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Mycobacterium leprae causes leprosy, which is a chronic infectious disease. It mostly affects the body's cooler portions, such as the skin and peripheral nerves. Leprosy causes a variety of biochemical and immunological alterations in the body, as well as trace metals including zinc, copper, and magnesium. Zinc is the second most abundant trace element in the body, after iron. This study aimed to correlate with clinical manifestations wherever possible and to look into the level of serum zinc in leprosy patients. A total of 63 people with newly diagnosed leprosy were included in the study.The cases were then divided into clinical subgroups and compared to the controls. Venous blood samples were taken, and serum zinc levels were estimated using serum. The majority of patients (26.9) had Intermediate Leprosy, while the minority (1.58) had Histoid Leprosy. Pure tuberculoid and indeterminate leprosy patients had the lowest serum zinc levels, whereas pure lepromatous and Erythema nodosum leprosum patients had the highest, indicating that leprosy patients with higher bacterial loads had lower serum zinc levels. This suggests that there could be a correlation between serum zinc levels and bacillary load.

Nevus depigmentosus (ND), also known as nevus achromicus or achromic nevus, is an uncommon congenital hypomelanosis of the skin that is often characterized as being nonprogressive and having serrated borders. It needs to be distinguished from other hypopigmented skin conditions such as nevus anemicus, hypomelanosis of Ito, Fitzpatrick patches (ash leaf spots) of tuberous sclerosis, vitiligo, indeterminate leprosy, and pigment demarcation lines. Treatment may be desired for aesthetic and possible psychosocial considerations. We review and update knowledge about ND and its simulants.

Background: Leprosy is a chronic, progressing, and disabling disease caused by Mycobacterium leprae, predominantly affecting the skin and peripheral nerves. Aim: The aim is to study clinicopathological correlation and response to treatment in leprosy patients attending King Fahd Hospital of University (KFHU), Al-Khobar, Eastern Saudi Arabia. Methodology: Records of all cases attending Dermatology Department of KFHU from 1985 to 2005 and labeled clinically as leprosy were retrieved. Their clinical data and histopathologic slides were reviewed. Many of the expatriates left Saudi Arabia after diagnosis. The remaining ones and Saudi nationals received the WHO standard treatment for 12 months and 18 months for paucibacillary and multibacillary leprosy, respectively. Results: Among 87 cases, there was a good clinicopathological correlation; the most common forms of leprosy clinically and histologically were of borderline leprosy (BB), 31 (35.63%) and 34 (39.08%), followed by tuberculoid type (TT), 22 (25.29%) and 27 (31.03%); lepromatous leprosy, 18 (20.69%) and 17 (19.54%); erythema nodosum leprosum (ENL), 6 (6.9%) and 5 (5.75%); indeterminate leprosy, 4 (4.6%) and 4 (4.6%); and nonspecific, 6 (6.9%). Thirty-two patients received the WHO standard treatment for paucibacillary and multibacillary leprosy, respectively; all cases showed complete clinical improvement with 24-month follow-up, except for two paucibacillary cases who developed ENL and lost follow-up after 16 months. Conclusions: There was a good clinicopathological correlation. The response to treatment was good in those who continued treatment and better in TT than lepromatous type of leprosy.

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

Background: Leprosy caused by Mycobacterium Leprae is an important public health concern. Single lesions in leprosy are commonly seen in TT, BT and indeterminate leprosy. Aim: The aim of the present study is to evaluate histopathological features of single lesions in different clinical types of leprosy and evaluate clinico histopathological correlation. Methods: Scalpel biopsies of single leprosy lesions from all 40 patients were done followed by staining of slides with Haemotoxilin and Eosin stains. A thorough study of histopathological features of slides was done followed clinico- histopathological correlation. Results: There were 7 cases of indeterminate leprosy, 27 cases of BT type and 6 cases of TT type clinically. There were clinico- histopathological correlations in 32.5% of the total cases. More clinico histopathological correlation was seen among TT type and least correlation was seen among BT type. Conclusion: There is clinico histopatholgical correlation in 32.5% of the total cases. More correlation is seen TT type of leprosy than in BT type of leprosy in single lesions.

Histoid leprosy is an uncommon variant of lepromatous leprosy characterized by unique histopathological findings and characteristic bacterial morphology. It occurs in patients relapsing after dapsone monotherapy, in the presence of dapsone resistance or at times de novo. Though it is commonly seen in lepromatous leprosy, very rarely it may be seen in borderline and indeterminate leprosy. We report here a case of de novo histoid leprosy with borderline tuberculoid leprosy because of its rarity.

Objective: To assess the profile and describe the clinical presentations and complications of childhood leprosy in a tertiary care hospital in North Kerala, South India during 2003–2012 and to analyse any change in the age-sex profile and the clinical pattern of leprosy in children below the age of 15 years over the 10-year study period. Design: A retrospective descriptive study of children less than 15 years of age diagnosed with leprosy and registered for treatment in a tertiary care institution from 2003 to 2012. Demographic, clinical, investigative and treatment data were collected using a pre-set proforma. Results: 138 (12.1%) of the total 1143 leprosy cases registered for treatment during the 10-year period were below 15 years of age. The 10-year study period witnessed a statistically insignificant decrease in the new childhood leprosy cases registered for treatment in our tertiary care institution. The majority of cases belonged to the 6–12 year age group (61.6%) with a male predominance. Borderline tuberculoid (BT) was the commonest clinical type (65.9%) followed by indeterminate leprosy (18.8%); 101 patients required paucibacillary (PB) and 37 needed multibacillary (MB) treatment. The number of patients requiring MB treatment showed a statistically significant increase and there was a significant decline in number of cases requiring PB treatment. During the entire study period no Type 2 lepra reaction was documented in patients below Hema 15 years and only two patients manifested Type 1 reaction. Ten (7.2%) out of the 138 patients were cases of relapse. There was a clear female predilection among relapse cases with the majority belonging to the adolescent age. Conclusions: Childhood leprosy still contributes to a significant proportion of the total case load denoting the continuing active horizontal transmission of leprosy. The rise in number of patients with more extensive disease in the background of declining disease prevalence is suggestive of the delay in diagnosis and treatment. A high relapse rate noted in the present study may be due to incorrect classification and treatment of MB as PB leprosy which in turn might have resulted in treatment failure due to inadequate treatment.

Leprosy is one of the oldest human bacterial disease recognized by a Norwegian scientist Armauer Hansen working in Bergen in 1873. Leprosy is still one of the infectious diseases and major health problem of developing countries. Leprosy is not a single entity but rather a spectral disease with varied clinico-pathological presentations. It is generally agreed that multibacillary cases (lapromatous and borderline lepromatous cases) are the most infectious for the community. This study has been taken to show the symptoms of leprosy and detection and management of indeterminate cases of leprosy

Introducción: La lepra Indeterminada corresponde a la forma inicial de la enfermedad clínicamente detectada, su diagnóstico es un reto tanto para el clínico como para el patólogo, ya que sus manifestaciones clínicas son inespecíficas y los hallazgos histopatológicos claves pueden ser difíciles de identificar. Sin embargo el diagnóstico de Lepra en su estado Indeterminado impacta en la disminución de la transmisibilidad de la enfermedad y en una menor discapacidad. Objetivo: Describir las características clínicas e histopatológicas de casos de Lepra Indeterminada en la población colombiana, incluyendo el estado de las fibras nerviosas intraepidérmicas utilizando el marcador de inmunohistoquímica PGP 9.5. Metodología: Estudio descriptivo. Se estudiaron las características clínicas e histopatológicas de 60 casos de Lepra Indeterminada y se realizó estudio de inmunohistoquímica con PGP 9.5 a 40 casos de Lepra Indeterminada para valorar las fibras nerviosas intraepidérmicas. Resultados: Se encontró que las características clínicas e histopatológicas de Lepra Indeterminada en población colombiana son similares a las de la población mundial. Se confirmó una disminución de las fibras nerviosas intraepidérmicas y dérmicas en casos de LI, con el estudio de inmunohistoquímica con PGP 9.5. Abstract Introduction: Indeterminate leprosy is the initial form of the disease clinically detected, the diagnosis is a challenge for both the clinician and the pathologist considering that clinical manifestations are nonspecific and the Histopathological key discoveries can be difficult to identify. However, diagnosis of leprosy in Indeterminate state impact on the reduction of the transmissibility of the disease and less disability. Objective: Describe the clinical and histopathological features of Indeterminate leprosy cases in Colombian population, including the status of intraepidermal nerve fibers using immunohistochemical marker PGP 9.5. Methodology: descriptive study. Clinical and histopathological features of 60 cases of Indeterminate leprosy were studied and immunohistochemical analysis was performed with PGP 9.5 to 40 cases of Indeterminate leprosy to assess intraepidermal nerve fibers. Results: We found that the clinical and histopathological features of Indeterminate leprosy in Colombian population are similar to those of the world population., A decrease of intraepidermal and dermal nerve fibers was confirmed in cases of Indeterminate leprosy by the study using PGP 9.5 immunohistochemistry. Otra

An infant, 8 months old having histologically confirmed indeterminate leprosy is reported. The source of infection and possible mode of transmission are discussed.

Leprosy is a chronic, infectious disease caused by Mycobacterium leprae . It mainly affects the peripheral nervous system, skin, and certain other tissues such as the reticulo-endothelial system, bones and joints, mucous membranes, eyes, testes, muscles, and adrenals. Leprosy clinical presentation varies from few to widespread lesions. In most patients, early leprosy presents as macular and hypopigmented lesions. This initial clinical presentation is known as indeterminate leprosy and occurs in individuals who have not developed cell-mediated immunity against M leprae yet. The number of lesions depends on the genetically determined cellular immunity of the patient. Individuals presenting a vigorous cellular immune response and limited humoral immune responses to M leprae , usually present few skin lesions. Without treatment, those patients tend to evolve into the polar tuberculoid or borderline tuberculoid form of leprosy. Due to the inability to mount an effective cellular-mediated response to M leprae and the consequent hematogenous spread of the bacilli, some patients may present with numerous and symmetrically distributed hypochromic lesions. Without treatment these patients evolve to a nonresistant form of leprosy, polar lepromatous.

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

Background: Rheumatic complications are common in leprosy (Hansen's disease) and can be the primary complaint delaying accurate diagnosis. Objective: Such a case is reported here: a 61-year-old woman with indeterminate leprosy presented with symmetric arthritis and purpura. Despite biopsy and evaluation by several physicians, leprosy was not suspected. After 2 years of progressive symptoms, a second biopsy revealed lepromatous leprosy. Conclusion: In this case, lack of clinical suspicion and unfamiliarity with the histology of indeterminate leprosy delayed diagnosis and treatment. Leprosy should be considered in the differential diagnosis of patients presenting with unusual rheumatic and persistent cutaneous manifestations.

A single, indeterminate leprosy lesion localised exclusively to a smallpox vaccination scar in a 32-year old Indian male is reported. The diagnosis was confirmed by histopathology. This is the second published report of a leprosy lesion occurring at the site of a smallpox vaccination.

The introduction of multidrug therapy has efficiently controlled leprosy in developing countries. However, Mycobacterium laprae may survive and cause relapse despite adequate treatment with antileprosy drugs. Relapse may be characterized by a combination of new signs or symptoms and presence of acid-fast bacilli on skin or nerve biopsy samples. We report a case of a child in whom ulnar abscess developed 12 months after successful completion of multidrug therapy with clinical and histopathological evidence of relapse.

11歳の女子の未定型群らいの1例を報告した。初診の約2ヵ月まえに脱毛と白毛を伴う低色素斑4個が出現した。DDS50mg連日投与し治療約3ヵ月で略治した。未定型群らいの皮疹は浸潤を伴わない淡紅色斑や低色素斑である。乾燥性で時に粃糠様鱗屑を伴う。知覚鈍麻, 脱失は軽度であることが多く判定に迷うことも多い。組織学的にも特徴的所見がみられず, らいの2型2群のうちもっとも診断が難しい病型と考えられた。らいの診断ならびに他の疾患との鑑別に重要な末梢神経内らい菌の検索に過よう素酸·カルボール·パラロザニリン法(原田法)とS-100蛋白の免疫染色が有用であるが, 本症例では同染色法で菌陰性であった。しかし末梢神経の部分的変性像が認められた。琉球大学附属病院では1982年∼1991年の10年間に6名の小児らいを経験しており沖縄県では新患がまだしばらく発見されることが予想された。

Objective To examine the potential role of angiogenesis in leprosy. Design Immunohistochemical analysis of leprosy lesions. Setting Department of Dermatology, Venereology, and Leprology, Kasturba Medical College; Division of Dermatology, University of California at Los Angeles; and Departments of Dermatology and Pathology, Emory University. Patients Thirty-two cutaneous lesions that represented the spectrum of leprosy were obtained from 32 patients. Main Outcome Measure CD31 microvessel counts. Results The mean CD31 microvessel count in borderline tuberculoid, midborderline, and lepromatous leprosy lesions was significantly higher than in indeterminate leprosy lesions. Conclusions Increased bacterial load is associated with increased angiogenesis. Angiogenesis inhibitors may be of benefit in the treatment of leprosy.

We report two cases of Hansen's disease. Case 1 was 71-year old Japanese man who developed left ulnar nerve palsy since 7 years ago, multiple erythema on his body since 2-3 years ago, and erythematous nodules on his face since 3 months ago. He had no history of living outside Ibaraki prefecture. The clinical feature, the skin biopsy, laboratory data showed that he had borderline lepromatous leprosy. He was treated with multi-drug therapy which was effective and was stopped 3 years after the bacterial index showed negative. Ten months later, erythema on his body and face appeared and the therapy was restarted. Case 2 was 68-year old Japanese man who developed 5 cm of nummular erythema with slight numbness on his right forearm since 3 months ago. He had lived in Brazil since he was 24 to 64 years old. The skin biopsy showed epithelioid cell granuloma in the dermis involving vessels and nerves. Polymerase chain reaction test showed the M.leprae DNA, and he was diagnosed as indeterminate leprosy. He was treated with dapson and rifampicin and 2 months later, erythema and numbness disappeared.

The density and distribution of mast cells was assessed in skin biopsies of 118 untreated leprosy cases and 20 healthy individuals taken as controls. Mast cells were present in only small numbers in the skin biopsies of healthy individuals. Significantly higher mast cell counts were obtained in the skin lesions of indeterminate leprosy (P < 0.01). The mast cell count in the tuberculoid group was significantly lower than that in the lepromatous group (P < 0.05). The lepromatous group also showed increased mast cell degranulation and altered morphology. The mast cell distribution in the skin biopsies of the two groups was, however, similar. The mast cell count in leprosy is probably determined by the pattern of cytokines released by the T lymphocytes. However, the influence of mast cells on the outcome of the disease needs to be evaluated further.

The objective of this paper is to encourage histopathologists to recognize and diagnose leprosy so that it can be treated effectively at the earliest stage possible, before irreversible deformities result. Recognition of the earliest form of leprosy-indeterminate-is emphasized. Histopathologic descriptions are made and illustrated for the principal types of leprosy. Emphasis is placed on (1) the need for dependable acid-fast staining of leprosy bacillus, (2) the non-specific infiltrate in indeterminate leprosy, and (3) the involvement of nerves in all types of leprosy.

Children numbering 2095 residing in 6 leprosy endemic villages of Pondicherry Union Territory were examined for evidence of leprosy by going door to door. The prevalence of leprosy among children was 32.46 per thousand. Sex specific prevalence rates were 29.40 and 35.58 per thousand for boys and girls respectively. Harijan children showed the highest prevalence rate of 53.73 per thousand. Only 25.9 percent gave the history of contact The type specific prevalence rates were found to be 7.63 per thousand for indeterminate leprosy, 23.38/1000 for tuberculoid leprosy and 1.43/1000 for borderline leprosy. Single skin lesion was the commonest presenting symptom and was seen in 67.65 percent of the cases. Leprosy disability rate was 1.47 percent.

Because the correct diagnosis of indeterminate leprosy (IL) requires the finding of acid-fast bacilli in skin lesions from clinically and histopathologically suggestive cases, it is necessary to develop a reliable method for this purpose. This paper presents a simple procedure, available to every general laboratory, which consists in obtaining 2 suspensions: SI, by mincing and grinding the tissue in phosphate-buffered saline; and SII, after treating SI with NaOH solution and digesting with trypsin. In 22 IL skin biopsies, bacilli were directly observed in only 3 with the Ziehl-Neelsen (ZN) stain; and with the peroxidase-antiperoxidase method it was impossible to differentiate between nonspecific precipitate and true positive reactions. In contrast, 18 positive results from the same 22 samples were obtained when both SI and SII were evaluated with ZN stain. The logarithmic bacterial index was also increased in at least 7 cases.

A recent case of leprosy posing a diagnostic problem was seen by us at Fort Bragg, N. C. This disease is so unusual in the army that we feel this case worth publishing. In addition, a review of military experience with leprosy is presented, with recent concepts in diagnosis and therapy. Report of Case A 59-year-old white man, an officer, was admitted to U. S. Army Hospital, Fort Bragg, N. C., from the Orthopedic Clinic on April 1, 1954, for observation of skin lesions of the left lower leg, suspected to be due to Hansen's disease. The patient stated that he first noted a slightly red area on the lateral aspect of the left ankle in July, 1951. He consulted a physician after the lesion had been present for about one month, when it was about the size of a quarter. He was given nonspecific therapy after a diagnosis of