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Introduction: Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. Methods: A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2–3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. Results: The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. Conclusion: People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) aims to reduce new leprosy cases by 70% by 2030, necessitating advancements in leprosy diagnostics. Here we discuss the development of two WHO's target product profiles for such diagnostics. These profiles define criteria for product use, design, performance, configuration and distribution, with a focus on accessibility and affordability. The first target product profile outlines requirements for tests to confirm diagnosis of leprosy in individuals with clinical signs and symptoms, to guide multidrug treatment initiation. The second target product profile outlines requirements for tests to detect Mycobacterium leprae or M. lepromatosis infection among asymptomatic contacts of leprosy patients, aiding prophylactic interventions and prevention. Statistical modelling was used to assess sensitivity and specificity requirements for these diagnostic tests. The paper highlights challenges in achieving high specificity, given the varying endemicity of M. leprae, and identifying target analytes with robust performance across leprosy phenotypes. We conclude that diagnostics with appropriate product design and performance characteristics are crucial for early detection and preventive intervention, advocating for the transition from leprosy management to prevention. [ABSTRACT FROM AUTHOR]

Leprosy is an infectious neglected tropical disease, which can cause irreversible disabilities if not diagnosed in time. Colombia continues to show high rates of leprosy-related disability, mainly due to a delay in diagnosis. Limited knowledge is available that explains this delay, therefore our study aimed to explore the perceptions and experiences of leprosy health professionals with the delay in leprosy diagnosis in the Cesar and Valle del Cauca departments, Colombia. Nine semi-structured expert interviews with leprosy health professionals were conducted in May-June 2023 in Colombia. Thematic analysis was performed to analyse the interview results. Our analysis highlighted that the main reasons for delay at the health system-level included accessibility issues to obtain a diagnosis, lack of expertise by health staff, and barriers related to the organisation of the care pathway. Individual – and community-level factors included a lack of leprosy awareness among the general population and leprosy-related stigma. Diagnostic delay consists of a fluid interplay of various factors. Structural changes within the health system, such as organising integral leprosy care centres and highlighting leprosy in the medical curriculum, as well as awareness-related interventions among the general population, might help reducing diagnostic delays. [ABSTRACT FROM AUTHOR]

Background: India achieved elimination target for leprosy in December 2005. However, many pockets in the country continue to report significant number of cases. Aim: The aim of the study was to study the profile of leprosy cases presenting to a tertiary care hospital in North India in post-elimination era. Patients and Methods: The study was conducted at Hansen’s disease clinic. The study design was a retrospective observational study. Chart review of treatment naive leprosy patients enrolled between 1stJanuary 2018 and 31st December 2019 was done. Data regarding demographic profile, clinical spectrum of leprosy, slit‑skin smears (SSSs) and histopathological findings were analysed. Statistical Analysis: Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 23 (SPSS Inc., Chicago, IL, USA). Data were statistically described in terms of range, mean ± standard deviation, frequency (number of cases), and relative frequency (percentages). Results: Amongst a total of 115 patients, males (68%, n = 79/115) outnumbered females. Children (<15 years) constituted 0.86% cases (n = 1/115) and 26% cases (n = 30/115) were above 50 years of age. Multibacillary leprosy (73%, n = 84/115) was more common. Borderline lepromatous (41.7%, n = 48/115) was the most common clinical type of leprosy, whereas Grade 2 disability was noted amongst 0.05% (n = 6/115) patients at presentation. SSS were positive in 60% (69/115) cases. Conclusions: The present study showed a significant increase in cases in the older age group and decrease in new cases in children. Furthermore, multibacillary cases outnumbered the paucibacillary cases. Similar trends were reported to be an indicator of decreasing incidence of leprosy in countries that eliminated leprosy. We speculate that India may be entering a phase of decreased community transmission of leprosy. Further, multicentric studies across the country may throw more light. [ABSTRACT FROM AUTHOR]

New pathways of host defence have emerged in leprosy, such as T helper (Th)-17, Th-9, T regulatory cells, and other factors like transforming growth factor-beta, etc. Interleukin (IL) 17 produced by Th17 cells has been found to be elevated in lepra reaction, especially type 2 lepra reaction (T2R). Role of IL-9 has not been studied widely in leprosy reactions so far. The study aimed to compare serum levels of IL-17 and IL-9 in leprosy patients with and without lepra reaction. This was a cross-sectional analytical study including untreated adult leprosy patients with and without lepra reaction. A total of 65 patients were included in the study with 30 leprosy patients without reaction and 35 with lepra reaction. Serum levels of IL-17 and IL-9 were measured in these patients using direct enzyme-linked immunosorbent assay and were compared. Borderline tuberculoid (BT) leprosy with type 1 and Lepromatous (LL) leprosy with T2R patients showed significantly higher levels of IL-17 than BT and LL leprosy patients without lepra reaction, respectively. LL patients with T2R showed significantly lower levels of IL-9 than lepromatous cases without reaction. IL-9 levels were higher in BT patients with T1R as compared to BT patients without reaction but the difference was not significant. We found evidence in support of role of IL-17 in the pathogenesis of T2R, which might serve as useful serum markers for the same. IL-17 might have a role in BT leprosy with T1R. IL-9 seems to have a protective role in T2R as opposed to IL-17, working in synergism with Th1 cytokines. [ABSTRACT FROM AUTHOR]

Copyright of Health Sciences Journal / Revista Ciências em Saúde is the property of Hospital de Clinicas de Itajuba - Associacao de Integracao Social de Itajuba and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Lazarine leprosy is an unusual expression of usually borderline tuberculoid (BT) form characterized by spontaneous ulceration of skin lesions. This is presumably the result of an exaggerated type 1 reaction. It commonly occurs in the BT, borderline lepromatous forms and rarely in the lepromatous forms of leprosy. We report two cases of lazarine leprosy in the BT and BT downgrading to borderline lepromatous spectrum in healthy and immunocompetent males. [ABSTRACT FROM AUTHOR]

Copyright of Revista Enfermagem Contemporânea is the property of Revista Enfermagem Contemporanea and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Two patients presented with side-locked frontal head pain, involving the supraorbital nerve territory, with an associated hypopigmented macule. The clinical progress and nerve biopsy in one indicated leprosy. In endemic regions, supraorbital neuralgia may be caused by leprosy sometimes without other neurocutaneous markers. [ABSTRACT FROM AUTHOR]

Objectives: Leprosy is caused by Mycobacterium leprae or Mycobacterium lepromatosis. This study reviews literature on M lepromatosis and reports on a Mexican family with this infection.Methods: The review included all primary studies. Family history and surveys were used to uncover the infection cluster. Genome-based differential polymerase chain reactions were designed to detect etiologic agents.Results: Since the discovery of M lepromatosis in 2008, 154 cases of M lepromatosis infection from 11 countries in the Americas and Asia have been reported, with most cases coming from Mexico. These cases included diffuse lepromatous leprosy (DLL) and other leprosy forms. Genomes of M lepromatosis strains have lately been sequenced, revealing 3,271,694 nucleotides and approximately 15% mismatches with M leprae. The Mexican family with leprosy involved the grandfather, mother, and 2 grandsons. The index was the oldest grandson, who manifested DLL and likely contracted the infection from his maternal grandfather approximately 13 years earlier. Family surveys diagnosed DLL in the index patient's mother and borderline leprosy in his brother; both were likely infected by the index patient. M lepromatosis was identified from archived biopsies from the index patient and his mother, while M leprae was excluded.Conclusions: M lepromatosis is a significant cause of leprosy in Mexico and requires better surveillance and control. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Leprosy is a chronic granulomatous disease of the peripheral nerve and muscle of upper respiratory tract. Consequence to the neighbouring primary site, oral lesions have been seen in 20-60% of patients with leprosy mainly lepromatous leprosy. The lepromatous nodules may be infective and may lead to the spread of disease and hence require proper diagnosis. Aim: To assess oral lesion in leprosy patients. To assess the disease and the occurrence of oral lesion according to age and gender. To detect any primary lesion in oral cavity and compare these lesions in duration to study. Material and Methods: One hundred patients with leprosy were examined and their oral manifestations were recorded. Results: It was found that 70 (70%) leprosy patients showed oral manifestations. Eighteen (25%) had chronic generalized periodontitis, 9 (12.8%) cases of oral melanosis, 7 (10%) atrophy of papillae and loss of taste sensation each, 6 (8.5%) complained of aphthous and candidiasis each, 5 (7.14%) depigmentation and 4 (5.71%) smokers palate, oral submucous fibrosis and fissured tongue. Conclusion: Our clinical findings are in conjugation with previous studies; however, as per the review of literature, this is the first study worldwide where we have examined 100 cases of leprosy which has not been documented till date. We suggest that the lesser incidence of oral lesions is observed recently compared to older reports because of more effective present treatment which is initiated earlier. [ABSTRACT FROM AUTHOR]

Background: The state of leprosy in Nigeria and the realities of post elimination era underscore the need for evidence- based cost-effective approach to early case detection for enhanced control and elimination of leprosy. This study evaluated the operational cost-effectiveness of a community delivered Legacy Innovative Project implemented to enhance leprosy case detection in northern Nigeria. Methods: Data were collected from an explorative cross-sectional study, undertaken in a practice setting among endemic communities in three states in northern Nigeria. Primary and secondary data were collected from the project, routine records and programme annual reports. Costs and effects were measured from both providers' and patients' perspectives, and outcome expressed as cost per new case detected. Incremental estimates of costs and effects of the project compared to routine practice were used to obtain the cost-effectiveness result, as incremental cost-effectiveness ratio (ICER). All costs were converted to the US Dollar at 2018exchange rate (N350 = US$1.00). Univariate sensitivity analysis was performed to evaluate uncertainties around the ICER. Results: The Project overall detected a total of 347 newly confirmed leprosy cases at a total annual cost of US$49,337.19, averaging US$142.18 per new case detected. Key cost drivers included routine meetings, which accounted for 28% of total expenditure, while Social Mobilization and Training/Workshop accounted for17% respectively. Findings were similar across the states. Overall, the Project dominated routine practice with ICER of US$(-17.73) per additional/new case detected, as a very cost-effective strategy. Sensitivity analysis reinforced the cost-effectiveness result. Conclusions: The Legacy Innovative Project demonstrated a more efficient and cost-saving approach to leprosy case detection. Findings present important information to policy and programmes for enhanced control and elimination of leprosy in related settings.. [ABSTRACT FROM AUTHOR]

Introduction Neuropathic pain is a common and disabling late complication of leprosy. We investigated the clinical and electrophysiological characteristics of neuropathic pain in leprosy patients by evaluating nerve conduction, sympathetic skin response (SSR) and A-waves. Methods Twenty one leprosy patients with neuropathic pain validated by the Douleur Neuropathique en 4 (DN4)Questionnaire were selected for study. Pain intensity was measured by the visual analog scale. Demographic and clinical data were collected for all patients. Clinical data included appraisal of the median, ulnar, radial, tibial and common peroneal nerves, assessment of the sympathetic skin response and conventional electrophysiological recordings. Results Among all electroneuromyographic presentations, multifocal mononeuropathy was still the most prevalent. Sensory loss was observed more frequently than motor deficits. As most patients presented advanced clinical forms of leprosy and were under treatment, this high mean was found and the ulnar nerve was most frequently affected. The sympathetic skin response was absent in 16 patients. Higher DN4 Questionnaire scores were observed in women and in those receiving corticosteroid therapy. These inferences are possible to be made, but our study's limitations don't allow us to be certain about it. The statistical significance found only permits us to evidence what we related on the textual part of the study. Limitations The small number of patients studied, the lack of sophisticated diagnostic methods for leprosy, as well as the difficulties in assessing nerve conduction were the main limitations of this study. Conclusion The neurophysiological and clinical findings in leprous neuropathy were modest despite the conspicuous neuropathic pain. Although electrophysiological studies are a vital tool to verify nerve damage, variations in the clinical presentation of leprosy neuropathic pain render the diagnosis challenging. Further studies are needed to describe the neurophysiological evolution of this disease. [ABSTRACT FROM AUTHOR]

Disability in leprosy is a direct consequence of damage to the peripheral nervous system which is usually worse in patients with no skin manifestations, an underdiagnosed subtype of leprosy known as primary neural leprosy. We evaluated clinical, neurophysiological and laboratory findings of 164 patients with definite and probable primary neural leprosy diagnoses. To better understand the disease progression and to improve primary neural leprosy clinical recognition we compared the characteristics of patients with short (≤12 months) and long (>12 months) disease duration. Positive and negative symptoms mediated by small-fibres were frequent at presentation (∼95%), and symptoms tend to manifest first in the upper limbs (∼68%). There is a consistent phenotypic variability between the aforementioned groups. Deep sensory modalities were spared in patients evaluated within the first 12 months of the disease, and were only affected in patients with longer disease duration (∼12%). Deep tendon reflexes abnormalities were most frequent in patients with longer disease duration (P < 0.001), as well as motor deficits (P = 0.002). Damage to large fibres (sensory and motor) is a latter event in primary neural leprosy. Grade-2 disability and nerve thickening was also more frequent in cases with long disease duration (P < 0.001). Primary neural leprosy progresses over time and there is a marked difference in clinical phenotype between patients with short and long disease duration. Patients assessed within the first 12 months of symptom onset had a non-length-dependent predominant small-fibre sensory neuropathy, whilst patients with chronic disease presented an asymmetrical all diameter sensory-motor neuropathy and patchily decreased/absent deep tendon reflexes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Diagnosing neuritis in leprosy patients with neuropathic pain or chronic neuropathy remains challenging since no specific laboratory or neurophysiological marker is available.Methods: In a cross-sectional study developed at a leprosy outpatient clinic in Rio de Janeiro, RJ, Brazil, 54 individuals complaining of neural pain (single or multiple sites) were classified into two groups ("neuropathic pain" or "neuritis") by a neurological specialist in leprosy based on anamnesis together with clinical and electrophysiological examinations. A neurologist, blind to the pain diagnoses, interviewed and examined the participants using a standardized form that included clinical predictors, pain features, and neurological symptoms. The association between the clinical predictors and pain classifications was evaluated via the Pearson Chi-Square or Fisher's exact test (p < 0.05).Results: Six clinical algorithms were generated to evaluate sensitivity and specificity, with 95% confidence intervals, for clinical predictors statistically associated with neuritis. The most conclusive clinical algorithm was: pain onset at any time during the previous 90 days, or in association with the initiation of neurological symptoms during the prior 30-day period, necessarily associated with the worsening of pain upon movement and nerve palpation, with 94% of specificity and 35% of sensitivity.Conclusion: This algorithm could help physicians confirm neuritis in leprosy patients with neural pain, particularly in primary health care units with no access to neurologists or electrophysiological tests. [ABSTRACT FROM AUTHOR]

Background and Design: Leprosy is a chronic granulomatous, infectious disease that primarily affects the skin and peripheral nerves. Leprosy in children is an indicator of active transmission in the community. This study aimed to analyze the prevalence and clinical spectrum of childhood leprosy and highlight the importance of examining close contacts and the impact of detection and treatment of leprosy in the community. Materials and Methods: This retrospective study included patients presenting to the dermatology department of a tertiary care hospital attached to a medical college during the years 2011-2019. Results: Two hundred and twenty-three patients with leprosy were analyzed, of which 201 were adults and 22 were children. Children constituted 9.87% of the patients (approx. one child with leprosy for every 10 adults with leprosy). Of 22 children with leprosy, 13 (59.09%) were boys and nine (40.90%) were girls, with a ratio of 1.4:1. Twelve of twenty-two child patients (54.54%) had a single patch, while 10 of 22 (45.45%) had more than one skin lesion. Fourteen patients (63.63%) were diagnosed clinically with borderline tuberculoid (BT) leprosy, and six patients (27.27%) had borderline lepromatous leprosy. Of the fourteen patients with BT leprosy, 10 patients (71.4%) had a single lesion. Eleven patients (50%) were diagnosed with multibacillary leprosy, and eleven patients (50%) were diagnosed with paucibacillary leprosy. A clinicopathological correlation was noted in 16 patients (72.72%). Family contact was observed in four children with leprosy. Conclusion: A high proportion of childhood leprosy cases indicates active transmission and warrants awareness among the community members and healthcare workers in terms of early detection and treatment of childhood and adult leprosy. This helps in preventing transmission, development of grave deformities, and associated social stigma of leprosy among the community members. [ABSTRACT FROM AUTHOR]

Several biologic agents have been approved for use in dermatology and other disciplines of medicine. However, based on the mechanism of action and a track record of the response, these agents are being increasingly used for off-label purposes to garner control of more remote and difficult disease processes. Herein, we present three difficult to treat patients where innovative uses of biologics beyond their approved indications have yielded good responses. Our first patient was a case of bullous pemphigoid, who showed excellent response to omalizumab. The second case was a patient of lepromatous leprosy with tenosynovitis and erythema nodosum leprosum, who was treated effectively with infliximab. Our third case was a treatment-resistant pyoderma gangrenosum, where infliximab showed a very good response. In the present study, we report the cases to highlight the usefulness of biologics that can expand much beyond the routine FDA approved indications. [ABSTRACT FROM AUTHOR]

Background: Despite the implementation of multidrug therapy by WHO to treat Hansen's disease (HD), new case detection rates are still high indicating active transmission. Aims and Objectives: To study the clinical profile of HD in central India along with its epidemiological characteristics. Materials and Methods: Medical records of clinically diagnosed Hansen's patients were recruited retrospectively during January 2015 to December 2018. Case records were evaluated with respect to demographic, clinical, histopathological, and bacteriological investigations, development of reaction, and deformities. Patients were classified based on Ridley Jopling classification and treated accordingly. Statistical analysis was done using proportion, mean, and percentage. Results: A total of 400 new patients were enrolled and males outnumbered females. Maximum cases, 115 (28.75%), were in the age group of 31–40 years. Sixteen (4%) cases belonged to the pediatric age (less than 18 years) group. Most common clinical spectrum was borderline lepromatous (n = 156, 39%) followed by lepromatous HD (n = 120, 30%). Eleven patients had pure neuritic HD and nine had histoid HD. Grade 2 deformity was found in 52 and grade 1 deformity was found in 16 patients. Most common lepra reaction was type 2 lepra reaction (n = 112, 28%). Thirteen (3.25%) patients were of relapse of HD among which maximum eight were BL HD followed by LL HD three (0.75%) and TT HD two (0.5%). Conclusion: Early diagnosis is very important for timely and proper implementation of treatment which will prevent sequelae and physical disabilities that can have an impact on the individual's social and working life, which are responsible for stigma and prejudice regarding the disease. Detection of this huge number of cases signifies a high burden of HD in this area even in the post elimination era. [ABSTRACT FROM AUTHOR]

Background: Recently developed immunosuppressive drugs, especially TNF antagonists, may enhance the risk of granulomatous infections, including leprosy. We aimed to evaluate the leprosy detection rate in patients under immunosuppression due to rheumatological, dermatological and gastroenterological diseases.Methods: We performed a systematic review of the literature by searching the PubMed, EMBASE, LILACS, Web of Science and Scielo databases through 2018. No date or language restrictions were applied. We included all articles that reported the occurrence of leprosy in patients under medication-induced immunosuppression.Results: The search strategy resulted in 15,103 articles; finally, 20 articles were included, with 4 reporting longitudinal designs. The detection rate of leprosy ranged from 0.13 to 116.18 per 100,000 patients/year in the USA and Brazil, respectively. In the meta-analysis, the detection rate of cases of leprosy per 100,000 immunosuppressed patients with rheumatic diseases was 84 (detection rate = 0.00084; 95% CI = 0.0000-0.00266; I2 = 0%, p = 0.55).Conclusion: Our analysis showed that leprosy was relatively frequently detected in medication-induced immunosuppressed patients suffering from rheumatological diseases, and further studies are needed. The lack of an active search for leprosy in the included articles precluded more precise conclusions.Trial Registration: This review is registered in PROSPERO with the registry number CRD42018116275 . [ABSTRACT FROM AUTHOR]

Background: Detection of peripheral nerve thickening and nerve function impairment is crucial in the diagnosis and the management of leprosy.Aims and Objectives: (1) To document the cross-sectional area, echotexture and blood flow of peripheral nerves in healthy controls and leprosy cases using high-resolution ultrasound, (2) to compare the sensitivities of clinical examination and high-resolution ultrasound in detecting peripheral nerve thickening in leprosy.Methods: Peripheral nerves of 30 leprosy patients and 30 age- and sex-matched controls were evaluated clinically and by high-resolution ultrasound. When the cross-sectional area of a peripheral nerve on high-resolution ultrasound in a leprosy patient was more than the calculated upper bound of the 95% confidence interval for mean for that specific nerve in controls, that particular peripheral nerve was considered to be enlarged.Results: Cross-sectional areas more than 7.1 mm2 for the radial nerve, 8.17 mm2 for ulnar, 10.17 mm2 for median, 9.50 mm2 for lateral popliteal and 11.21mm2 for the posterior tibial nerve were considered as nerve thickening on high-resolution ultrasound. High-resolution ultrasound detected 141/300 (47%) nerves enlarged in contrast to the 60 (20%) diagnosed clinically by palpation (P < 0.001). Clinical examination identified thickening in 31/70 (44.3%) nerves in cases with impairment of nerve function and 29/230 (12.6%) in the absence of nerve function impairment. High-resolution ultrasound detected thickening in 50/70 (71.4%) nerves with impairment of function and in 91/230 (39.6%) nerves without any impairment of function.Limitation: A single-centre study design was the major study limitation.Conclusion: High-resolution ultrasound showed greater sensitivity than clinical examination in detecting peripheral nerve thickening in leprosy cases. High-resolution ultrasound, may therefore improve the sensitivity of the diagnostic criterion of peripheral nerve enlargement in the diagnosis and classification of leprosy. [ABSTRACT FROM AUTHOR]

Background: Pure neuritic leprosy (PNL) poses a diagnostic challenge because of absence of skin patches, inconclusive skin biopsies and nerve conduction studies. Nerve biopsy though the diagnostic gold standard, is invasive, requires expertise, and may not be feasible in all cases. Fine needle aspiration cytology (FNAC) of accessible thickened nerves can be utilized as a minimally invasive diagnostic modality in PNL. This study was carried out to describe cytomorphological patterns of nerve aspirates in patients of PNL for diagnosis and classification of leprosy and study its advantage, if any, over skin biopsy. Methods: Twenty-seven treatment naive clinically diagnosed patients of PNL were included in this cross-sectional study carried out from January 2017 to December 2018 at a tertiary care centre in Western India. FNAC was done from a clinically involved nerve and aspirates were evaluated for cytomorphological characteristics and the presence of Acid-Fast Lepra bacilli. Results: Nerve aspirates were diagnostic in 10 (37%) patients while 17 (63%) aspirates showed non-specific or no inflammation. Of the diagnostic aspirates, six (22.2%) were classified as tuberculoid leprosy, three (11.1%) as lepromatous and one (3.7%) as borderline leprosy. Mycobacterium leprae were demonstrated among three (11.1%) of these aspirates. In comparison, only three (11.1%) skin biopsies were diagnostic of leprosy with features of indeterminate spectrum. Remaining 24 skin biopsies showed normal histology in 20 (74.1%) cases to perivascular lymphocytic infiltrate in four (14.8%) cases. Conclusion: Our study demonstrates that FNAC of clinically thickened nerves has a better diagnostic yield than skin biopsy in PNL and shows all spectrums of leprosy. It also offers the advantage of sampling major nerve trunks without the fear of residual neurological deficit. However, most of the smears were paucicellular and a negative aspirate does not rule out leprosy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate quality of life and associated factors in patients with leprosy. Methods: A cross-sectional study with 63 people diagnosed as leprosy, seen at a reference service for the disease in the southeastern region of Mato Grosso, Brazil. The questionnaire World Health Organization Quality of Life Bref was used to evaluate quality of life. Simple and multiple linear regressions evaluated the association between sociodemographic variables and quality of life domains. Results: The highest mean of quality of life was observed in the psychological domain (16.28±2.30), and the lowest in the environmental domain (13.86±2.21). Females, individuals with no partners, and people who owned their own house had the lowest quality of life means within the psychological domain. People who did not receive visits by Community Health Workers had the lowest means in quality of life within the environmental domain. Multivariate analysis revealed that the best quality of life was associated to self-reported white skin color within the environmental domain, and the worst quality of life was associated to less schooling within the physical domain. Conclusion: This study showed the influence of sociodemographic factors on the quality of life of patients with leprosy, and indicated the need for comprehensive health care, considering the social determinants of health. [ABSTRACT FROM AUTHOR]

Objective: To analyze the prevalence of leprosy cases using as parameters the number of diagnosed cases, age group, sex, clinical form of the disease, degree of physical disability, affected nerves, and therapeutic methods. Methods: This was a descriptive study. Data were collected in the Information System for Notifiable Diseases (Sistema de Informações de Agravos de Notificação) from 2014 to 2017 in the state of Mato Grosso (MT), Brazil. Results: In the studied period, 11,388 cases were notified in the state, with a higher prevalence in the year 2017. Most cases were diagnosed in individuals older than 15 years with a slight predominance of men. During diagnosis, there was prevalence of zero degree of physical disability and among individuals with affected nerves, mostly had less than five nerves affected. Conclusion: Analyzing the prevalence and epidemiological profile of leprosy cases in the state of Mato Grosso (MT) turns to be essential for coping with the disease, as it helps in its management and treatment, with an emphasis on multidisciplinary approach for the recovery of existing cases and prevention of new cases, especially at hyperendemic states. [ABSTRACT FROM AUTHOR]

The article analysis of a nerve biopsy is an invasive procedure in which a piece of nerve is removed from an organism and examined under a microscope. Topic include the nerve damage in lepromatous and borderline lepromatous (BL) cases has been attributed to demyelination caused by direct Schwann cell damage by bacilli, macrophage‑induced myelin toxicity and also an immune attack on Schwann cells.

Leprosy is an infectious disease which is a national public health problem, because several regions in Indonesia have a high prevalence rate. There were 17,012 new cases of leprosy in Indonesia in 2010, consisting of 13,734 cases of Multi Basiler and 3,278 cases of PausiBasiler with a Newly Case Detection Rate (NCDR) of 7.22 per 100,000 population. The number was recorded as many as 20,329 cases with a prevalence of 0.86 per 10,000 population. In Indonesia, there are 12 provinces that still have leprosy rates above one person per 10,000 population, including the Province of Nangro Aceh Darussalam (1.51), South Kalimantan (1.07), East Java (1.67), North Sulawesi (2.57), Central Sulawesi (1.17), South Sulawesi (2.02), Southeast Sulawesi (1.21), Gorontalo (3.62), NTT (1.17), North Maluku (9.51), Maluku (3.47), and Papua (4.62). This study aims to see the risk factors for leprosy in children aged 5-14 years in Sorong City, West Papua Province. This type of research is a case control study and the population is children 5-14 years old in Sorong City with a sample of 54 respondents. The research data were analyzed using SPSS 16. Data analysis used the Chi-Square test. The results showed that the socioeconomic level p (0,000) 1 = risk risk) history of home contact p (0.000) 1 = risk risk) associated with the incidence of leprosy in children aged 5-14 years in Sorong City, while education p (0.569)> sig (0.05), parent's occupation p (0.766)> sig (0, 05), personal hygiene p (0.136)> sig (0.05) is not a risk factor for the incidence of leprosy in children in Sorong City. It is recommended that parents increase knowledge about leprosy transmission by seeking information from both health workers and the mass media, as well as the public who can actively participate in supporting government programs and efforts to prevent leprosy. [ABSTRACT FROM AUTHOR]

An observational pilot study was conducted to assess the nutritional status and morbidity profile of childhood contacts of leprosy in an endemic area (Chengalpattu) in India. A total of 70 such children were included in the study. Sociodemographic data were collected using a one-to-one interview method and the children were evaluated by dermatologists qualified in paediatric leprosy. The obtained data were computed. Three children were diagnosed to have leprosy through this study. Nutritional status assessment in these children demonstrated malnutrition, a common finding. Regular contact screening of children in endemic areas for early case detection, disability prevention and thereby prevention of community transmission is mandatory. Further research is needed concerning the role of malnutrition in children and its relation to morbidity in leprosy. The closeness and duration of contact of leprosy is also an important risk factor. Effective strategies to diagnose subclinical infection are needed. [ABSTRACT FROM AUTHOR]

Introduction: Leprosy or Hansen's disease is a chronic debilitating disease caused by Mycobacterium leprae. Host genetics are believed to strongly influence the course of the disease. It is known that cytokines play an important role in leprosy and cytokine gene polymorphisms probably influence the course of the disease.Methods: In the present study, we evaluated 70 patients with leprosy and 243 controls. DNA was extracted from the peripheral blood and genotyping was done for the following polymorphisms: IL-1 RA intron 2, IL-1β-511 C/T and TNF-α A/G.Results: A strong association of TNF-α-308 G/A polymorphism with Hansen's disease with both genotypes and alleles was found. However, no correlation was identified between the other two polymorphisms and Hansen's disease. A strong association between the IL-1β gene polymorphisms and the type of reactions seen in leprosy was found. In contrast, the other two polymorphisms did not show any such association.Limitations: Genetic polymorphisms are association studies. They are not a direct reflection of the transcriptome or proteome and this is a major limitation of this study.Conclusion: In conclusion, cytokine gene polymorphisms appear to influence the susceptibility and course of Hansen's disease. An evaluation of the cytokine levels in the skin during lepra reactions would confirm this observation. Possibly, in future, this would be a guide to therapeutic decisions in cases of lepra reactions. [ABSTRACT FROM AUTHOR]

Background and Objective: Chronic leprosy disease is caused by the transmission of Mycobacterium leprae bacilli, and leprosy is still as an enigmatic disease which is not fully understood. In terms of the national level, leprosy disease in Indonesia remains a public health problem. 16S rRNA gene is a gene that encodes which codes the 16S part of the ribosome and it has specific nucleotides and can specifically be used to detect the cases of leprosy. Materials and Method: This study was classified as the observational study using a case-control research design. The total samples were 81 individuals that consisted of 27 leprosy patients (the case group) and 54 non-leprosy patients (the control group). Analysis of 16S rRNA gene expression was conducted using the RFLP-PCR method to detect the risk of leprosy. Results: All samples of swabs of ear lobes for the case group (27 samples) were definitely positive infected by M. leprae and 2 dust samples (7%) collected from houses of the case group showed positive infected by M. leprae bacilli, i.e. S05 and S09 respectively. Of all samples of dust collected from houses of non-leprosy patients (the control group), 4 dust samples (14%) was positive infected by Mycobacterium leprae, i.e. C03, C05, C09, C11 respectively, and 2 non-leprosy patients were infected by M. leprae due to close social interactions with leprosy patients. Conclusion: Dust medium and close social interactions were the causal factors for the transmission of leprosy disease. Therefore, it is suggested to conduct strict control to prevent the widespread of leprosy disease by keeping the cleanliness of houses at the local areas and the surrounding environment as well as the caution to do social interactions with leprosy individuals. [ABSTRACT FROM AUTHOR]

A subset of neuritic form of leprosy, called pure neuritic leprosy (PNL), seen in a minority of leprosy patients, is characterized by peripheral neuropathy without skin lesions and an absence of acid‐fast bacilli on skin smears. Patients with PNL are often started on drug therapy without confirmation of diagnosis. We, therefore, did a prospective study of clinically diagnosed PNL patients with correlation of ultrasonographic and biopsy findings. A total of 100 consecutive patients with PNL, diagnosed according to the consensus case definition, were included in the study. All patients underwent nerve conduction study, peripheral nerve ultrasonography, and sural nerve biopsy. Multiple mononeuropathies were present in 75% of cases, mononeuropathy in 18%, and polyneuropathy in the remaining 7%. Compared to clinical examination, ultrasonographic assessment of the peripheral nerves was not only better at the detection of thickening but also helped in characterization of their fascicular architecture, echogenicity, and vascularity. A total of 32 cases were confirmed on nerve biopsy, out of which 75% had demonstrable lepra bacilli. Cranial nerve involvement, presence of trophic ulcers, and bilateral thickening of the great auricular nerve were significantly associated with the positivity of lepra bacilli. A significant improvement in the disability score happened after multidrug therapy. A comprehensive electrophysiologic, ultrasonographic, and histological evaluation may be helpful in establishing a diagnosis of PNL with greater confidence, while ruling out other non‐leprosy diagnoses. [ABSTRACT FROM AUTHOR]

Background: Trophic ulcers secondary to leprosy pose a great stigma to patients and remain a challenge to the treating dermatologists. Platelet-rich plasma (PRP) introduces growth factors directly into the wound and aids in rapid healing. The role of PRP in the treatment of trophic ulcers in leprosy patients has not yet been established by randomized controlled trials.Aims: To study the effectiveness and safety of autologous PRP therapy with total contact casting versus total contact casting alone in the treatment of trophic ulcers in leprosy.Methods: In an observer-blind, randomized (1:1) controlled study, 118 patients were enrolled. PRP was prepared by the manual double-spin method (1600 rpm for 10 min followed by 4000 rpm for 10 min). After wound bed preparation, activated PRP was injected intra- and perilesionally, and platelet-poor plasma gel was applied over the ulcer bed. Occlusive dressings and total contact casting were then applied in Group A, and only total contact casting was applied in Group B. The same procedure was repeated every 2 weeks for 8 weeks.Results: In all, 56 patients were analyzable in Group A and 52 in Group B. The surface area of the ulcer decreased significantly from first follow-up onward in both the groups (P < 0.001 in both the groups). Intergroup comparison showed that the reduction in the surface area of the ulcer was significantly more in Group A than in Group B from the first follow-up onward (P = 0.038) and the difference was maintained till the fifth follow-up (P < 0.001). At the end of the study, 91.10 ± 9.65% ulcer surface area reduction had occurred in Group A, whereas it was 79.77 ± 17.91% in Group B (P < 0.001). Trophic ulcers healed completely more often in paucibacillary leprosy patients (P < 0.001) and in those with a lower initial surface area of the ulcer (P < 0.001).Limitation: Short duration of treatment (8 weeks).Conclusion: PRP combined with total contact casting accelerates the healing of trophic ulcers of leprosy and is more effective than total contact casting alone. Complete remission is more likely to occur when the duration and surface area of ulcer are less and in the paucibacillary spectrum. [ABSTRACT FROM AUTHOR]

Background: Leprosy was declared to be eliminated from India in 2006, but recent reports point to an increase in newly detected cases despite the overall fall in prevalence.Aim: This study aimed to analyze the patterns and trends of epidemiological and operational indicators of leprosy at a tertiary care center in northern India over a decade.Methods: This is a 10-year retrospective study from 2005 to 2014 conducted at the urban leprosy centre (ULC) of the Department of Dermatology, Venereology, and Leprology, Government Medical College, Jammu (J and K), India. Data were obtained from the preformatted standard leprosy cards of the urban leprosy centre. Details of demographic data, clinical features, smear results and treatment received were collected from individual cards and analyzed to observe various epidemiological trends.Results: A total of 743 cases were analyzed for the period 2005-2014, of which 8.6% were childhood cases, 52.5% patients were immigrants, and 56.4% were farmers and laborers. Lepromatous cases showed a significantly increasing trend when compared with tuberculoid cases (P < 0.05). Smear positivity was seen in 29.6% of cases and showed an increasing trend (P < 0.05). An important observation was the increase in multibacillary cases. World Health Organization (WHO) grade 2 disability also showed an increasing trend over the past decade pointing to delayed diagnosis.Limitation: The study is limited by its retrospective design.Conclusion: The increasing trend of lepromatous and multibacillary cases and cases with grade 2 disability is a poor sign as it indicates delays in diagnosis. Further, smear-positive cases contribute to continued transmission of disease in the community. Leprosy has been declared to be eliminated, but recent reports including the present study suggest a rise in newly detected cases and hence in disease burden. [ABSTRACT FROM AUTHOR]

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae affecting the skin, peripheral nervous system, and other tissues. The disease is associated with social stigma, and the patients sometimes suffer social discrimination because it often leads to visible physical deformities. Hence, leprosy may have severe impact on the quality of life (QoL) of patients. Aims and Objectives: The aim of this study was to assess the effect of leprosy on the QoL of the affected patients and to find out whether there is some association with certain demographic and clinical factors. Materials and Methods: The Dermatology Life Quality Index (DLQI) questionnaire was used to assess the QoL of 114 patients with leprosy who attended dermatology outpatient department of a tertiary care center of eastern India. This was a cross-sectional study. Results: Among a total of 114 patients, leprosy had no impact on the QoL of 15 (13.16%) patients. There was a mild impact in 23 (20.18%) of the patients. There was moderate impact in 37 (32.46%) of the patients. The disease had severe impact in the QoL of 39 (34.21%) patients. None of the patients had a very severe impact. Several of the clinical aspects such as nerve involvement, systemic features, deformity, disability grade, and type of leprosy have significant impact on QoL. Among the demographic factors, gender had some effects on QoL. Conclusion: Leprosy adversely affects the QoL of those affected. Although it is considered a social disease, at least in our part of the country, demographics have minimal effect on the QoL. Rather, important clinical aspects such as systemic features, nerve involvement, reaction, deformity, and disability have profound impact on the QoL of the patients. [ABSTRACT FROM AUTHOR]

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BACKGROUND Leprosy is an infectious disease that is still a health problem worldwide, including in Indonesia. The clinical symptoms are similar to other skin diseases and it is difficult to establish a diagnosis for paucibacillary (PB) leprosy. Current serological and histopathological tests have limitations, especially in patients with negative acid-fast bacilli (AFB). Serological tests often give false-negative results, while histopathological results often consist of non-specific inflammation. Probe-based real-time polymerase chain reaction (RT-PCR) assays is an alternative test that may be more sensitive and more specific to detect Mycobacterium leprae. METHODS This study was done in June 2015 until March 2016; detected M. leprae in PB patients with negative AFB smears using TaqMan® probe-based RT-PCR assay on slit skin scrapings and skin biopsy specimens from 24 patients. The skin scrapings were obtained from skin tissue on ear lobes, skin lesions, as well as those from biopsy. Samples were tested with RT-PCR while histopathological examinations were only performed on skin from biopsy. RESULTS The RT-PCR assay showed positive results of 21%, 25%, and 96% for specimens obtained from skin scrapings of the ear lobe, skin lesions, and skin biopsy, respectively. On the other hand, the positive rate for the histopathological test from skin biopsy was 79%. It indicated that the TaqMan® RT-PCR assay could increase the diagnostic capacity of histopathological examination by as much as 17%. CONCLUSIONS TaqMan® PCR assay can improve the diagnostic capacity of histopathological examinations, which could be used as the new gold standard for the diagnosis of leprosy. [ABSTRACT FROM AUTHOR]

Case presentation: We report on a German leprosy patient originating from Pakistan who had a relapse more than 5 years after completion of multi-drug therapy (MDT) of his first episode of multibacillary (MB) leprosy. State-of-the-art laboratory techniques (histopathology, PGL-I serology, microscopy and DNA/RNA qPCR) were applied for laboratory confirmation and monitoring of treatment outcome. Serology indicated the relapse long before the presence of unambiguous clinical signs. At the time of diagnosis of the relapse the patient had a remarkably high bacterial load suggesting increased risk for a second relapse. Furthermore, unexpectedly prolonged excretion of viable bacilli through the upper respiratory tract for more than 3 months after onset of MDT was shown. Therefore, MDT was administered for 2 years. Discussion and conclusions: The clinical course of the patient, as well as the prolonged excretion of viable bacilli, underlines the usefulness of laboratory assessment. Laboratory tools including up-to-date molecular assays facilitate rapid diagnosis, timely MDT, identification of individuals excreting viable bacilli and patients at risk for relapses, monitoring of treatment outcome and respective adaptation of treatment where appropriate. [ABSTRACT FROM AUTHOR]

This article reports an unusual case of neuropathic orofacial pain secondary to leprosy. To the authors' knowledge, it is the first case of leprosy reported in the Western literature that was initially thought to be dental pain, then mistaken as a temporomandibular disorder before the correct diagnosis was made. The patient had migrated to Australia from India 24 years previously and was otherwise healthy without any overt features suggestive of infection. A review of the literature revealed that the trigeminal nerve is frequently involved in leprosy, usually associated with sensory loss rather than neuropathic pain. Even in Western countries, patients originally from countries where leprosy is endemic may develop symptoms of the disease many years later. The possibility of leprosy should be considered in the diagnosis of neuropathic orofacial pain in such patients. [ABSTRACT FROM AUTHOR]