Clinical Diagnosis of Leprosy

Kumar, Dhananjay; Uprety, Shraddha; Dogra, Sunil

doi:10.1489/itl.2.1

Cited by 14 publications

(5 citation statements)

References 13 publications

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“…Within the Ridley-Jopling classification system, borderline leprosy denotes the disease state that exists between the two poles in the clinical spectrum of disease. Between tuberculoid leprosy (robust cell-mediated immunity with mild disease) and lepromatous leprosy (impaired immunity with high bacillary load), borderline leprosy represents an unstable transitional state in which cell-mediated immunity may shift to pole [20]. Because leprosy reactions result from these immunologic transitions, borderline leprosy accounts for the majority of reactions and overall burden of disease worldwide [20].…”

Section: Discussionmentioning

confidence: 99%

“…Between tuberculoid leprosy (robust cell-mediated immunity with mild disease) and lepromatous leprosy (impaired immunity with high bacillary load), borderline leprosy represents an unstable transitional state in which cell-mediated immunity may shift to pole [20]. Because leprosy reactions result from these immunologic transitions, borderline leprosy accounts for the majority of reactions and overall burden of disease worldwide [20]. Therefore, early recognition of the variable clinical features of this disease state is particularly important.…”

Section: Discussionmentioning

confidence: 99%

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Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report

Driedger,

Teo,

Roth

2023

BMC Infect Dis

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Background Leprosy is rare within non-endemic countries such as Canada, where cases are almost exclusively imported from endemic regions, often presenting after an incubation period of as many as 20 years. Due to its rarity and prolonged incubation period, diagnosis is often delayed, which may result in neurologic impairment prior to the initiation of treatment. In this report we describe a case that is novel in its incubation period, which is the longest reported to-date and may have contributed to diagnostic delay. The case also uniquely demonstrates the challenges of distinguishing leprosy reactions from new rheumatologic manifestations in a patient with established autoimmune disease. Case presentation We describe an 84-year-old male patient with rheumatoid arthritis on methotrexate and hydroxychloroquine, with no travel history outside Canada for 56 years, who presented in 2019 with new-onset paresthesias and rash. His paresthesias persisted despite a short course of prednisone, and his rash recurred after initial improvement. He underwent skin biopsy in May 2021, which eventually led to the diagnosis of leprosy. He was diagnosed with type 1 reaction and was started on rifampin, dapsone, clofazimine and prednisone, with which his rash resolved but his neurologic impairment remained. Conclusion This case report serves to highlight the potential for leprosy to present after markedly prolonged incubation periods. This is especially relevant in non-endemic countries that is home to an aging demographic of individuals who migrated decades ago from endemic countries. The importance of this concept is emphasized by the persistent neurologic impairment suffered by our case due to untreated type 1 reaction. We also demonstrate the necessity of skin biopsy in distinguishing this diagnosis from other autoimmune mimics in a patient with known autoimmune disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report

Driedger,

Teo,

Roth

2023

BMC Infect Dis

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“…The BI is a semi‐logarithmic scale of the density of M. leprae bacilli per oil immersion field; in LL bacilli may be grouped in clusters known as globi. 1 …”

Section: Case Reportmentioning

confidence: 99%

Localised erythema nodosum leprosum—A rare entity managed with thalidomide

Patel,

De Barros,

Walker

2024

Skin Health and Disease

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Leprosy is caused by Mycobacterium leprae. The condition primarily affects the skin and peripheral nerves. There are two types of leprosy reactions, Type 1 and Type 2 or erythema nodosum leprosum (ENL). ENL is a severe multi‐system, immune‐mediated complication of lepromatous leprosy. It is characterised by widespread painful cutaneous nodules, fever and peripheral oedema. This report discusses the unusual case of a 29‐year‐old woman who developed a localised form of ENL which required thalidomide to induce remission.

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“…Tuberculin skin tests (TST): Do not significantly crossreact with M. leprae infection; in one study of a population in which tuberculosis was highly endemic, 70% of controls had positive TST, but only 15-50% of leprosy patients had positive TST [29] .…”

Section: Skin Testsmentioning

confidence: 99%

A current perspective on leprosy (Hansen's disease)

Mostafa,

Soliman,

Far

et al. 2023

Int. J. Dermatol. Venereology Leprosy Sci.

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Leprosy is a chronic granulomatous disease, which affects dermis and peripheral nerves and also can involve the eye, the mucosa of the upper respiratory tract, muscle, bone, and testes, caused by the intracellular pathogen M.leprae. Leprosy is not highly contagious. It is challenging to spread by human-to human contact unless there is consistently close-living proximity with an infected individual. The skin is not important in leprosy transmission. Bacilli are not excreted by the skin and are rarely found in the epidermis. The various clinical manifestations of leprosy are not due to different strains of M. leprae but are rather the results of the variations in the host tissue response to the bacilli in the body. There are two classification Ridley-Jopling and WHO classification. The WHO classification is useful for allocating patients to treatment groups and should be used in peripheral centers where skin smears and histopathology are not available. Leprosy causes nerve damage and permanent disabilities including blindness and paralysis. People affected by leprosy face stigma and discrimination in society. Although multidrug therapy is available, millions of people are still affected by leprosy, so new vaccine, drug and disease management approaches are urgently needed for control, prevention and treatment of this disease.

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Clinical Diagnosis of Leprosy

Abstract: Clinical Diagnosis of Leprosy

Cited by 14 publications

References 13 publications

Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report

Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report

Localised erythema nodosum leprosum—A rare entity managed with thalidomide

A current perspective on leprosy (Hansen's disease)

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Clinical Diagnosis of Leprosy

Abstract: Clinical Diagnosis of Leprosy

Cited by 14 publications

References 13 publications

Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report

Leprosy with type 1 reaction in a patient from Ontario, Canada without recent travel misdiagnosed as vasculitic neuropathy: a case report

Localised erythema nodosum leprosum—A rare entity managed with thalidomide

A current perspective on leprosy (Hansen&#39;s disease)

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A current perspective on leprosy (Hansen's disease)