An Epidemiologist's View of Leprosy KENNETH W
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
(ERYTHEMA NODOSUM LEPROSUM) the Term
? THE HISTOPATHOLOGY OF ACUTE PANNICULITIS NODOSA LEPROSA (ERYTHEMA NODOSUM LEPROSUM) w. J. PEPLER, M.B., Ch.B. Department of Pathology, South African Institute for Medical Research, Johannesburg R. KOOIJ, M.D. Westfort Institution, Pretoria AND J. MARSHALL, M.D. University of Pretoria, Pretoria The term "erythema nodosum leprosum" has frequently appeared in the literature on leprosy since the 1930's, apparently popularized by the Japanese (9). The occurrence of "erythema nodosum" in leprosy had previously been noted at the end of the nineteenth century by Brocq (6) and by Hansen and Looft (8), but the term seems to have fallen into disuse. As will become clear from our clinical and histological descriptions of the phenomenon commonly known as erythema nodosum leprosum, we believe the title to be a misnomer. We suggest that it would be more accurate to call it panniculitis nodosa leprosa (P.N.L,). This condition is commonly confused with acute lepra reaction, both processes being referred to as "acute reactions"; but a sharp line of distinction must be drawn between them. P.N.L. occurs only in patients with lepromatous leprosy as an acute, subacute or chronic skin eruption, with or without fever. It is characterized by showers of dusky red nodules, 0.5 to 2 cm. in diameter, on the extensor surfaces of the limbs, on the face, and, less often, on the trunk. The number of lesions appearing in an attack varies from a few to several hundreds, and they sometimes coalesce to form plaques. The nodules may be painful, and they are usually tender to touch. -
Chapter 3 Bacterial and Viral Infections
GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge. -
Leprosy – Eliminated and Forgotten: a Case Report Shiva Raj K.C.1,5* , Geetika K.C.1, Purnima Gyawali2, Manisha Singh3 and Milesh Jung Sijapati4
K.C. et al. Journal of Medical Case Reports (2019) 13:276 https://doi.org/10.1186/s13256-019-2198-1 CASE REPORT Open Access Leprosy – eliminated and forgotten: a case report Shiva Raj K.C.1,5* , Geetika K.C.1, Purnima Gyawali2, Manisha Singh3 and Milesh Jung Sijapati4 Abstract Background: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. -
Volume 61, Number 4, December 1990 Published Quarterly for The
Volume 61, Number 4, December 1990 LEPROSY REVIEW Published Quarterly for the British Leprosy Relief Association ISSN 0305-7518 Leprosy Review A journal contributing to the better understanding of leprosy and its control British Leprosy Relief Association LEPRA Editorial Board PRO~ESSOR J . L. TURK (Chairman and Edilor) DR R . J . W . R EES , C.M .G . (Vice-Chairman) The Royal Coll ege of Surgeons National Institute fo r Medical Research Department of Pa thology, The Ridgeway 35- 43 Lincoln's Inn Field Mill Hill, London NW7 IAA London W C2A 3PN JANE EVILLE, M .B.E. DR M . J . COLSTON 5 Sandall Close National Institute for Medical Research Ealin g The Ridgeway, Mill Hill Lo ndo n W 5 IJ E London NW7 I AA PROFESSOR P. E. M . FINE DR PATRI CIA ROSE Department of Epidemiology Allendale Ho use and Populati on Sciences A ll endale Road London School of H ygiene Hexha m N E46 2DE and Tropical Medicine Keppel Street DR M . F. R . WATERS , O .B. E. London W C I E 7HT Hospital fo r Tro pical Diseases DR S. LUCAS 4 St Pa ncras W ay School of Medicine Lo ndo n NW l OPE University Col1ege and Middlesex Medical School, London DR H . W . WH EATE , O .B.E. U ni versi ty Street 50 Avenue Road, Belmo nt, Sulto n Lo ndo n W C IE 6JJ Surrey SM2 6JB Editorial Office: Lepra, Fa irfax House, Causton Road, Colchester C01 1 PU , England Assistant Editor: Jennet Batten, 94 Church Road, Wheatley, Oxon OX9 1 LZ, England Leprosy Review is published by the British Leprosy Relief Association (LEPRA) with the main objective of contributing towards the better understanding of leprosy a nd its control. -
Lepromatous Leprosy Simulating Sweet Syndrome
ISSN: 2469-5750 Zemmez et al. J Dermatol Res Ther 2018, 4:056 DOI: 10.23937/2469-5750/1510056 Volume 4 | Issue 1 Journal of Open Access Dermatology Research and Therapy CASE REPORT Lepromatous Leprosy Simulating Sweet Syndrome Youssef Zemmez1*, Ahmed Bouhamidi1, Salwa Belhabib2, Rachid Frikh1, Mohamed Boui1 1 and Naoufal Hjira Check for updates 1Department of Dermatology-Venereology, Mohammed V Military Training Hospital, Rabat, Morocco 2Department of Pathological Anatomy, Mohammed V Military Training Hospital, Rabat, Morocco *Corresponding author: Youssef Zemmez, Department of Dermatology-Venereology, Mohammed V Military Training Hospital, Rabat, Morocco, Tel: 0658150805, E-mail: [email protected] Abstract Leprosy or Hansen's disease is an infection by Mycobac- terium leprae (M. leprae), whose prevalence has consid- erably decreased since the application of the new anti-lep- rosy strategies advocated since 1982 by the World Health Organization (WHO). However, in the endemic countries several cases of leprosy are reported annually. We report a clinical case of lepromatous leprosy revealed by dissemi- nated maculopapular lesions simulating a Sweet syndrome highlighting the importance of knowing how to evoke this diagnosis in patients from endemic areas. Keywords Lepromatous leprosy, Rash, Sweet syndrome Introduction Lepromatous leprosy is generally manifested by Figure 1: a) Maculopapular erythematous lesions of the non-inflammatory lesions, hypochromic macules, and face; b) Papulonodular erythematous lesions in forearms progressive erythematous papulo-nodules. We report and hands. an observation of lepromatous leprosy in a 62-year-old patient from rural Morocco who was diagnosed with abdomen (Figure 2a and Figure 2b). The neurological maculopapular lesions. examination showed hypoesthesia in gloves and socks, with bilateral hypertrophy of the ulnar nerve. -
Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting As
Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting as Chronic Ulcers with Vasculitis: A Case Report and Discussion Anny Xiao, DO,* Erin Lowe, DO,** Richard Miller, DO, FAOCD*** *Traditional Rotating Intern, PGY-1, Largo Medical Center, Largo, FL **Dermatology Resident, PGY-2, Largo Medical Center, Largo, FL ***Program Director, Dermatology Residency, Largo Medical Center, Largo, FL Disclosures: None Correspondence: Anny Xiao, DO; Largo Medical Center, Graduate Medical Education, 201 14th St. SW, Largo, FL 33770; 510-684-4190; [email protected] Abstract Leprosy is a rare, chronic, granulomatous infectious disease with cutaneous and neurologic sequelae. It can be a challenging differential diagnosis in dermatology practice due to several overlapping features with rheumatologic disorders. Patients with leprosy can develop reactive states as a result of immune complex-mediated inflammatory processes, leading to the appearance of additional cutaneous lesions that may further complicate the clinical picture. We describe a case of a woman presenting with a long history of a recurrent bullous rash with chronic ulcers, with an evolution of vasculitic diagnoses, who was later determined to have lepromatous leprosy with reactive erythema nodosum leprosum (ENL). Introduction accompanied by an intense bullous purpuric rash on management of sepsis secondary to bacteremia, Leprosy is a slowly progressive disease caused by bilateral arms and face. For these complaints she was with lower-extremity cellulitis as the suspected infection with Mycobacterium leprae (M. leprae). seen in a Complex Medical Dermatology Clinic and source. A skin biopsy was taken from the left thigh, Spread continues at a steady rate in several endemic clinically diagnosed with cutaneous polyarteritis and histopathology showed epidermal ulceration countries, with more than 200,000 new cases nodosa. -
Introduction to Bacteriology and Bacterial Structure/Function
INTRODUCTION TO BACTERIOLOGY AND BACTERIAL STRUCTURE/FUNCTION LEARNING OBJECTIVES To describe historical landmarks of medical microbiology To describe Koch’s Postulates To describe the characteristic structures and chemical nature of cellular constituents that distinguish eukaryotic and prokaryotic cells To describe chemical, structural, and functional components of the bacterial cytoplasmic and outer membranes, cell wall and surface appendages To name the general structures, and polymers that make up bacterial cell walls To explain the differences between gram negative and gram positive cells To describe the chemical composition, function and serological classification as H antigen of bacterial flagella and how they differ from flagella of eucaryotic cells To describe the chemical composition and function of pili To explain the unique chemical composition of bacterial spores To list medically relevant bacteria that form spores To explain the function of spores in terms of chemical and heat resistance To describe characteristics of different types of membrane transport To describe the exact cellular location and serological classification as O antigen of Lipopolysaccharide (LPS) To explain how the structure of LPS confers antigenic specificity and toxicity To describe the exact cellular location of Lipid A To explain the term endotoxin in terms of its chemical composition and location in bacterial cells INTRODUCTION TO BACTERIOLOGY 1. Two main threads in the history of bacteriology: 1) the natural history of bacteria and 2) the contagious nature of infectious diseases, were united in the latter half of the 19th century. During that period many of the bacteria that cause human disease were identified and characterized. 2. Individual bacteria were first observed microscopically by Antony van Leeuwenhoek at the end of the 17th century. -
Leprosy in Two Patients with Relapsing Remitting Multiple Sclerosis Treated with Fingolimod Alfred Balasa, M.D.1 and George J
Leprosy in Two Patients with Relapsing Remitting Multiple Sclerosis Treated with Fingolimod Alfred Balasa, M.D.1 and George J. Hutton, M.D.2 1 Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience; 2 Department of Neurology; Baylor College of Medicine, Houston, Texas Background A B Leprosy (Hansen’s disease) is a chronic infection caused by Mycobacterium leprae. The disease develops over months to years and may cause extensive damage to the skin and peripheral nervous system. A B In multiple sclerosis (MS), fingolimod treatment is Figure 3. Immune response in the polar clinical forms of leprosy. known to increase the risk for infections. There is one prior reported case of leprosy while on [A] In tuberculoid leprosy (TT) patients, the innate immune response is activated by M. leprae through toll-like receptors (TLR2/1). IL-15 fingolimod for relapsing remitting multiple sclerosis stimulates the vitamin D-dependent antimicrobial program in macrophages and inhibits phagocytosis of mycobacteria. These events (RRMS). We report two further cases of leprosy in promote a Th1 T-cell cytokine response (IFN-γ, IL-2, TNF, and IL-15) that contains the infection in well-formed granulomas, and a Th17 patients with RRMS and treated with fingolimod. C D response (IL-17A, IL-17F, IL-21 and IL-22) that leads to tissue inflammation and destruction, neutrophil recruitment, macrophage activation, and enhancement of Th1 effector cells. [B] In lepromatous leprosy (LL) patients, IL-4, IL-10, leukocyte immunoglobulin-like receptor subfamily A member 2 (LILRA2), and oxidized phospholipids inhibit TLR2/1-induced cytokine responses but preserve IL-10 release. -
Lepromatous Leprosy Masquerading As Rhinophyma
International Journal of Otorhinolaryngology and Head and Neck Surgery Krishna S et al. Int J Otorhinolaryngol Head Neck Surg. 2015 Jul;1(1):34-36 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20150585 Case Report Lepromatous leprosy masquerading as rhinophyma 1 1 1 2 Sowmyashree Krishna *, Malcolm Pinto , Manjunath Mala Shenoy , Mahesh SG 1 Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India 2Department of Otolaryngology-Head and Neck Surgery, A.J. Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India Received: 26 May 2015 Accepted: 24 June 2015 *Correspondence: Dr. Sowmyashree Krishna, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Leprosy a major global health problem, especially in the developing world, is an infectious disease caused by Mycobacterium leprae. Leprosy has a predilection to with cooler areas of the body. Lepromatous leprosy presents with varied manifestations like nodules, cervical lymphadenitis, hyperpigmented patches and other presentations which can mimic various other diseases and pose a diagnostic challenge in endemic areas. We report a case presenting with nodular infiltration of the nose mimicking rhinophyma who presented with faint reddish swelling over the nose which progressed to nodular infiltration. There was bilateral symmetrical thickening of nerves following which diagnosis was confirmed by slit skin smear and the patient was started on multibacillary multidrug therapy. -
6/12/2018 1 Infectious Dermatopathology
6/12/2018 Infectious Dermatopathology – What is “bugging” you? Alina G. Bridges, D.O. Associate Professor Program Director, Dermatopathology Fellowship ASDP Alternate Advisor to the AMA-RUC Department of Dermatology, Division of Dermatopathology and Cutaneous Immunopathology Mayo Clinic, Rochester Disclosures ▪Relevant Financial Relationships ▪None ▪Off Label Usage ▪No Background ▪ One of the most challenging tasks in medicine is the accurate and timely diagnosis of infectious diseases ▪ Classically, infectious disease diagnosis is under the domain of the microbiology laboratory ▪ Culture ▪ May not be performed due to lack of clinical suspicion ▪ Time consuming ▪ Not possible for some organisms ▪ May fail to grow organism due to prior antibiotic treatment, sampling error 1 6/12/2018 Background, continued ▪ Infectious diseases has always played a significant role in our specialty ▪ Many infectious diseases have primary skin manifestations ▪ Dermatopathologists offer invaluable information: ▪ Knowledge of inflammatory patterns and other similar appearing non-infectious conditions ▪ Visualize microorganisms and associated cellular background ▪ Colonization versus Invasion Course Objectives At the end of this course, participants should be able to: ▪ Identify common and important infectious organisms in dermatopathology specimens based on histopathologic features ▪ Develop an appropriate differential diagnosis based on morphologic features, clinical presentation, exposure history, and corresponding microbiology results ▪ Use an algorithm -
Immunological Aspects of Leprosy with Special Reference to Autoimmune Diseases 0
'Bull. Org. mond. Sante 1969, 41, 793-804 Bull. Wld Hlth Org. Immunological Aspects of Leprosy with Special Reference to Autoimmune Diseases 0. WAGER1 Leprosy, particularly lepromatous leprosy, is associated with a multitude of (auto) immune aberrations, and its clinical features also have much in common with the collagen diseases. Immunopathological studies of the 2 groups of diseases may thus elucidate the basic mechanisms of both. The reported evidencefor a genetically determined hyporeactivity ofcell-mediated (CM) immunity in lepromatous subjects is reviewed; most, but not all, of the findings fit such a hypothesis well. The possibility remains that the observed hyporeactivities may be secondary to direct effects of Mycobacterium leprae. Evidencefor a general hyperreactivity of the antibody-mediated (AM) immunity in lepromatous leprosy is then reviewed and considered to be fragmentary. The concept and general criteria of autoimmunity are discussed briefly and the high incidence in lepromatous leprosy of various (auto)immune aberrations, resembling those in systemic lupus erythematosus (SLE) and in rheumatoid arthritis is reviewed. Although autoantibodies are not likely to be directly deleterious to the host, immune complexes containing autoantibodies may be pathogenic. Mixed cryoimmunoglobulins, consisting of 2 (IgG-IgM or IgG-IgA) or 3 immunoglo-. bulins, and occasionally also containing measurable amounts of complement components, have recently been encountered in SLE and its variants and also in a number of microbial diseases with autoimmune features (syphilis, streptococcal nephritis and endocarditis, mononucleosis, Mycoplasma pneumoniae pneumonia). They may represent circulating immune complexes, analogous to the IgM (IgA) rheumatoid factors in combination with their IgG reactants. In leprosy also, the existence of pathogenic immune complexes is indirectly suggested by mixed cryoglobulinemia andfurther by a number of other features reviewed in this article. -
Medical Bacteriology
LECTURE NOTES Degree and Diploma Programs For Environmental Health Students Medical Bacteriology Abilo Tadesse, Meseret Alem University of Gondar In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education September 2006 Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center, the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document. Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. ©2006 by Abilo Tadesse, Meseret Alem All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. PREFACE Text book on Medical Bacteriology for Medical Laboratory Technology students are not available as need, so this lecture note will alleviate the acute shortage of text books and reference materials on medical bacteriology.