Inoculation Leprosy Subsequent to Small-Pox Vaccination

Sehgal, V N; Rege, V. L.; Vadiraj, S.N.

doi:10.1159/000252506

Cited by 11 publications

(5 citation statements)

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“…Although the PCR positivity rates of the two anatomic sites were no different when compared statistically, the finding supports a role for skin and nasal exposure in transmission of leprosy. Further supporting the role of skin in transmission are reports by Sehgal and others [21][22][23] and Abraham and others, 9 documenting cases of leprosy that developed in the skin at sites of trauma.…”

Section: Discussionmentioning

confidence: 77%

Transmission of Leprosy: A Study of Skin and Nasal Secretions of Household Contacts of Leprosy Patients Using PCR

Job

Jayakumar²,

Kearney³

et al. 2008

The American Journal of Tropical Medicine and Hygiene

123

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It is generally held that dissemination of Mycobacterium leprae is from nasal mucosa and not through the skin of infected patients. In this study, we evaluated M. leprae in the unbroken skin and nasal secretions of multibacillary (MB) leprosy patients and their contacts. Specimens were examined by direct microscopy and polymerase chain reaction (PCR) for M. leprae DNA. Results showed that 60% of untreated MB leprosy patients examined histologically had acid-fast bacilli in the keratin layer. By PCR studies it was found that 80% of the patients had M. leprae DNA in skin washings and 60% had M. leprae DNA on swabs obtained from the nasal mucosa. Ninety-three contacts of the untreated MB cases were also tested for exposure to M. leprae by analyzing skin washings and nasal secretions by PCR. PCR analysis showed significant skin (17% positive) and nasal muscosal (4%) exposure in contacts before instituting treatment of the index cases. After 2 months of treating the index cases, all contacts tested were negative for M. leprae DNA. These data suggested that both skin and nasal epithelia of untreated MB leprosy patients contribute to the shedding of M. leprae into the environment and contacts of untreated MB cases are at risk for contact with M. leprae through both the nasal mucosa and exposed surfaces of their skin.

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Section: Discussionmentioning

confidence: 77%

Transmission of Leprosy: A Study of Skin and Nasal Secretions of Household Contacts of Leprosy Patients Using PCR

Job

Jayakumar²,

Kearney³

et al. 2008

The American Journal of Tropical Medicine and Hygiene

123

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“…Subsequently, several cases of tattoo inoculation leprosy were reported, mostly from India 3–7 . Interestingly, leprosy lesions have also been reported at the site of roadside injuries 8,9 vaccination 10,11 and dog bite 12,13…”

Section: Commentsmentioning

confidence: 99%

Inoculation (tattoo) leprosy: a report of 31 cases

Ghorpade¹

2002

Acad Dermatol Venereol

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Thirty-one female patients with leprosy lesions starting over tattoo marks observed over a period of 16 years are reported. All the patients belonged to the Chhattisgarh State, which is highly endemic for leprosy. Most of the patients were in the third decade of life. All of them had ornamental tattooing done by roadside tattoo artists, who used unsterile needles for tattooing a large gathering one after another with the same needles. In all of them, the first lesion of leprosy started over a tattoo mark. Twenty-five cases had only single lesion of leprosy exclusively confined to tattoo marks. The duration between tattooing and appearance of first lesion in most of the cases varied from 10 to 20 years. Paucibacillary leprosy was the commonest type observed in 29 cases, while two had multibacillary leprosy. The diagnosis was confirmed by histopathology in all cases. The present report supports the hypothesis of transmission of leprosy in these cases through tattooing. To the best of our knowledge, such a large collection of leprosy cases subsequent to tattooing has not been reported so far.

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“…Sehgal et al ., 17 who published the first report of tuberculoid leprosy over a smallpox vaccination scar in 1970, conjectured that, if one or two lesions of leprosy are present, the possibility of inoculation leprosy should be considered. Earlier publications 2–6 and the present report are strongly supportive of one of Koch's postulates, which are yet to be fulfilled 1 .…”

mentioning

confidence: 99%