tender nodules and plaques on the posterior aspect of the lower legs. Although EI is considered idiopathic in most cases, it can be associated with M. leprae. Given the atypical presentation of a rash, a biopsy was done. It showed epithelioid granulomatous dermatitis with lobar panniculitis. A DNA polymerase chain reaction (PCR) was also sent and revealed the presence of M. leprae. Treatment of EI without association with M. leprae includes potassium iodide, non-steroidal anti-inflammatory drugs (NSAIDs), rest, elevation, compression and, in severe cases, systemic immunosupressives. If tuberculoid leprosy is confirmed, the attending physician is encouraged to consult the infectious disease department as treatment varies with presentation. CONCLUSIONS: This case details the diagnosis and management involved in a case of tuberculoid leprosy masquerading as EI. Management of the EI involved NSAIDs and potassium iodide. The leprosy was treated with dapsone and rifampin in conjunction with an infectious disease consultation. Our case highlights the importance of relying on a strong clinical suspicion based on a patient’s social history in order to diagnose rare entities accurately.

Summary To end the decade-long, obstinately stagnant number of new leprosy cases, there is an urgent need for field-applicable diagnostic tools that detect infection with Mycobacterium leprae, leprosy's etiologic agent. Since immunity against M. leprae is characterized by humoral and cellular markers, we developed a lateral flow test measuring multiple host proteins based on six previously identified biomarkers for various leprosy phenotypes. This multi-biomarker test (MBT) demonstrated feasibility of quantitative detection of six host serum proteins simultaneously, jointly allowing discrimination of patients with multibacillary and paucibacillary leprosy from control individuals in high and low leprosy endemic areas. Pilot testing of fingerstick blood showed similar MBT performance in point-of-care (POC) settings as observed for plasma and serum. Thus, this newly developed prototype MBT measures six biomarkers covering immunity against M. leprae across the leprosy spectrum. The MBT thereby provides the basis for immunodiagnostic POC tests for leprosy with potential for other (infectious) diseases as well., Graphical Abstract, Highlights • Prototype MBT that quantitatively detects six host-derived biomarkers is developed • The immunopathological spectrum of leprosy is ideally suited to evaluate the MBT • MBT discriminated patients with leprosy from controls in a high and non-endemic area • Application of the MBT using low invasive fingerstick blood is technically feasible, Diagnostic Technique in Health Technology; Applied Microbiology; Biotechnology

Background: At present, the WHO recommends fixed duration multidrug therapy (FD-MDT) for the treatment of leprosy, in which treatment is provided for a fixed duration regardless of clearance of skin lesions or bacterial status of the patient. There is divided opinion regarding the efficacy of FD-MDT; especially for paucibacillary Hansen's disease, in which treatment is provided for 6 months. In addition, there is a paucity of literature on clinical and histopathological features of treated leprosy. Objectives: The objectives of this study were to prospectively observe the effects of MDT on clinical and histopathological features in paucibacillary leprosy and to assess the efficacy, safety and tolerability of MDT-paucibacillary (PB) regimen. Materials and Methods: A total of 52 new cases of PB leprosy diagnosed by clinicopathological correlation and slit skin smear were administered standard WHO PB-MDT for 6 months. Patients were reviewed at 3rd month and 6th month of therapy and 3 months posttherapy for their clinical and histopathological assessment. Results: Among 52 new cases of PB-leprosy 43 patients (mean age 31.74 ± 12.2 years, m:f 1.53:1) completed the study as per protocol. Fourteen percent patients recovered completely, 76.7% patients had a residual patch at the end. Number of lesions reduced significantly 2nd follow-up onwards while the lesional size showed significant decrease 1st follow-up onward. Nerve palpability also reduced significantly at treatment completion. Histological improvement was appreciable; lymphocytic infiltration reduced significantly 2nd follow-up onward and presence of granuloma 1st FU onward. Only four patients complained of occasional, uneventful epigastric pain during the study. Conclusion: Although the frequency of persistence of lesions after completion of therapy was high, histological evidence of activity was present in a minority (7%). Thus, the standard WHO MDT-PB regimen was found to be effective, safe and well-tolerated.

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: Indonesia is the third highest contributor to leprosy in the world. The prevalence of Pausi Basiler (PB) type leprosy in East Java has increased from 2015-2017, but the success rate of treatment is more common in PB leprosy compared to Multi Basiler leprosy (MB). Purpose: This study aimed to analyze the relationship between the numbers of PB type leprosy incidence with the success rate of leprosy treatment in East Java in 2015-2017. Methods: This study was an observational analytic study with cross-sectional design. The population used is leprosy patients who have successfully treated by leprosy therapy in East Java which was recorded from 2015 to 2017. The population sampling technique was performed in this study. Moreover, univariate and bivariate analysis were used. Specifically, Spearman correlation test was part of bivariate analysis. Results: This study showed the success presentation of leprosy treatment in male patients has increased for three consecutive years, namely 59.07% in 2015, 59.74% in 2016, and 63.96% in 2017. Oppositely, the success rate of leprosy in the female group decreased each year. There is a significant relationship between the number of PB type leprosy cases with the success rate of leprosy treatment in East Java from 2015 to 2017 (p= 0.00; p

International audience; The Xpert MTB/RIF Ultra assay has recently been launched to improve the detection of smear negative disease. This retrospective study compares the sensitivity of Xpert MTB/RIF Ultra with that of Xpert MTB/RIF tests and IS6110 real-time PCR in sputum. Diagnostic performance of three molecular tests was evaluated using 48 culture-positive clinical respiratory specimens diluted to obtain paucibacillary sputum specimens. Xpert MTB/RIF Ultra had the highest sensitivity of 100% compared to 42% (P

This systematic review (number register: CRD42018112736) was performed to compare the sensitivity and specificity of leprosy diagnostic methods. The search was conducted in 3 electronic databases in January 2021. Studies evaluating leprosy diagnostic tests were included according the eligibility criteria. Meta-analysis was performed to calculate the sensibility and specificity of the groups. We included 36 studies. The test sensitivity for paucibacillary patients was 0.31 (95%CI: 0.29-0.33) and the specificity was 0.92 (95%CI: 0.92-0.93). In multibacillary patients, the sensitivity was 0.78 (95%CI: 0.77-0.80) and specificity was 0.92 (95%CI: 0.92-0.93). Comparing the sensitivity and specificity of the different techniques included, it should be noted that polymerase chain reaction (PCR) test presented the highest sensitivity for paucibacillary patients, while the western blot technique showed the highest sensitivity for multibacillary patients. However, further studies are needed to optimise the diagnosis of leprosy, requiring research with a larger number of samples and more uniform protocols.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae . The identification of mycobacteria in tissue sections can be made through a microscopic examination with fite-faraco staining or PCR method. Paraffin blocks from four patients with leprosy were retrieved from The Pathologic Department of Dr.Soetomo Hospital, Surabaya. Two cases were from paucibacillary leprosy patients with no mycobacteria stained by fite-faraco. PCR assay showed a negative result. The other two cases were multibacillary leprosy with many bacteria stained by fite-faraco. PCR assay showed a positive result.

Background: Leprosy is an oldest chronic infectious disease known to mankind that predominantly affects the skin and peripheral nerves. Objective: To evaluate the bacteriological and morphological indices in smear positive cases. Materials and Method: Retrospective observational study was undertaken for one year duration on suspected cases of leprosy. Smears were prepared from one from each of the ear lobes by slit and scrap method and one from the site of lesion. Smears were stained with modified Ziehl-Neelsen stain and bacteriological/morphological indices were calculated. Results: Among 345 clinically suspected cases, 160 (46.38%) were multibacillary with male to female ratio 1.9:1 and most of cases from rural area of lower/middle class of third and fourth decade. All the three sites smears were positive in 112 (70%) cases. 66 (41.25%) cases had bacteriological index of 1+ while more than 1000 bacilli, on average, in 1each oil-immersion field (BI 6+) was observed in 1 (0.62%) cases. In 70 (43.75%) cases morphological index was less than 25 while in 14(8.75%) cases it was more than 50. Conclusion: Bacteriological and morphological index is one of the most important tools for diagnosis, classification, monitoring of treatment and disease severity.

Background Dermatological diseases have a negative impact on quality of life (QoL), affecting mental and physical health. Leprosy patients usually present with a worse QoL compared with those affected by other conditions. Reactions, neural damage, and pain are some of the consequences that contribute to the lower QoL. However, due to the wide spectrum of the disease, symptoms vary according to leprosy's subtype. This study aimed to compare the QoL between paucibacillary and multibacillary leprosy patients. Individuals were also compared considering the presence of reactions and a correlation between questionnaires was performed. Methods A total of 104 patients with leprosy aged 18 years old and over were selected. QoL was assessed by the Brazilian-Portuguese validated versions of the Medical Outcomes Study 36-item short-form health survey (SF-36) and the Dermatology Life Quality Life Index (DLQI). Results Multibacillary patients showed a more impaired physical function, worse bodily pain, lower score of SF-36, and higher interference of skin on the performance of daily activities when compared to the paucibacillary group. Individuals without reactions presented lower bodily pain and less effect of the skin on clothing choices compared to those with reactions. The SF-36 domains exhibited weak correlations with most DLQI questions, and the linear regression model showed that 32% of changes in QoL were related to the skin aspect. Conclusions Multibacillary leprosy patients have a worse QoL when compared to paucibacillary patients. Reactions played a small role in the QoL of our cohort of patients.

Background: Substantial number of patients with paucibacillary leprosy may still have active skin lesions at the end of MD treatment because of the continuing immune responses, though this does not denote failure of treatment. A clinical trial was conducted to compare efficacy of a homoeopathic medicine with MDT for the cure of leprosy. Aim: To compare the effect of a homoeopathic medicine - Sulphur with the Multi drug in the treatment of Paucibacillary leprosy according to WHO guidelines. Materials and Methods: Out of total 90 patients enlisted, 60 confirmed Borderline Tuberculoid (BT) leprosy patients of the age 14 years to less than 60 years were registered under this trial. All the patients were allotted a precoded number, randomly and equally divided in two groups. One group was treated with Sulphur in 200 potency in liquid orally once in week for two years and the other group received Paucibacillary (PB) regimen as recommended by WHO. At the end of two years findings were corroborated. Results: The study showed that MDT therapy (PB regimen) and homoeopathic medicine were found equally effective as histopathology of skin showed no granulomatous lesion. The most significant clinical sign observed in all cases treated with Sulphur was reappearance of normal skin colour and regain of loss of sensation of the skin lesion. Conclusions: MD therapy (PB regimen) and homoeopathic medicine were found equally effective. The patients of paucibacillary leprosy could get rid of the skin symptoms if treatment with Sulphur (is also given with MDT).

Objectives: To study cure rate and relapse rate of standard World Health Organization paucibacillary multidrug therapy (PB-MDT) with monthly rifampicin, ofloxacin, and minocycline for six months (ROM-6) among paucibacillary leprosy patients. Methods: A total of 268 patients, detected during active search in Agra district during 2001-2004, who had paucibacillary (PB) leprosy having 1-5 skin lesions and/or one nerve thickening/tenderness, were allocated, using random number tables, to two treatment groups; PB-MDT and ROM-6. On the first day of the month, dose of PB-MDT and of the ROM were given under supervision for 6 months. After completion of drug therapy, patients were followed every 6 months for first 5 years and later annually for next 3 years for monitoring disease status, cure rates, reactions and relapses. Cηi σθuαρe test was used to compare relapse rates. Results: The cure rate at 2 years was 99% in ROM-6 and 97.0% in PB-MDT group, of those who completed treatment and the difference was statistically not significant. At 5 years, only 88 patients in PB-MDT group and 90 patients in ROM-6 group could be followed; all were observed to be cured. However, during the period of 5-8 years, 3 of 67 patients in PB-MDT group and 1 of 73 in ROM-6 group were observed to have relapsed. In all, 10 relapses were noted (3 in ROM-6 and 7 in PB-MDT group) giving a relapse rate of 1.10/100 person years in PB-MDT and 0.435/100 person years in ROM groups (P = 0.053 ; statistically not significant). Of the 10 relapses, 5 occurred within 5 years (3 in PB-MDT group and 2 in ROM-6), 4 during 5-8 years (3 in PB-MDT and 1 in ROM-6), and 1 occurred in MDT group after 8 years. Limitation: A number of patients were lost to follow up after release from treatment and thus actual number of relapses in the study could not be assessed. Additionally, diagnosis was purely clinical and histology could not be done for reasons related to functional difficulties in the field. Conclusion: The study shows that PB-MDT and ROM-6 have almost similar acceptability, cure rate and relapse rate.

The diagnosis of single-lesion paucibacillary leprosy remains a challenge. Reviews by expert dermatopathologists and quantitative polymerase chain reaction (qPCR) results obtained from 66 single-plaque biopsy samples were compared. Histological findings were graded as high (HP), medium (MP) or low (LP) probability of leprosy or other dermatopathy (OD). Mycobacterium leprae-specific genes were detected using qPCR. The biopsies of 47 out of 57 clinically diagnosed patients who received multidrug therapy were classified as HP/MP, eight of which were qPCR negative. In the LP/OD (n = 19), two out of eight untreated patients showed positive qPCR results. In the absence of typical histopathological features, qPCR may be utilised to aid in final patient diagnosis, thus reducing overtreatment and delay in diagnosis.

Background Leprosy often heals with residual skin lesions after completion of treatment. WHO recommends fixed duration multidrug therapy (MDT) irrespective of whether lesions clear or persist after treatment. Patients with residual lesions are often unsatisfied and may undergo repeat biopsy and re-treatment. This study was conducted to compare the clinicohistopathological features in paucibacillary leprosy before and after MDT from September 2012 to February 2014. Methods Sixty-one untreated cases of paucibacillary leprosy were investigated and given standard WHO paucibacillary-MDT for 6 months. Scoring of clinical activity was done; histopathological activity was graded according to granuloma fraction. Forty-four patients who completed the treatment were subjected to post-treatment biopsy. Clinical response to therapy was graded as active, resolving and inactive and histopathological changes were compared in all patients. Results Among the 44 patients, the lesions were inactive, resolving and active in 39% (17/44), 39% (17/44) and 23% (10/44) of patients respectively. Histologically, disease was inactive, resolving and active in 30% (13/44), 9% (4/44) and 61% (27/44). But histomorphological features suggesting regression: loose granulomas (59%, 26/44); lymphocyte predominance (66%, 29/44); vacuolar change in epithelioid cell cytoplasm (59%, 26/44), were statistically significant in post-treatment compared to pre-treatment. Conclusions Although histological resolution is slower than clinical resolution, qualitative histomorphological changes in correlation with clinical inactivity can offer a fair suggestion to the clinician to terminate therapy.

INTRODUCTION: Operational classification of leprosy based on the number of skin lesions was conceived to screen patients presenting severe forms of the disease to enable their reception of a more intense multidrug regimen without having to undergo lymph smear testing. We evaluated the concordance between operational classification and bacilloscopy to define multibacillary and paucibacillary leprosy. METHODS: We selected 1,213 records of individuals with leprosy, who were untreated (new cases) and admitted to a dermatology clinic in Recife, Brazil, from 2000 to 2005, and who underwent bacteriological examination at diagnosis for ratification of the operational classification. RESULTS: Compared to bacilloscopy, operational classification demonstrated 88.6% sensitivity, 76.9% specificity, a positive predictive value of 61.8%, and a negative predictive value of 94.1%, with 80% accuracy and a moderate kappa index. Among the bacilloscopy-negative cases, 23% had more than 5 skin lesions. Additionally, 11% of the bacilloscopy-positive cases had up to 5 lesions, which would have led to multibacillary cases being treated as paucibacillary leprosy if the operational classification had not been confirmed by bacilloscopy. CONCLUSIONS: Operational classification has limitations that are more obvious in borderline cases, suggesting that in these cases, lymph smear testing is advisable to enable the selection of true multibacillary cases for more intense treatment, thereby contributing to minimization of resistant strain selection and possible relapse.

We present the case of a 26 year old Indian base worker who attended the Role 2 enhanced hospital in Iraq with a case of leprosy. The patient presented four times over a 12 month period with non-specific pain in the right hand and forearm combined with a large lesion of dry skin and reduced sensation in the forearm. A clinical diagnosis of leprosy was made, which was subsequently confirmed as paucibacillary leprosy by skin smears sent to the UK. It was not possible to treat the patient locally and a recommendation made to the patient’s employer that the patient return to India to commence treatment.

Background: Leprosy is a chronic infectious disease primarily affecting the peripheral nervous system and skin. Multibacillary leprosy is associated with nerve damage which could contribute to myelin alteration. As ceramide is a constituent of myelin sheath, the present study aimed to compare anti-ceramide antibody titre in paucibacillary and multibacillary leprosy patients with controls. Methodology: Serum levels of anti-ceramide antibody were measured using enzyme-linked immunosorbent assays (ELISA) in 50 leprosy patients (25 paucibacillary and 25 multibacillary) and 25 healthy controls. Results were reported in OD units as mean ± SD and analyzed by Chi square test (significance at p < 0.05). Results: Patients suffering from multibacillary leprosy had significantly higher anti-ceramide antibody serum levels compared to paucibacillary leprosy patients and healthy controls (p < 0.005). Conclusions: Since nerve damage is the most debilitating effect of leprosy, the search for a serum marker for assessing nerve damage is required in countries where leprosy is still widespread. In multibacillary leprosy patients, the role of anti-ceramide antibody as a marker for nerve damage should be explored.

This study presents estimates of incidence of leprosy among the familial contacts (FC) and non-familial contacts (NFC) of leprosy patients in Agra, a district endemic for leprosy. The study covers 42,113 persons followed up for 123,951.2 person years (PY) during which 77 individuals developed leprosy giving an incidence of 6.2/10,000 PY in the total leprosy-free population studied (TLPS). The incidence rate in NFCs was observed to be 4.6/10,000 PY while the FCs had a significantly higher incidence rate of 67.6/10,000 PY (P < 0.001). Incidence rate among the FC of paucibacillary leprosy (PB) patients was 41.0/10,000 PY while the corresponding figure for multibacillary leprosy (MB) contacts was 131.3/10,000 PY (P < 0.05). Applying methods of survival analysis, the incidence rate at the end of 1 year was observed to be 4.0 (per 10,000), increased to 12.0 by 2 years and 18.0 at the end of 3 years in TLPS. The incidence rate was almost similar in both the sexes and was found to increase significantly with age. The observations clearly indicate that leprosy is still endemic in the area and transmission continues.

Finger print patterns of 150 leprosy patients (100 paucibacillary and 50 multibacillary leprosy) were compared with 100 controls matched accordingly. The finger print pattern such as whorls, loops, arches, total finger ridge count (TFRC) and absolute finger ridge count (AFRC) were calculated. These dermatoglyphic parameters were compared to that of the controls. It was observed that the finger print pattern showed increase in the whorls and decrease in the loops in paucibacillary leprosy patients and increase in the loops and decrease in whorls in multibacillary leprosy patients (p

Leprosy is a chronic infectious disease caused by an obligatory intracellular mycobacteria Mycobacterium leprae, which presents tropism for Schwann cells and skin macrophages. Leprosy is a public health problem and early diagnosis is essential to avoid incapacities. The disease´s clinical presentation varies from few to widespread lesions and its diagnosis continues to be a challenge due to the low sensibility of the conventional methods, based on bacillary counts of skin smears and histopathology. Molecular techniques, especially the methods to identify M. leprae DNA based on polymerase chain reaction (PCR) have emerged as a support of the conventional methods for the analysis of clinical samples in difficult to diagnose cases, such as pure neural leprosy, indeterminate and paucibacillary leprosy. The technique has also proved useful in the study of leprosy transmission and monitoring resistance to the WHO recommended Multidrug treatment. Different biological samples can be analysed and there is no consensus in the molecular diagnostic techniques respect of the most efficient nucleic acid extraction method, most appropriate methodology and genetic target for PCR. These methods provide a very valuable option for confirmation of difficult clinical cases with scarce bacilli but requires a well-equipped laboratory and the high cost makes it inaccessible to be used as a routine diagnostic tool in most endemic countries.

Thirty-one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty-five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.

Lacaziose é infecção crônica causada pelo fungo Lacazia loboi, originalmente descrita por Jorge Lobo (1931) em paciente oriundo da Amazônia brasileira. Manifesta-se, sobretudo, por lesões cutâneas queloidiformes. Relata-se o caso de paciente com placa eritêmato-violácea, cuja hipótese diagnóstica inicial foi de hanseníase dimorfa tuberculóide, doença também endêmica na região amazônica. Ressalta-se a importância da inclusão de formas paucibacilares de hanseníase no diagnóstico diferencial da lacaziose.

Five of 10 paucibacillary leprosy patients were Quantiferon Gold (Q-G) positive with negative chest X-rays. Forty multibacillary leprosy patients were negative. Reports have shown 100% cross-reactivity of ESAT6 and CFP10 between Mycobacterium leprae and Mycobacterium tuberculosis. The Q-G test cannot detect latent tuberculosis in patients with leprosy.

The third paragraph of the Results section should read "Among the total number of contacts diagnosed with leprosy, 89.4% (404/452) had multibacillary index cases. Of the total contacts, 74.5% (337/452) had paucibacillary leprosy, 65% of whom (222/337) had the borderline-tuberculoid form."

Background. Diagnosis of paucibacillary leprosy is often difficult. A method that could confirm the diagnosis is the polymerase chain reaction (PCR) of M. leprae DNA. This reaction was applied to biopsied tissues of leprotic patients to determine the suitability and sensitivity of the reaction. Methods. Biopsy samples were taken from previously untreated patients with multibacillary (5 patients) and paucibacillary (3 patients) leprosy, fixed in formalin, and embedded in paraffin, DNA was extracted from paraffin blocks and PCR applied. The sensitivity of the PCR method was tested by using the serially diluted DNA sample as the template. Results. All eight patients showed a positive PCR for M. leprae DNA. The sensitivity was such that a single organism of M. leprae, as counted by staining of the acid-fast bacilli was identified by the PCR. Conclusions. The PCR method is simple, sensitive, specific, and does not require the use of radioisotopes. It can be applied to the unequivocal diagnosis of paucibacillary leprosy which is difficult by other means. The diagnosis can be obtained within 10 hours. Int J Dermatol 1993; 32:710–713

INTRODUÇÃO: Reações hansênicas são a principal causa de lesões dos nervos e incapacidades provocadas pela hanseníase. MÉTODOS: Estudo retrospectivo com objetivo de verificar a frequência de reações hansênicas em pacientes com alta por cura pela poliquimioterapia (PQT). RESULTADOS: Pacientes que apresentaram reações durante o tratamento, 35,5% continuaram pós-PQT; aqueles que não apresentaram no tratamento, somente 12,7% tiveram pós-PQT; 63,4% multibacilares apresentaram durante e 31,7% após; paucibacilares 27,7% durante e 8,3% após. CONCLUSÕES: Existe relação diretamente proporcional entre presença de reações durante e após o tratamento. Formas clínicas multibacilares apresentam maior frequência de reações durante e após a cura. INTRODUCTION: Reactional states are the main cause of nerve lesions and incapacities provoked by leprosy. METHODS: Retrospective study aimed at verifying the frequency of leprosy reactions in discharged patients following cure by multidrug therapy (MDT). RESULTS: Among patients who presented reactions during treatment, 35.5% continued after MDT; of those that did not present during treatment, only 12.7% presented after discharge; 63.4% multibacillary patients presented during and 31.7% after; 27.7% paucibacillary patients presented during and 8.3% after. CONCLUSIONS: A direct proportional relation exists between the presence of reactions during and after treatment. Multibacillary clinical forms present a greater frequency of reactions during and after cure.

INTRODUÇÃO: As reações são frequentes e importantes no contexto da hanseníase, representando uma significativa parcela de pacientes com incapacidades e submetidos ao retratamento da hanseníase. A caracterização clínico-epidemiológica dos padrões reacionais é primordial para o manejo dos pacientes. O objetivo desse trabalho é descrever as características epidemiológicas e clínicas das reações hansênicas em indivíduos paucibacilares e multibacilares. MÉTODOS: Estudo transversal onde foram avaliados 201 pacientes com história de quadro reacional, atendidos em dois centros de referência para tratamento da hanseníase. Variáveis como baciloscopia inicial, sexo, idade, fototipo, procedência, forma clínica, tipo de tratamento e de reação, índice baciloscópico final e período de surgimento da reação em relação ao tratamento foram avaliados. A análise estatística foi realizada usando-se frequências simples. Para cálculo dos fatores de risco para as formas multibacilares, foram realizadas análises univariada e multivariada. RESULTADOS: Sexo masculino, idade entre 30-44 anos, fototipo V, a forma clínica borderline, tratamento regular, reação tipo I, neurite, presença de 10 a 20 nódulos e surgimento da reação hansênica durante o tratamento foram os achados mais frequentes. CONCLUSÕES: Predominaram os indivíduos do sexo masculino que se associaram a um maior risco de desenvolvimento da forma multibacilar. As reações hansênicas foram mais frequentes durante o tratamento, os pacientes multibacilares foram mais propensos ao retratamento da hanseníase e aqueles com reações tipo I e II, apresentaram maior frequência de neurite, linfadenopatia, artrite e irite do que aqueles com reação isolada. INTRODUCTION: Significant reactions frequently occur among leprosy cases, and thus a significant proportion of leprosy patients present disabilities and undergo leprosy retreatment. Clinical-epidemiological characterization of reaction patterns is essential for managing such patients. Objective to describe the epidemiological and clinical characteristics of leprosy reactions among paucibacillary and multibacillary individuals. METHODS: In this cross-sectional study, 201 patients with histories of reactions who were attended at two reference centers for leprosy treatment were evaluated. Variables such as initial bacilloscopy, sex, age, skin phototype, origin, clinical presentation, type of treatment, type of reaction, final bacilloscopy index and time of reaction onset in relation to the treatment were evaluated. Statistical analysis was performed using simple frequencies. To calculate risk factors for multibacillary forms, univariate and multivariate analyses were performed. RESULTS: Male sex, age between 30 and 44 years, phototype V, borderline clinical form, regular treatment, type I reaction, neuritis, presence of 10 to 20 nodules and onset of the leprosy reaction during the treatment were the most frequent findings. CONCLUSIONS: Male patients predominated and were associated with greater risk of developing the multibacillary forms. Leprosy reactions occurred most frequently during the treatment. Multibacillary patients were more likely to need leprosy retreatment, and those with type I and type II reactions presented greater frequency of neuritis, lymphadenopathy, arthritis and iritis than did those with isolated reactions.

Pooled faecal culture (PFC) is a widely used test in ovine Johne’s disease (OJD) control programmes in Australia but information about its characteristics is limited. We conducted this study to estimate sensitivity and flock-sensitivity of PFC in sheep with different OJD histopathological lesions in simulated flocks with a range of infection prevalence levels. Initially, a known quantity of faeces from sheep with pauci- or multi-bacillary lesions was pooled with uncontaminated faeces from confirmed non-infected sheep and cultured using PFC technique. PFC sensitivity, calculated as a proportion of the pools of a particular size that tested positive, was determined to be 90% in sheep with the multibacillary form of the disease but varied with pool size in sheep with the paucibacillary form of OJD. Subsequently, probabilistic models were developed to estimate overall pool-sensitivity achieved in a flock (Sek) and flock-sensitivity of PFC (FSe) in various simulated scenarios. In flocks with a given ratio of multi- to pauci-bacillary sheep and with low to moderate infection prevalence level, Sek decreased with increase in pool size, but increased with pool size in flocks with ≥ 10 % prevalence. FSe, in contrast, increased with pool size in all the tested scenarios. Both Sek and FSe increased with infection prevalence, ratio of multi- to pauci-bacillary sheep and the number of pools sourced from flocks. Sensitivity analyses indicated that the estimates and trends were robust to moderate changes in input parameters. The results suggest that the current testing of seven pools of size 50 is adequate for most scenarios, however, for very low prevalence flocks, a gain in FSe can be made by increasing the number of pools tested and a higher Sek can be achieved by reducing pool sizes. Keywords: pooling, paratuberculosis, ovine Johne’s disease, Australia, Mycobacterium, epidemiology. Meat and livestock australia

The multi-sections, which were stained by Fite method, of skin biopsies taken from twelve active BT cases were examined under the guidance of special stains for demonstration of nerve components. All cases were AFB positive. Bacilli were found in infiltrated nerves in 11 cases, of which, in 7 cases, bacilli were detected in nerve fragments within epithelioid cell granuloma. And bacilli were seen in arrector pili muscles in 2 cases. No bacilli were detected in other sites. Since the survival of M. leprae in nerves is one of the reasons causing relapse, this paper suggests that it would be better to treat active BT cases with multibacillary regimen recommended by WHO even though smear-negative.

For this paper we conducted a secondary data analysis to test the hypothesis that a linear trend exists in the protective effect of bacillus Calmette-Guerin (BCG) vaccine against types of leprosy. We used data from two previous case-control studies to perform an unmatched test for linear trend. We observed that both the studies revealed a significant linear trend (P0.00001). One study that estimated an insignificant protective effect of BCG against paucibacillary leprosy showed a significant departure from linearity. We conclude that, the protective effect of BCG vaccination is differential across severity of leprosy as it brings about a shift in the immune response to a higher level of cell mediated immunity. We recommend that future studies dealing with the protective effect of BCG against leprosy should also conduct an analysis for trend.

The most convenient way of diagnosing an infectious disease is by serological methods. To improve the quality of diagnosis in leprosy, simple tests in addition to diagnosis by clinical signs, are necessary. Here, PGL-I based methods for detection of multibacillary and paucibacillary leprosy, have been revisited and newer methods are discussed.

BACKGROUND: The World Health Organization recommends treatment regimens for paucibacillary (PB) and multibacillary (MB) leprosy, which differ in their duration and components. Hence accurate classification of the disease is required. To overcome difficulties in classification Uniform Multi Drug Therapy (U-MDT) has been recommended. AIM : To evaluate the benefit of adding clofazimine to paucibacillary regimens in leprosy patients by measuring clinical and histological resolution. METHODS: Forty-four paucibacillary patients were included in the study. Twenty-two patients were given MDT-PB regimen and the remaining MDT-MB regimen for six months . Skin biopsies were done before the commencement and at the end of treatment. Clinical and histological resolutions were measured according to the standard criteria a laid down. The results were analyzed using Fishers′ test and Crammers′ V test. RESULTS: Clinical improvement was observed in 90.9% in the MB group as compared to 27.3% in the PB group. Regression in the nerve swelling was observed in 70% in the MB group and in 37.5% in the PB group while histological resolution was observed in 72.8% and 54.5% respectively. CONCLUSIONS: Addition of clofazimine helps to resolve leprosy lesions both clinically and histologically, thus justifying the concept of Uniform MDT regimen for all patients.

Background Involvement of the oral mucosa can occur in lepromatous leprosy; however, lesions in the oral mucosa of paucibacillary patients have not been previously observed. Objective The objective of this study is to determine whether clinical and subclinical lesions exist in oral mucosa in nontreated paucibacillary leprosy patients, using clinical and histopathological examination. Materials and Methods A clinical and histopathological study involving 30 untreated paucibacillary leprosy patients was conducted. All patients underwent biopsies of the buccal mucosa, soft palate, and tongue. When acid-fast bacilli in association with inflammatory infiltrate, granulomatous or not, were encountered, it was considered “specific” involvement of the oral mucosa; and “nonspecific” involvement when the bacilli were not encountered. Results Eight nonspecific chronic inflammatory reactions and 1 granulomatous inflammatory process without acid-fast bacilli were detected. Conclusions Paucibacillary leprosy patients do not exhibit specific, clinical or subclinical, involvement in the oral mucosa; nonspecific alterations occur even in the absence of signs and symptoms.

Estudo descritivo, objetivando avaliar o programa de controle da hanseníase do Município de Buriticupu, Maranhão. Foram analisados 214 prontuários de pacientes portadores das diversas formas clínicas de hanseníase, atendidos na unidade de saúde da Universidade Federal do Maranhão, localizada no referido município. A população de estudo foi constituída de 110 casos de hanseníase das formas paucibacilares (PB) e 104 das formas multibacilares (MB) registrados no período de janeiro de 1991 a dezembro de 1995. As informações referentes à forma clínica, número de contatos registrados, examinados e avaliados, grau de incapacidade no início e final do tratamento e situação de registro, foram coletadas num formulário específico. A análise dos resultados foi baseada nos parâmetros dos indicadores operacionais definidos pelo Ministério da Saúde. Houve um discreto predomínio da forma PB da doença. Observou-se baixos percentuais em relação aos pacientes com grau de incapacidade física avaliada no início e final do tratamento, a alta por cura e contatos examinados. O percentual de abandono foi elevado. O programa foi considerado "precário" em todos os indicadores utilizados para o estudo. This is a descriptive study to assess the leprosy control program in the municipality of Buriticupu in Maranhão State, Brazil. The records of 214 patients with different forms of leprosy were studied. Patients were treated at a health center of the Federal University in Maranhão located in the above-mentioned municipality. The study population was comprised of 110 cases with paucibacillary leprosy (PB) and 104 with multibacillary leprosy (MB). The patients were registered between January 1991 and December 1995. Data on the form of the disease, number of contacts registered, examined, and assessed, degree of disability at the beginning and end of treatment, and the register's status were collected on a form designed specifically for this purpose. Analysis of results was based on operational guidelines developed by the Ministry of Health. There was a slight predominance of the PB form. Observation of patients with physical disabilities at the beginning and end of treatment was low, as were levels of successful treatment and examined contacts. There was a high dropout level. The program was considered "low-level performance" for all indicators used in the study.

A case of borderline tuberculoid leprosy involving the hairy scalp is reported. To the best of our knowledge, only two paucibacillary leprosy patients with scalp lesion have been reported, and in only one was the scalp covered with hair.

A population-based pair-matched case-control study was carried out in an urban community, Nagpur, India, to estimate the effectiveness of BCG vaccination in the prevention of leprosy. The study included 212 cases of leprosy (diagnosed by WHO criteria), below the age of 35 years, detected during a leprosy survey conducted by the Government of Maharashtra over a population of 20,03,325. Each case was pair-matched with one neighbourhood control for age, sex and socioeconomic status. A significant protective association between BCG and leprosy was observed (OR = 0.40, 95% CI = 0.23-0.68). The overall vaccine effectiveness (VE) was estimated to be 60% (95% CI = 32-77). The BCG effectiveness against multi-bacillary and paucibacillary leprosy was 72% (95% CI = 35-88) and 45% (95% CI = 3-73), respectively. Vaccine was more effective during the first decade of life, among females and in lower socioeconomic strata. The overall prevented fraction was 39% (95% CI = 16-58). In conclusion, this first ever population-based case control study performed in Central India, identified a beneficial role of BCG vaccination in prevention of leprosy in study population.

In 37 clinically-diagnosed borderline-tuberculoid (BT) leprosy patients skin biopsies were done prior to starting multidrug therapy (MDT) and at the end of 6 months therapy. Clinical and histopathological activity, graded as active, resolving and inactive, were studied at the end of 6 months of MDT. Of the 37 clinically-diagnosed BT patients 24 could be confirmed by histopathology as having BT leprosy, while the other 13 biopsies showed features of indeterminate (I) leprosy. After 6 months of MDT, out of the 24 histopathologically-confirmed BT patients, 4 (17%) showed clinical activity and 8 (33%) showed histopathological activity. Of the 13 histopathologically-diagnosed indeterminate cases all were clinically inactive but histological activity persisted in 3 cases (23%). Out of the 37 clinically-diagnosed BT patients 3 showed both clinical and histopathological activity at the end of MDT. This study emphasizes the importance of performing histopathological examinations on leprosy patients undergoing research studies for the confirmation of diagnosis and for proper classification of the disease. The histopathological activity that outlasts the MDT may be due to the bacillary fragments that persist but clinical activity coupled with histopathological activity seen in 3 patients at the end of 6 months may foreshadow a relapse and these patients and others like them need to be followed up for longer durations.

Clinically and histopathologically paucibacillary leprosy shows similar features with initial morphea. In this case we report a 24 yr-old male patient who presented to our dermatology department with diagnosed paucibacillary leprosy by his local dermatologist, and confirmed by perineurovascular lymphocytic infiltrate in the histopathological exam. On physical examination we found new plaque lesions that were suggestive of morphea with alteration of sensitivity. A new biopsy was performed showing sclerotic superficial dermis with thickening of the collagen bundles in deep dermis and linear arrays lymphocytic infiltrate between the collagen bundles that confirm the diagnosis of morphea.

DOI: http://dx.doi.org/10.4038/jccp.v42i1-2.4553 Journal of the Ceylon College of Physicians, 2011, 42 , 35-36

Two hundred and fifty paucibacillary (PB) leprosy patients were treated with WHO recommended multidrug therapy (MDT) and followed up them for four years. The paucibacillary MDT regimen (PBR) was well accepted and tolerated by the patients. Clinical regression was attained in 60% patients after 6 doses of PBR. Reversal reaction occurred in 14% cases and relapse were found in 1.6% cases 18-24 months after completing the treatment. The incidence of reversal reaction was high in patients with more than 2 thickened nerve trunks associated with more than 5 patches.