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This chapter deals with the etiology of disability in leprosy. The different dimensions of disability are introduced using the WHO International Classification of Functioning, Disability, and Health (ICF) framework. The major cause for disability is nerve function impairment (NFI). Nerve function assessment is briefly discussed, namely voluntary muscle testing and sensory testing with monofilaments. Distinction is made between primary and secondary impairments resulting from NFI. Simple exercises can prevent and overcome joint contractures as an often avoidable result of NFI. A major complication of loss of protective sensation are plantar ulcers. Basic principles regarding prevention of plantar ulcers and care for ulcers are presented.

The permanent paralytic deformities due to leprosy neuropathy can all be surgically corrected. Tendon transfer surgery can correct the muscular imbalance that may result from ulnar, median, and common peroneal paralysis. Surgery should be performed by surgeons who have had some training with a surgeon experienced in leprosy reconstructive surgery. Pre- and postoperative therapy by experienced therapists is equally important. Rehabilitation should also involve the social consequences of leprosy, e.g., inappropriate community attitudes, loss of work, etc., as they also often contribute to “disability.” Community-based rehabilitation involvement should be included in leprosy control projects to raise awareness, change attitudes, and ensure that leprosy-affected people can take and/or maintain their rightful places in society.

Background: To determine the health needs non-nationals, information on disease occurrence is fundamental. Goals: The goal of this study was to assess the clinical and behavioral characteristics of non-Italians with a new sexually transmitted infection (STI). Methods: Data were taken from Italy’s National STI Surveillance System (1991–1999). Results: Of the 61,798 STI cases reported from January 1991 to December 1999, 6847 (11.2%) were diagnosed among non-Italians, 47.1% of whom were Africans. Being a non-Italian patient with an STI was associated with male gender (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.11–1.27), youngest age (AOR, 1.71; 95% CI, 1.43–2.04), no formal education (AOR, 20.25; 95% CI, 17.51– 23.42), and having contracted the STI abroad (AOR, 13.98; 95% CI, 12.59 –15.54). The HIV-1 prevalence among non-Italian patients with STIs was 5.5% (95% CI, 4.9 – 6.2), with large differences by continent of origin. The highest prevalence was found among European injecting drug users (54.1%; 95% CI, 37.1–70.1), South American homosexual men (41.6%; 95% CI, 32.0 –51.8), and heterosexuals from Sub-Saharan Africa (8.9%; 95% CI, 7.2–10.8). Conclusions: Non-Italian patients with STIs seem to consist mainly of migrants, and STI transmission patterns differ from those among Italians; this information is important for developing targeted STI prevention efforts. THE MASSIVE MOVEMENT ALONG the modern migration routes represents one of the most important determinants of human health and of modifications in social status worldwide. In addition to the health implications for the migrants themselves, migration has an impact on the healthcare systems of the countries that host these persons. 1 So that these countries can better assess and satisfy the health needs of migrants, and of non-nationals in general, it is necessary to have adequate information on disease occurrence among these populations. Although such data should ideally be provided by national health surveillance systems or large multisite studies, this is rarely the case, and few national health statistics anywhere distinguish between disease cases among non-nationals and those found in the native population. 2

The specific dermatoses of pregnancy represent a recently reclassified heterogeneous group of pruritic inflammatory skin diseases unique to pregnancy that include pemphigoid gestationis, polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy, and atopic eruption of pregnancy (AEP). Among them, PEP and AEP are the most frequent ones. We performed a histopathological study of a series of PEP and AEP patients (n = 41). Twenty-two patients had PEP that started in the third trimester in 16 (73%) patients and postpartum in 6 (27%) patients. Histopathology revealed a superficial or superficial and deep perivascular dermatitis with eosinophils in all biopsies and signs of a lymphocytic vasculitis in 5 (23%) cases. Epidermal changes, including epidermal hyperplasia, spongiosis, and parakeratosis, occurred in 8 cases, in particular in elder lesions. Nineteen patients had AEP that started earlier [ less than third trimester, 14 (74%) patients; third trimester, 5 (26%) patients]. Clinically, 5 (26%) patients showed eczematous lesions, 7 (37%) papular lesions, 3 (16%) presented both eczematous and prurigo lesions, and 4 (21%) experienced exacerbation of preexisting atopic dermatitis. Histopathologically, AEP was characterized by a perivascular lymphohistiocytic infiltrate with frequent eosinophils (74%) and epidermal changes in all but most of P-type biopsies. No definitive differential histopathological criteria between PEP and AEP were found. Only lymphocytic vasculitis with a mixed infiltrate with eosinophils was more frequent in PEP patients. Timing of onset, morphology of skin lesions, and a detailed clinicopathologic correlation are essential for diagnosis.

Lepromatous leprosy (LL) represents the highest infective and multibacillary form of leprosy. Clinical manifestations are consequent to the haematogenous spread of bacilli and include macules, plaques and nodules in a symmetric distribution or a diffuse infiltration of the skin. LL may mimic many different inflammatory and neoplastic skin diseases and in a small percentage of patients, skin manifestation may be atypical. This article reports the case of a South American child with LL presenting with symmetrically distributed hypopigmented macules previously misdiagnosed as pytiriasis alba, atopic dermatitis and pityriasis versicolor. Atopy and pityriasis versicolor are common skin conditions that can be also observed in leprosy patients and that can masquerade the diagnosis of LL, especially if occurring in dark skin. Dermatologists in Europe should be aware of this unusual form of presentation of leprosy and must take in mind Hansen disease in the differential diagnosis in patients coming from endemic areas.

This study was undertaken to investigate the influence of beta 2-glycoprotein I (GPI) on anticardiolipin antibody (aCL) titration in leprosy. The study group consisted of 140 sera from patients with multibacillary leprosy (46 borderline, 94 lepromatous). The group included newly diagnosed, previously untreated patients, patients under treatment and patients released from treatment. GPI addition enhanced significantly the aCL titres in sera from lepromatous leprosy but not in those from borderline leprosy. Moreover, when the patients were classified according to their bacteriological status, aCL titres were found to be significantly higher in skin smear positive patients compared to bacteriologically negative patients. Thus, the present study demonstrates that aCL in multibacillary leprosy patients are mainly of the GPI-dependent type and emphasizes the importance of GPI addition for aCL titration in leprosy.