Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic

Leon, Kristoffer E.; Jacob, Jesse T; Franco‐Paredes, Carlos; Kozarsky, Phyllis E.; Wu, Henry M.; Fairley, Jessica K.

doi:10.1093/ofid/ofw063

Cited by 28 publications

(34 citation statements)

References 21 publications

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“…Leprosy is also known to occur in the United States with cases from Louisiana, Texas, Mississippi, Georgia, and Florida. 4 Skin and peripheral nerve affliction in leprosy has been extensively studied and published, but reports on involvement of the central nervous system (CNS) and proximal nerves are extremely rare. [5][6][7] Clinical and histopathological findings on skin and nerve tissue are usually sufficient to diagnose leprosy.…”

Section: Introductionmentioning

confidence: 99%

Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging–Based Study

Polavarapu

Preethish‐Kumar

Vengalil

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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Neurotropism and infiltration by Mycobacterium leprae of peripheral nerves causing neuropathy are well established, but reports of central nervous system (CNS) damage are exceptional. We report CNS magnetic resonance imaging (MRI) abnormalities of the brain and spinal cord as well as lesions in nerve roots and plexus in leprosy patients. Eight patients aged between 17 and 41 years underwent detailed clinical, histopathological, and MRI evaluation. All had prominent sensory-motor deficits with hypopigmented and hypo/anesthetic skin patches and thickened peripheral nerves. All demonstrated M. Leprae DNA in affected peripheral nerve tissue. All received multidrug therapy (MDT). Two patients had brainstem lesions with enhancing facial nuclei and nerves, and one patient had a lesion in the nucleus ambiguus. Two patients had enhancing spinal cord lesions. Follow-up MRI performed in four cases showed resolution of brainstem and cord lesions after starting on MDT. Thickened brachial and lumbosacral plexus nerves were observed in six and two patients, respectively, which partially resolved on follow-up MRI in the two cases who had reimaging. The site and side of the MRI lesions corresponded with the location and side of neurological deficits. This precise clinico-radiological correlation of proximal lesions could be explained by an immune reaction in the gray matter corresponding to the involved peripheral nerves, retrograde axonal and gray matter changes, or infection of the CNS and plexus by lepra bacilli. Further study of the CNS in patients with leprous neuropathy is needed to establish the exact nature of these CNS MRI findings.

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Section: Introductionmentioning

confidence: 99%

Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging–Based Study

Polavarapu

Preethish‐Kumar

Vengalil

et al. 2019

The American Journal of Tropical Medicine and Hygiene

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“…M. leprae is a noncultivable obligate intracellular pathogen with a slow division time that targets peripheral nerves by predominantly infecting Schwann cells and histiocytes and keratinocytes in the skin (72,74,(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88)(89)(90). The entry of the M. leprae bacillus into the Schwann cell activates the cell to enter into a dedifferentiation process.…”

Section: Leprosymentioning

confidence: 99%

“…4) (72,74,78). Leprosy reactions, due to their potential inflammatory compromise of the nerve fibers, lead to sensory and motor loss (85,(90)(91)(92). Histologically, intraneural or perineural granulomas may assist the pathologist in distinguishing leprosy from cutaneous tuberculosis (47).…”

Section: Leprosymentioning

confidence: 99%

Cutaneous Mycobacterial Infections

et al. 2018

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SUMMARY Humans encounter mycobacterial species due to their ubiquity in different environmental niches. In many individuals, pathogenic mycobacterial species may breach our first-line barrier defenses of the innate immune system and modulate the activation of phagocytes to cause disease of the respiratory tract or the skin and soft tissues, sometimes resulting in disseminated infection. Cutaneous mycobacterial infections may cause a wide range of clinical manifestations, which are divided into four main disease categories: (i) cutaneous manifestations of Mycobacterium tuberculosis infection, (ii) Buruli ulcer caused by Mycobacterium ulcerans and other related slowly growing mycobacteria, (iii) leprosy caused by Mycobacterium leprae and Mycobacterium lepromatosis, and (iv) cutaneous infections caused by rapidly growing mycobacteria. Clinically, cutaneous mycobacterial infections present with widely different clinical presentations, including cellulitis, nonhealing ulcers, subacute or chronic nodular lesions, abscesses, superficial lymphadenitis, verrucous lesions, and other types of findings. Mycobacterial infections of the skin and subcutaneous tissue are associated with important stigma, deformity, and disability. Geography-based environmental exposures influence the epidemiology of cutaneous mycobacterial infections. Cutaneous tuberculosis exhibits different clinical phenotypes acquired through different routes, including via extrinsic inoculation of the tuberculous bacilli and dissemination to the skin from other sites, or represents hypersensitivity reactions to M. tuberculosis infection. In many settings, leprosy remains an important cause of neurological impairment, deformity, limb loss, and stigma. Mycobacterium lepromatosis, a mycobacterial species related to M. leprae, is linked to diffuse lepromatous leprosy of Lucio and Latapí. Mycobacterium ulcerans produces a mycolactone toxin that leads to subcutaneous tissue destruction and immunosuppression, resulting in deep ulcerations that often produce substantial disfigurement and disability. Mycobacterium marinum, a close relative of M. ulcerans, is an important cause of cutaneous sporotrichoid nodular lymphangitic lesions. Among patients with advanced immunosuppression, Mycobacterium kansasii, the Mycobacterium avium-intracellulare complex, and Mycobacterium haemophilum may cause cutaneous or disseminated disease. Rapidly growing mycobacteria, including the Mycobacterium abscessus group, Mycobacterium chelonei, and Mycobacterium fortuitum, are increasingly recognized pathogens in cutaneous infections associated particularly with plastic surgery and cosmetic procedures. Skin biopsies of cutaneous lesions to identify acid-fast staining bacilli and cultures represent the cornerstone of diagnosis. Additionally, histopathological evaluation of skin biopsy specimens may be useful in identifying leprosy, Buruli ulcer, and cutaneous tuberculosis. Molecular assays are useful in some cases. The treatment for cutaneous mycobacterial infections depends on the specific pathogen and therefore requires a careful consideration of antimicrobial choices based on official treatment guidelines.

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“…Another important point is that the leprosy does not come to mind because of the rare occurrence in some areas and the patients are followed up with false diagnoses. The implementation of information programs for healthcare professionals is also important in this context [114][115][116].…”

Section: Prevention Of Disabilitymentioning

confidence: 99%

An Update on the Epidemiology, Diagnosis and Treatment of Leprosy

Akpolat¹,

Akkus²,

Kaynak³

2019

Hansen's Disease - The Forgotten and Neglected Disease

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Leprosy is a granulomatous, chronic infection caused by Mycobacterium leprae that has been reported for than 2000 years. The infection primarily affects the skin and peripheral nerves.M. leprae is bacterium that cannot be cultured in vitro and transmission and pathophysiological data is still uncertain and limited. Today the prevalence of this ancient disease is declining in most around the world. This decline is a direct effect of widespread administration by public health workers of multidrug therapy. However, emerging despite the use of multidrug therapy, identifying and monitoring resistance are still necessary.

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Delayed Diagnosis, Leprosy Reactions, and Nerve Injury Among Individuals With Hansen's Disease Seen at a United States Clinic

Abstract: This case series of patients from a Hansen's disease clinic focuses on the frequency of delays in diagnosis and of HD reactions, both known risk factors for nerve damage.

Cited by 28 publications

References 21 publications

Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging–Based Study

Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging–Based Study

Cutaneous Mycobacterial Infections

An Update on the Epidemiology, Diagnosis and Treatment of Leprosy

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